Medical Claims Processor Resume Sample (+Guide)

Updated on: October 15, 2023

Are you ready to make your mark in the world of medical claims processing? Look no further than our comprehensive Medical Claims Processor Resume Sample and Writing Guide.

This invaluable resource is designed to help you create a compelling resume that highlights your expertise and stands out to prospective employers.

Whether you’re a seasoned professional or just starting out, our guide will provide you with valuable insights and tips to ensure your resume shines.

Get ready to take your career to new heights in the fast-paced and rewarding field of medical claims processing. Let’s get started!

Medical Claims Processor Resume Example

Jennifer Smith
Syracuse, NY
Contact #
Email Address

Dedicated Medical Claims Processor: Streamlining Insurance Claims for Optimal Reimbursement

Dedicated and detail-oriented Medical Claims Processor with 5+ years of experience in medical billing and coding. Proficient in analyzing medical records, processing insurance claims, and ensuring accurate reimbursement. Strong knowledge of medical terminology, CPT coding, and ICD-10 guidelines. Adept at collaborating with healthcare providers and insurance companies to resolve claim issues promptly.


  • Claims Processing and Reimbursement
  • Medical Terminology
  • ICD-10 and CPT Coding
  • Insurance Verification
  • HIPAA Compliance
  • Electronic Health Records (EHR) Systems
  • Communication and Interpersonal Skills
  • Problem-solving and Attention to Detail


  1. Processed an average of 200 medical claims per day with an accuracy rate of 98%, resulting in timely reimbursement for healthcare providers.
  2. Reduced claim discrepancies by 20% through thorough investigation and prompt resolution, ensuring smooth reimbursement processes for insurance companies and patients.
  3. Collaborated with the coding and billing team to implement new coding guidelines, resulting in a 15% increase in clean claim submissions.
  4. Detected and reported 10 cases of fraudulent claims, leading to significant cost savings for the organization and maintaining integrity in the claims processing system.


Medical Claims Processor
ABC Healthcare Systems, Anytown, USA
June 2021 – Present

  • Review and verify medical claims for accurate information, including patient demographics, diagnosis codes, and procedural codes.
  • Determine coverage eligibility and benefits by liaising with insurance companies and patients.
  • Ensure compliance with HIPAA regulations and insurance policies during the claims processing.
  • Resolve claim discrepancies and denials by investigating and communicating with relevant parties.
  • Maintain organized records of claims, payments, and related documents for audit purposes.
  • Collaborate with medical coders and billers to ensure accurate coding and billing practices.
  • Identify and report fraudulent claims to the appropriate authorities.

Medical Office Assistant
XYZ Medical Clinic, Anytown, USA
September 2018 – May 2021

  • Assisted medical providers in managing patient scheduling, registration, and billing processes.
  • Updated and maintained patient records in the electronic health records (EHR) system.
  • Prepared and submitted insurance claims for reimbursement.
  • Verified insurance coverage and obtained necessary authorizations for medical procedures.
  • Assisted patients with insurance inquiries and billing discrepancies.

Bachelor of Science in Health Information Management
Anytown University, Anytown, USA
June 2013

Certified Professional Coder (CPC)
American Academy of Professional Coders (AAPC)
June 2019

Available upon request

“I am eager to bring my skills and passion for accurate medical claims processing to contribute to your team’s success.”

How to Write a Professional Resume for Medical Claims Processor Position?

To write a professional resume for a medical claims processor position, consider the following tips:

1. Begin with a clear and concise summary:
Start your resume with a brief summary that highlights your experience, skills, and key accomplishments as a medical claims processor. This will provide employers with an overview of your qualifications.

2. Emphasize relevant achievements:
Include selected achievements that demonstrate your ability to process medical claims accurately and efficiently. Focus on quantifiable results, such as the number of claims processed per day and your accuracy rate.

3. Highlight your expertise:
Showcase your knowledge of medical terminology, CPT coding, and ICD-10 guidelines. This will demonstrate your understanding of the field and your ability to navigate the complexities of medical claims processing.

4. Showcase your collaboration skills:
Highlight your ability to collaborate with healthcare providers and insurance companies to resolve claim issues and ensure timely reimbursement. This will demonstrate your interpersonal skills and your commitment to customer service.

5. Include your professional experience:
Provide a detailed account of your previous work experience as a medical claims processor. Describe your responsibilities, such as reviewing and verifying claims, determining coverage eligibility, resolving discrepancies, and maintaining accurate records.

6. Mention relevant certifications and education:
Include any certifications you hold, such as the Certified Professional Coder (CPC) certification. Additionally, mention your educational background in a relevant field, such as Health Information Management.

Remember to tailor your resume to the specific job requirements and use a professional and organized format to make it visually appealing. Proofread carefully to ensure correct grammar and spelling.

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