Claims Processor Resume Samples

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I Walter

Itzel

Walter

12222 Desiree Crescent

Chicago

+1 (555) 487 9764

12222 Desiree Crescent

Chicago

Phone

p +1 (555) 487 9764

Experience Experience

Los Angeles, CA

Claims Processor

Los Angeles, CA

Green-Hansen

Los Angeles, CA

Claims Processor

Assist in developing recommendations for improvements to the claim processing system
Gathers information, produces and updates management reports and assists with data management to support the achievement of department objectives. 15%
Performs second reviews of work performed by others while helping resolve problems and difficult situations
Assess worker’s time lost and return to work possibilities
Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality and attendance
Assisting with continuous improvement
Communicate identified trends to the Claims Department Supervisor for use in development of provider training programs

Dallas, TX

Immediate Need for a Medical Claims Processor {west Houston}

Dallas, TX

Kertzmann LLC

Dallas, TX

Immediate Need for a Medical Claims Processor {west Houston}

Perform other duties as assigned by department manager
Review and research incoming healthcare claims for patient-s (clinics, etc.) by navigating multiple computers systems and platforms and verifies the data/ information necessary for answering any and all questions regarding their claim
Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance
Schedule management
Actively follow up and collect on all electronic claims, including resolution of any billing errors assigned following established procedures
Spreadsheet development
Regulations - Regarding all insurance carriers

present

Phoenix, AZ

Claims Processor Associate

Phoenix, AZ

Legros LLC

present

Phoenix, AZ

Claims Processor Associate

present

Pricing identification of errors and management of resolution with provider contracting/maintenance internal teams
May perform outbound calls to providers to obtain information
Independently respond to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity. May seek assistance with complex customer services issues
Contribute towards the Center's achievement of providing exceptional customer service by demonstrating stamina to successfully complete customer calls within established work hours
Provide, accept and act on performance feedback from peers, business partners, leadership and customer survey results
Perform research to respond to inquiries and interprets policy provisions to determine most effective response. Mail or route claim forms and supporting documentation to various units for final processing
Receive requests by mail, telephone, or in person regarding insurance claims/policies while operating on multiple computer applications. Respond to inquiries from policy holders, providers and/or others for information and assistance

Education Education

Bachelor’s Degree in Initiative

University of Delaware

Bachelor’s Degree in Initiative

Skills Skills

Detailed oriented with ability to multi-task and meet production and quality standards
Basic knowledge of financial systems and processes
Basic computer knowledge in Microsoft Office and Windows
Overall performance accountability (attendance, communication, flexibility, adaptability, interpersonal skills, teamwork and cooperation)
This position resides in a heavy phone volume environment where the ability to gather and process information quickly is important. (Mainly outbound calls or return phone calls from customers)
Establish and maintain effective relationships with internal and external customers, while consistently demonstrating honesty, integrity, courtesy and respect when interacting with others
Knowledge of and proficiency with MS Office
Strong interpersonal skills and good written and verbal communication skills
Knowledgeable in Word, Excel, PowerPoint, Outlook, and Adobe Acrobat
Ability to self-manage in a fast-paced, detail-oriented environment

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Claims Processor Resume Examples & Samples

3 to 5 years' claims processing experience
Computer/Database experience
Typing and office skills $

Claims Processor Resume Examples & Samples

1+ year of related experience
Experience processing UB04 and CMS 1500 claims
Knowledge of managed care terminology, Medicaid and Medicare policies, reimbursement guidelines, DRG, CPT and ICD*9 coding
Ability to read and interpret documents such as medical reports and procedure manuals

Claims Processor Resume Examples & Samples

Primary Insurance experience
Basic understanding of Insurance Policy terminology
Microsoft Office/Suite proficient (Excel, Word, Outlook, etc.)
Excellent communication skills (written and verbal)(
Insurance and/or Claims Processing experience

