Medical Claims Adjudicator Resume Sample

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 close supervision.

A good resume helps you get the interview for Medical Claims Adjudicator job.

Take a look at 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 Willow 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
• Knowledge of insurance and accounting procedures and pertinent computer software

Professional Skills
• Skilled in accounts payable and general accounting
• Good computer skills
• Excellent communication skills
• Familiar with Utilization Management and URAC standards

Professional Experience

Medical Claims Adjudicator | KELLY SERVICES, Jamestown, ND | Jun 2010 – Present
• Accurately and timely evaluate, regulate, and pass judgment of Medicare claims.
• Research and take action in response to telephone and written inquires.
• Enter and check over claims into system.
• Send system generated letters to providers.
• Create authorizations when essential based on individual supplier and carrier contracts.
• Review electronic claims and process data as required into the claims system

Claims Adjudicator | CARE CENTRIX, Hartford, CT | May 2008 – Jun 2010
• 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.
• Worked collaboratively to achieve standads of timely, well-organized and accurate claim processing.
• Resolved computer generated correct conditions, and determined right payment.

High School Diploma | Thomas Piblic School, Houston, TX – 2002

Professional references available

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