The following Medical Claims Processor Resume Sample covers all aspects which should be present in a Medical Claims Processor Resume. Modify this sample resume as per job requirements.

Medical Claims Processor Job Description

This position is responsible for processing medical claims for the individuals and assuring proper payment in keeping the insurance benefit plan. He or she provides customer service for plan benefits, provider networks and accessible services. Resolve claim issues for members and providers.


Medical Claims Processor Resume Sample


Jennifer Smith

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

Punctual ● Organized ● Flexible

Dependable professional with 2 years’ experience in coding and processing claims forms for payment while ensuring all information is supplied before eligible payments are made.

• Demonstrated capability of communicating to customers in a timely, polite manner
• Track record of meeting targets for staff and unit performance
• Typing speed: 25 wpm, 10 key proficiency: 105spm
• Substantial knowledge of medical terminology, CPT codes and ICD-9 codes

✔  Overpayment audits ✔  Dispute management ✔ Recovery of money
✔  Answering telephone ✔  Claims adjustment ✔ Flag quality issues
✔  Generating correspondence ✔  Equipment maintenance ✔ Maintaining logs

• Detected potential frauds in claims processing which saved 70000 $
• Successfully completed on the job training


Medical Claims Processor | Kelly Services – Syracuse, NY | May 2010 – July 2012

• Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements
• Entered claims data into system
• Resolved problems resulting from claim settlement
• Performed audit of randomly selected claims to ensure quality processing
• Researches 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 system and followed up on issue

AS, Accounting | ABC College, Syracuse, NY | 2009

• Excellent communication skills
• Outstanding telephone etiquette
• Effective interpersonal skills to handle several inquiries in a diplomatic manner
• Demonstrated computer skills in MS Word, Excel, Email and Internet
• Ability to provide professional customer service in hectic situations