Claims Processor Medical Resume Examples & Samples

Research and make benefit determination for the processing of Medicare member claims according to processing guidelines
Maintain production and quality standards
Investigate claims for required processing information
Making outbound phone calls to members or providers to get required information for processing
Previous experience in a healthcare or medical environment
Knowledge of medical claims processing
Commitment to preserving confidentiality
Must have experience in a production based department and exhibit professionalism
College degree or some college coursework preferred
Medical terminology, CPT-4 and ICD-9 coding & Medicare experience desired

Mortgage REO / Claims Processor, Senior Resume Examples & Samples

Reviews and analyzes more complex claims and takes appropriate action
Evaluates, processes, and monitors mortgage loan foreclosure/workout claims from the date of filing to the date funds are received when a foreclosure or loss mitigation action has been completed
Reviews Consumer Finance Department foreclosure, First Hawaiian Bank and SBO foreclosure requests. Communicates with the requestor marketing views and/or opinions for the approval or denial of the requests
Communicates directly with the claims outsource vendor, the real estate management company and SBO companies to ensure timely filing, monitors file during eviction, discusses marketing strategies, resolves outstanding problems, and facilitates the sale of each property
Approves initial and subsequent repair requests and negotiates purchase offers within guidelines
Ensures that each OREO loan carries a proper book balance and adjusts the balance accordingly by processing appropriate accounting entries
Controls losses by resolving problems, analyzing timelines, providing reasons for delays, and documenting unusual circumstances to obtain maximum claim reimbursement
Makes recommendations to management outside of guidelines
Completes functions within established policies, procedures and regulations for four different types of insurers and any investors, if applicable
Completes monthly OREO status report with current updates of each property along with reconciliations of accounting entries made, adjusting OREO book balances to the total general ledger amount. Also provides monthly reporting on foreclosure, marketing and sold status of SBO loans
Prepares all final OREO dispositions and journals when properties are sold. Closes out claim file by auditing claim for any supplemental claim filings and closing claim loans when final funds are received
Provides customers and other departments with information for OREO properties
Assists with the training of other department employees
High school diploma or equivalent combination of education and experience
One to three years of experience in mortgage loan servicing
One year of experience in real estate/property management
Good knowledge of mortgage documents and mortgage servicing procedures
Good knowledge of collections/foreclosure/bankruptcy procedures
Thorough understanding of all mortgage loan claim requirements
Knowledge of MS Office software, including Word, Excel, Outlook and Windows
Attention to details
Customer service and interpersonal skills
Personal computer skills
Problem resolution skills
Team-building skills

Claims Processor Intern Resume Examples & Samples

Must be enrolled at a University/College or Graduation date must be within the last six months
Excellent interpersonal and communication skills (technical and non-technical)
Extremely “Detail-Oriented” individual with the ability to multi-task
Must be able to maintain awareness of multiple sets of business rules
Capable of performing tasks in dynamic/changing circumstances
Strong “customer-focused” individual with a passion for responding to the needs of customers
Working knowledge of the following software applications: Microsoft Word, Microsoft Excel, Microsoft Access, Microsoft Outlook

Claims Processor Resume Examples & Samples

Research and make benefit determination for the processing of Medicare member claims according to processing guidelines
Strong data entry skills required
Previous experience in a healthcare or medical environment
Knowledge of medical claims processing
Must have experience in a production based department and exhibit professionalism
Medical terminology, CPT-4 and ICD-9 coding & Medicare experience desired

Warranty Claims Processor Resume Examples & Samples

Process warranty claims through the NATT warranty system
Interface with Athens Service / Field Service / Aftermarket to identify and report standard and extended warranty emerging issues
Apply ACE process / tools to identify improvement opportunities in NATT claim processing
Review claims submitted to check for complete and accurate information, determine appropriate action for claim processing, and enter claim data into warranty system
Follow up with dealer / customer claims administrators as needed to request additional information and resolve disputes
Evaluate returned parts as assigned to determine claim processing action
Assist in supplier recovery process to seek reimbursement on component issues

