Medical Claims Processor Resume Example

Updated October 1, 2021
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You may not know this but the way you write your resume has a huge effect on prospective employers.

They usually skim through resumes but this skimming is enough to give them a heads up about you as a candidate.

If you do not measure up, your resume can be rejected.

Have a look at the following resume sample to see how one can be written:

Medical Claims Processor Resume Sample

Nolan Page
12 16th Ave South
Fargo, ND 10202
(000) 879-7458
nolanpage @ email . com


MEDICAL CLAIMS PROCESSOR

Performance Summary
Highly ambitious and hardworking medical claims processor with 8 years of extensive experience of accurately and timely entering, reviewing, and resolving simple to moderate complexity medical claims in accordance with set policies, procedures, and guidelines. Proficient in entering claims data into predefined systems while interpreting coding in relation to diagnosis and procedures.

Highly organized, able to review and analyze claims through the utilization of available resources. Analyzes and applies plan concepts to claims including deductibles, coinsurance, copay, and out-of-pocket costs. Effectively examines claims to determine if further investigation is required from other departments.

PROFESSIONAL EXPERIENCE

Medical Claims Processor
United Claims Situation, Fargo, ND
6/2016 – Present

• Review received claims for accuracy and ensure that their eligibility is verified
• Identify processing deficiencies and initiate corrective actions according to specified instructions
• Enter claims data into the system, interpreting correct codes as they relate to medical procedures
• Analyze and apply plan concepts to claims such as copays, deductibles, and coinsurances
• Examine each claim to determine if any further intervention is required, and route claims through the system
• Release claims in a time-efficient manner, ensuring accurate and efficient claims processing procedures are followed
• Ascertain that all claims and patient demographic information are confidentially maintained
• Compose and send letters of explanation regarding claims issues and policy provisions

Selected Accomplishments
• Successfully entered 25000 claims into the system, within one week, in the absence of 3 other claims processors
• Implemented a system that provided dynamic alerts for demographic information updates

Medical Claims Assistant
Moda Health, Fargo, ND
3/2009 – 6/2016

• Sorted out incoming claims requests and assisted adjusters in managing them appropriately
• Punched claims data into the system, making sure that it is accurately entered
• Updated patient demographic information into the system, placing special focus on ensuring its integrity
• Assisted claims processors in determining discrepancies and ensured that they were resolved as soon as possible
• Contacted insurance companies to determine statuses of admitted claims and recorded all derived information

Selected Accomplishments
• Introduced a system, applying which resulted in 100% data confidentiality.
• Improved the claims processing system, making it 65% more efficient than before.

EDUCATION
Associate of Applied Science in Medical Insurance, Billing and Coding
Stratford University, Fargo, ND | 2010

Professional Competencies
✓ Claims Routing
✓ Data Entry
✓ Data Confidentiality
✓ CPT Coding
✓ Medical Terminology
✓ EDI Processing
✓ Adjudication of Claims