Medical Claims Examiner Resume Sample

Updated on: May 13, 2022
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Applying for a medical claims examiner position means that you have to write a resume to impress.

However, impressive resumes are not the norm. In fact, they are a rarity.

As a medical claims examiner, it is important to highlight your knowledge of the work, as well as your experience in it.

A resume for a medical claims examiner position must emphasize the applicant’s skills and abilities. These will include knowledge of examining filed claims in order to determine if they must be paid out or not.

In addition, your accomplishments such as determining fraudulent claims must be emphasized.

It is also important to remember that your resume’s format must be well-structured.

The following is a sample to help you accordingly:

See also: Medical Claims Examiner Cover Letter for Resume

Medical Claims Examiner Resume Example

Diane Peterson
889 6th Avenue
New York City, NY 99827
(000) 999-9999


• Competent medical claims examiner with 8+ years of solid track record in determining the eligibility of filed claims.
• Implemented a unique claims processing system, which reduced processing time by 65%.
• Introduced the concept of batching, hence, improved claims collection processes.
• Significantly decreased claims processing issues by implementing a quality assurance system.
• Successfully processed 105 claims in a day, on a particularly busy workday.


BatchingPrioritizingAccount Verification
Claims ProcessingClaims IdentificationReview
Fraud DeterminationAdjustmentsForms Handling


Medical Claims Examiner
Prime Healthcare, New York City, NY
• Check claims in order to ensure that they are complete.
• Examine associated documentation.
• Enter claims payments into predetermined systems.
• Process claims for both inpatient and outpatient clients.
• Approve or deny claims based on the investigation.
• Determine fraudulent claims.
• Batch and prioritize submitted claims.
• Verify patients’ accounts in order to determine eligibility.

Medical Claims Examiner
Sava Healthcare, New York City, NY
• Processed complex claims.
• Read and interpreted medical contracts.
• Identified claims that were not financially risky.
• Forwarded approved claims for payments.
• Reviewed pending claims.
• Followed up on pending or denied claims.

Medical Claims Officer
Keene Medical Facility, New York City, NY
• Checked incoming claims in order to ensure complete documentation.
• Ensured that all claims were fed into the system.
• Checked the status of claims.
• Responded to inquiries regarding claims.
• Completed claims documentation, and sent it for assessment purposes.

AS Degree in Accounting
St. Paul’s Technical College, New York City, NY – 2009

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