Claims Resolution Specialist Resume Sample

Updated on: November 24, 2015

Take out an old resume – one that you may have written a few years ago – and look through it. What is missing? The newness. Isn’t that the most obvious answer? In a manner, yes. A resume that you may have written as far back as a year ago, may have lost its appeal in today’s employment market. Things have changed and if you want to be successful in appealing to an employer in the year 2015, you have to do a lot of resume rehashing.

Find out what a particular employer likes – a hiring manager will be interested in seeing how well-informed a candidate is. Research the company and its culture and prepare your resume accordingly.

What follows is a great resume sample for a claims resolution specialist position:


Claims Resolution Specialist Resume Sample


Noah Diaz

507 S Huron Street ● Englewood, CO 627391 ● (999) 999-9999 ● noah.diaz @ email . com

 Claims Resolution Specialist

Performance Summary
• Highly-motivated, creative and versatile individual with 5 years of experience in maintaining provider relationships to facilitate current and future negotiations.
• Well-versed in performing claim research and analysis to provide support in obtaining payments.
• Hands-on experience in initiating provider contact with respect to proposals
• Proficient in overcoming objections and effectively applying negotiation skills to reach successful resolutions
• Adept at addressing counter offers and presenting proposals while adhering to departmental goals
• Skilled in keeping current with all claim actions by monitoring reports and meeting deadlines for closing claims


• Deadline-driven • Workers’ compensation • Claims discrepancies
• Electronic billing • Carrier payment • Rebilling
• Refunds processing • Third party billing • Revenue codes
• Claims adjudication • Medicare and Medi-Cal • Medical terminology

• Consistently ranked as a top performer in claims resolution working, with a high success rate of 93%
• Implemented a system that automatically rebilled claims rejections, decreasing processing time by 48 hours
• Conducted 6 workshops on fostering team environment which resulted in a 51% increase in operational efficiency
• Hold record for getting 9 out of 10 claims paid between 2011 and 2015

State Auto Insurance Company, Englewood, CO | 11/2011 to Present
Claims Resolution Specialist
• Examine unpaid and rejected claims to determine reasons for rejection and non-payment
• Review and investigate claims and create plans to maximize recovery
• Identify and investigate claims payment discrepancies and litigation status
• Assess risk levels and research and act upon obtained information to expedite reimbursement
• Develop and implement internal systems for data collection and entry and financial analysis
• Create and maintain liaison between insurance carriers, benefit managers and patients
• Contact payers to follow up on claims status and inquire into reasons for rejections
• Rebill claims after making applicable corrections
• Address discrepancies in posted charges, demographic data, payments and adjustments
• Submit corrected and secondary claims and appeal / re-appeal using approved forms and other means of correspondence

Anthem Inc., Englewood, CO | 6/2010 to 11/2011
Claims Processor
• Assessed reasons for claim denials and non-payments and investigated into root causes
• Conferred with clients to determine how claims were paid and if any information was left out
• Contacted insurance companies over the telephone or through email to determine status of claims
• File new medical claims to receive payment from patients’ medical plans
• Contact patients for payment of any copays and ensure that payments are made in a time efficient manner
• Validate information on medical forms and manage claim inventories according to health plans and regulatory policies

G.E.D | Englewood High School, Englewood, CO | 2008