Claims Processor Resume Examples & Samples

Prior processing experience in a claims support role
Familiarity with insurance policies, coverage forms and basic coverage analysis
Knowledgeable in Word, Excel, PowerPoint, Outlook, and Adobe Acrobat
Strong problem solving and decision-making abilities
Willingness to assist on special projects
Self-motivated, analytical, inquisitive, and organized

Claims Processor Resume Examples & Samples

Knowledgeable in Word, Excel, PowerPoint, Outlook, Adobe Acrobat
Strong problem solving and decision making abilities
Self-motivated, analytical, and inquisitive

Claims Processor Resume Examples & Samples

Strong problem-solving and decision making abilities
Excellent work ethic
Excellent organization and analytical skills

Claims Processor Resume Examples & Samples

2+ years of prior processing experience in a claims support role is required
Microsoft Office/Suite proficient (Word, Excel, PowerPoint, Outlook)
Strong problem solving and decision making abilities & good work ethic

Claims Processor Resume Examples & Samples

2+ years of prior Processing experience in a Claims support role
Degree in a related field
Familiarity with Insurance policies, coverage forms and basic coverage analysis

Claims Processor Resume Examples & Samples

Previous experience working within the Pharmaceutical or related Healthcare industry
Medical Billing background
Microsoft Office/Suite proficient (Excel, Outlook, PowerPoint, Word, etc.)
Solid time management and problem solving skills
Expertise using Access

Claims Processor Resume Examples & Samples

Knowledge of billing and coding
Experience processing claims/examining claims for a comparable managed care/healthcare insurance company
Ability to follow a structured approach
Ability to explain complex processes

Claims Processor Resume Examples & Samples

1+ year of experience in the Pharmaceutical or a related Healthcare industry
Understanding of Medical Billing terminology
Working knowledge of Access

Claims Processor Resume Examples & Samples

1+ year of Claims Processing experience
Previous experience in the Pharmaceutical and/or Health industry
Customer Service oriented

Claims Processor Resume Examples & Samples

Experience in the pharmaceutical industry or related healthcare industry coupled with customer service
Expert using Microsoft Office, particularly Word, Excel and PowerPoint
Expertise in Microsoft Access

Claims Processor Resume Examples & Samples

Ability to analyze and process transactions, with a strong understanding of Claims processing and utilization of Desk Level Procedures
Interact with customers and internal departments to resolve issues and accurately process claims
Properly adjudicate claims based on your knowledge of covered benefits, insurance and provider contracts
Determine plan liability as well as diversion and recovery activity for claims

Claims Processor, Grade Resume Examples & Samples

Receive incoming medical forms, disability claims and requests for release of information
May process state disability (SDI), private disability claims including extensions, and Paid Family Leave (PFL) applications and FMLA forms
Assign ICD code(s) to claim(s)
Verify that forms completed and signed correctly and appropriate fees have been collected
Redirect any request for information which is not complete, not signed or signed incorrectly
May process release of information (ROI) requests including records, forms, letters and reports
Identify appropriate information to be released per authorization
Print medical information from computer systems
Route as appropriate
Request inpatient and outpatient charts, as appropriate
Log in/log out requests
Abstract information from patient's charts and transfer to appropriate form; sign form if authorized
If not authorized, send completed form to attending physician for approval and signature
Maintain a tracking system for requests sent to physicians which are not returned completed in a timely manner
View/run reports as necessary for follow-up of outstanding claims and requests
Prioritize requests
Must be able to process claims and other requests in a timely and accurate manner and meet deadlines
Complete productivity tracking report
May maintain accurate accounting of all applicable HIPAA disclosures
Enter applicable HIPAA disclosures in designated database
Troubleshoot any problems that arise in completing disclosure accounting
Open mail, sort and prioritize requests
Troubleshoot issues (i.e. track records, previous correspondence, etc.)
Research information missing in charts when necessary
Answer telephone inquiries and interact with members, third party entities, physicians and other staff
Make copies and file as necessary
May assist with on the job training of other employees, as required
Maintain excellence in service to members, physicians, other departments and fellow employees
Function as team member in completing work of the department
Testing: Typing 30 WPM
Testing: PC Skills Test (able to pass PC skills assessment)
Testing: Medical Terminology (able to pass standardized test)
Must be service oriented with strong customer service skills and ability to communicate effectively
Must have basic PC and keyboard skills, ability to enter data into database
Ability to work independently, organize and complete work with minimal supervision
Must be able to work in Labor Management Partnership
Minimum of one (1) year of release of information (ROI) experience preferred
Knowledge of medical terminology required and ICD-9 coding preferred

