Position Overview

Medical Claims Adjudicator reviews and scrutinizes claims, processes claims into the computer system and matches claim data with the right authorizations. They also determine accurate claims payment or denial, identifies and elevates dubious claims and authorizations or system issues as suitable. Medical Claims Adjudicator has to work under a close supervision.

A good resume is important to get the interview for Medical Claims Adjudicator job. See the following example in order to create your resume for this position.

See also: Medical Claims Adjudicator Resume Sample 2


Medical Claims Adjudicator Resume Sample


Sara Preece

32 Example Street, Houston, TX 65552
(000) 989-7865 , s.preece @ email . com

Objective: Seeking a position as a Medical Claims Adjudicator with a reputed company. Bringing 2 years of experience in claims processing, accounts payable and general accounting.

Key Qualifications
• Outstanding knowledge of claims processing and medical terminology
• Superb data entry skills with high accurateness
• Strong written and spoken communication skills
• Good computer skills

Professional Experience

Medical Claims Adjudicator | KELLY SERVICES, Jamestown, ND | Jun 2010 – Present
• Accurately evaluate, regulate, and pass judgment of Medicare claims in a timely manner
• Research and take action in response to telephone and written inquires
• Enter and check over claims into system
• Send system generated letters to providers

Claims Adjudicator | CARE CENTRIX, Hartford, CT | May 2008 – Jun 2010
• Created authorizations when essential based on individual supplier and carrier contracts.
• Reviewed electronic claims and processes data as required into the claims system, resolved computer generated correct conditions, and determined right payment
• Researched and practice claim payment adjustments resulting from consumer service referrals, audited data incorrectness as detected.
• Exercised excellent judgment, interpreted medical claim data and contracts
• Processes responses accordingly.
• Achieved joint effort, production and value standards so as to guarantee timely, well-organized and accurate claim processing.

High School Diploma | AA School, Houston, TX – 2002

• Skilled in accounts payable and general accounting
• Knowledge of insurance and accounting procedures and pertinent computer software
• Excellent communication skills
• Familiarity with Utilization Management and URAC standards

References: Available on request