Medical Claims Processor Resume Sample

Updated: October 3, 2021

A medical claims processor handles medical claims for the individuals and assures proper payment in keeping with the insurance benefit plan.

He or she provides customer service for plan benefits, provider networks, and accessible services, and resolves claim issues for members and providers.

The following sample resume contains all sections and bullet points that should be present in a Medical Claims Processor Resume.

Feel free to modify this sample resume as per job requirements.

Medical Claims Processor Resume Example

Jennifer Smith
33 Example Street, Syracuse, NY 32644
Contact #, Email Address

Punctual | Organized | Flexible

Dependable medical claims expert with 12 years of first-hand experience in coding and processing claims forms for payment while ensuring all information is supplied before eligible payments are made. Demonstrated ability to communicating with customers in a timely and polite manner. Track record of meeting targets for staff and unit performance.

• Medical Terminology
• CPT codes and ICD-9 codes
• Excellent communication skills
• Outstanding telephone etiquette
• Practical interpersonal skills to handle several inquiries in a diplomatic manner
• Ability to provide professional customer service in hectic situations

• Detected potential frauds in claims processing, which saved $70000.
• Completed on-the-job training.


Medical Claims Processor
Kelly Services, Syracuse, NY                     
• Processed claim forms, adjudicate for the provision of deductibles, co-pays, co-insurance maximums, and provider settlements.
• Entered claims data into the system.
• Resolved problems resulting from claim settlement.
• Performed audit of randomly selected claims to ensure quality processing.

Claims Processor
Sava Healthcare, Syracuse, NY       
• Researched claim overpayments and requests funds.
• Followed adjudication policies and procedures to make sure proper payment of claims.
• Provided timely customer service to members, providers, billing departments, and other insurance companies on the subject of claims.
• Logged telephone calls in the system and followed up on the issue.

AS, Accounting
ABC College, Syracuse, NY     2009

✓Overpayment audits
✓ Answering telephone
✓ Correspondence handling
✓ Dispute management
✓ Claims adjustment
✓ Equipment maintenance
✓ Recovery
✓ Flag quality issues
✓ Maintaining logs

• Microsoft Word and Excel
• Typing speed: 25 wpm
• Ten key proficiency: 105spm
• Email and Internet

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