Worker s Comp Claims Processor Resume Examples & Samples

Request for internal /external records
Creates accounts in the KP internal systems
Transfer charges to the appropriate KP Health Connect patient account
Reviews subpoena requests
Prepare office supply orders
Promotes, ensures and improves customer service to internal/external customers by demonstrating skills which are consistent with the organization's philosophy of providing extraordinary customer relations and quality service as well as all other Kaiser Permanente Policy Procedures
Typing 35 wpm required. Typing must be current within one (1) year. Please contact Human Resources for testing
Successfully passed a medical terminology test
Knowledge of Workers' Compensation claims Processing
Ability to research, summarize and communicate clearly to the public, both verbally and in writing
Ability to use computer to perform assigned duties

Disability Claims Processor Resume Examples & Samples

Upholds KP's Policies & Procedures, Principles of Responsibilities, & applicable state, federal & local laws
Screens disability claims, interviews patients, locates & orders medical records
Abstracts medical information & diagnoses using ICD-9 codes
Screens correspondence of State, Federal & commercial disability claim forms
Assembles bills/reports & sends to appropriate payor/collections
Reviews authorization for release of medical information
Follows original & supplemental disability claims w/ physicians until the patient disability claim has ended
One (1) year relevant experience in health care industry
Typing 45 wpm. Typing score must be current within one (1) year. Please contact Human Resources for testing
Demonstrated ability to utilize Medical Terminology and International Classification Diagnosis (ICD 9) coding at a level appropriate to the job

Claims Processor Resume Examples & Samples

Reviews patient's medical records to locate the history, treatment, prognosis & other medical information relevant to reporting of the patient's condition
For Worker's Compensation claims, processing may complete Doctors First Report of work injury, check for proper authorization, obtain physician's signature & file report within the 5 day time limit pursuant to California Labor Code; at periodic intervals during patient's continuing treatment, but no less than each 45 days, review patient medical records & prepare narrative style medical progress report describing patient's current complaints, treatment, time off, work orders, light duty & other medical information relevant to the patient's industrial claim; consults w/ treating physician as necessary
Creates & registers patient account on automated billing system, inputting patient & employer demographic data to prepare account for billing; enters account notes when account has previously been established at another medical center; consolidates or corrects duplicate accounts by using appropriate on-line system functions; requires knowledge of automated billing system
Interviews patient & gathers information, contacts employers/carriers to obtain authorization for treatment
Schedules follow-up appointments reports status to employers/carriers, & expedites needed referrals as directed
Audits all patients medical & hospital records, including ambulance & pharmacy records, accesses & screens systems to identify industrial services paid for by Kaiser for rebilling to the patient's employer or workers compensation insurance carrier; requires knowledge of medical terminology, CPT procedure codes, anatomy & physiology to identify all billable services, including secondary medical conditions directly or indirectly related to the principle industrial condition being claimed or litigated by the patient; consults w/ treating physician on complex cases; decisions made affect revenue
Selects ICD diagnostic Code(s) accurately describing the patient's diagnoses, symptoms, conditions, problems, complaints or other reasons for the outpatient visit a documented in the patients' medical records; consults w/ treating physician on complex cases or if outpatient records are undocumented; requires thorough knowledge of ICD Coding
Provide patient & telephone reception, check in/out, appointment scheduling & other department clerical duties as directed
Verifies eligibility, creates files, collects forms, & checks for legibility & completeness
Prepares schedules & provides personalized & professional patient/member service
Establishes & maintains courteous & cooperative relations w/ the public, patients & other personnel
For more details, refer Job Description
One (1) year recent Medicare, Worker's Compensation claims processing, filing physicians reports & knowledge of the rules & regulations of Worker's Compensation
Two (2) years experience processing health care claims
Demonstrated knowledge of Medical Terminology, International Classification of Disease (ICD-9) & Current Procedure Terminology (CPT)
Ability to use a computer keyboard to perform assigned duties
Minimum 1 year Form Works Claims application experience preferred

