Claims Resolution Specialist Resume Sample

Updated on: May 31, 2021

In order to write a good resume for a claims specialist job, you have to find out what a particular employer likes. That being said, the hiring manager will be interested in seeing how well-informed a candidate is.

Research the company and its culture and prepare your resume accordingly.

Here a great resume sample for a claims resolution specialist position:

Claims Resolution Specialist Resume Example

Noah Diaz
507 S Huron Street, Englewood, CO 627391
(000) 210-2510
noah.diaz @ email . com

 Claims Resolution Specialist

• 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

• 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


Claims Resolution Specialist
State Auto Insurance Company, Englewood, CO
11/2014 to Present
• 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, benefits 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

Claims Processor
Anthem Inc., Englewood, CO
6/2010 to 11/2014
• 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 the 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

Englewood High School, Englewood, CO 

• 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