Claims Processor Resume Examples & Samples

Three years experience in a capitated claims environment or related field. One-year actual experience processing Managed Care claims required
This position generally requires some combination of
1-3 years experience utilizing a PC including Word, Excel, and MS Outlook
1-3 years data entry experience
1-3 years processing health claims
1-3 years working knowledge of medical terminology, HCFA-1500, CRVS, UB92, CPT, ICD-9 coding and claims processing guidelines
This position generally requires a demonstrated ability to
Accurately and efficiently enter data using the computer and a calculator
Understand medical terminology
Understand and interpret insurance contracts
Understand COB guidelines

Claims Processor Resume Examples & Samples

2-3 years of claims experience in an automated claims processing environment
Good Knowledge of Medicare guidelines, data entry procedures, CPT 4 coding applications, medical terminology and claims practices
Must have the ability to make decisions in accordance with established policies and procedures and work independently as required
Excellent analytical skills and attendance required

Claims Processor Resume Examples & Samples

High school diploma is required
1+ year of healthcare or insurance related experience; claims processing experience
Preference given to candidates with previous claim processing or equivalent experience
Must meet minimum qualifications to perform the job including satisfactory completion of all training and testing: Basic Computer Literacy test Typing skills: 30 WPM
Ability to multitask in fast paced environment
Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills
Proficiency in English language skills including spelling punctuation and grammar in both written and verbal communication to ensure communications are issued in a professional manner
Working knowledge of personal computer and application software such as Microsoft Office Suite
Computer software typically used: Facets PEGA WinStrat Content Manager
Ability to utilize basic office equipment including PC scanner telephone copier printer fax calculator

OHS Claims Processor Resume Examples & Samples

Answer and screen incoming phone calls for the department
Receives and filters messages to providers/clinicians/case managers/case coordinators through the Health Connect system and reply as appropriate
Greet patients/visitors and determine nature of visit
Handles customer inquires
Assists patients in completing required forms
Schedule appointments for workers' compensation patients
Interact with internal/external customers to schedule appointments or obtain information
Make rounds to certain internal departments to retrieve paperwork, as necessary
Consolidate or corrects duplicate accounts by using appropriate system functions
Enters account notes on patient cases
Review KP internal systems to ensure that duplicate visits are not captured
Complete transfer of care forms
Clear designated Health Connect work queues daily
Open and distribute mail to proper areas; match bills to reports and mail to carrier along with any other documentation as necessary
Type various documentation as required in our current KP systems
Payment and collection for OHSS services, as required
Performs other related duties as required to maintain efficient departmental operations
Minimum of one (1) year relevant clerical and customer service experience in Workers' Compensation
Typing 35 wpm required. Typing score must be current within one (1) year. Please contact Human Resources for testing
All testing must be completed by the end of posting period
Equipment Utilized: Computer, Adding Machine, Fax Machine, Photocopier, Telephone and Typewriter

Claims Processor Resume Examples & Samples

Audits and processes claims submissions following HP’s program/promotion guidelines
Provides customer support via email or phone to participants that inquire about their claims submissions
Prepares Month End Close files to have payments properly accounted against HP General Ledger
Ensures training documentation associated to processes assigned is up to date and it’s accurate
Researches how to improve existing processes through FOCUS Solution Engineering team
Solve minor process and system problems
Moderate business acumen
Developing presentation skills; moderate PowerPoint skills
Associate degree or first level university degree with recommended focus in finance or computer sciences
Typically 2+ years of experience in a related field
Basic knowledge of financial systems and processes
Strong oral and written communication skills in English
Proficiency in Excel and Access
Intermediate analytical skills
Basic understanding of accounting principles

Claims Processor Resume Examples & Samples

Receive incoming medical forms, disability claims and requests for release of information. 　
May process state disability (SDI), private disability claims including extensions, and Paid Family Leave (PFL) applications and FMLA forms. 　
Assign ICD code(s) to claim(s). 　
Verify that forms completed and signed correctly and appropriate fees have been collected. 　
Redirect any request for information which is not complete, not signed or signed incorrectly. 　
May process release of information (ROI) requests including records, forms, letters and reports. 　
Identify appropriate information to be released per authorization. 　
Print medical information from computer systems. 　
Route as appropriate. 　
Request inpatient and outpatient charts, as appropriate. 　
Log in/log out requests. 　
Abstract information from patient's charts and transfer to appropriate form; sign form if authorized. 　
If not authorized, send completed form to attending physician for approval and signature.　
Maintain a tracking system for requests sent to physicians which are not returned completed in a timely manner. 　
View/run reports as necessary for follow-up of outstanding claims and requests. 　
Prioritize requests. 　
Must be able to process claims and other requests in a timely and accurate manner and meet deadlines.　
Complete productivity tracking report. 　
May maintain accurate accounting of all applicable HIPAA disclosures. 　
Enter applicable HIPAA disclosures in designated database. 　
Troubleshoot any problems that arise in completing disclosure accounting. 　
Open mail, sort and prioritize requests. 　
Troubleshoot issues (i.e. track records, previous correspondence, etc.). 　
Research information missing in charts when necessary. 　
Answer telephone inquiries and interact with members, third party entities, physicians and other staff. 　
Make copies and file as necessary. 　
May assist with on the job training of other employees, as required. 　
Maintain excellence in service to members, physicians, other departments and fellow employees. 　
Function as team member in completing work of the department. 　
QBS level 1 Spanish Required
Testing: Typing 30 WPM　
Testing: PC Skills Test (able to pass PC skills assessment)　
Testing: Medical Terminology (able to pass standardized test)　
Excellent attendance record required. 　
Must be service oriented with strong customer service skills and ability to communicate effectively. 　
Must have basic PC and keyboard skills, ability to enter data into database. 　
Ability to work independently, organize and complete work with minimal supervision. 　
Must be able to work in Labor Management Partnership.　
Minimum of one (1) year of release of information (ROI) experience preferred. 　
Knowledge of medical terminology required and ICD-9 coding preferred. 　
If it is determined that you need to complete testing to qualify for this position, you will receive an email inviting you to take the assessment(s) listed above. Passing test scores remain on file for one year

Claims Processor Resume Examples & Samples

Pharmaceutical industry or related healthcare industry coupled with customer service
2+ years in a customer service/call center environment handling escalations
Strong organizational skills and time management
Microsoft Access expertise

Occupational Health Services Claims Processor Resume Examples & Samples

Receives and filters messages to providers/clinicians/case managers/case coordinators through the Health Connect system and reply as appropriate
Greet patients/visitors and determine nature of visit
Handles customer inquires
Assists patients in completing required forms
Request for internal /external records
Creates accounts in the KP internal systems
Make rounds to certain internal departments to retrieve paperwork, as necessary
Enters account notes on patient cases
Complete transfer of care forms
Open and distribute mail to proper areas; match bills to reports and mail to carrier along with any other documentation as necessary
Prepare office supply orders
Performs other related duties as required to maintain efficient departmental operations
Promotes, ensures and improves customer service to internal/external customers by demonstrating skills which are consistent with the organization's philosophy of providing extraordinary customer relations and quality service as well as all other Kaiser Permanente Policy Procedures
Minimum one (1) year of relevant clerical and customer service experience in Workers' Compensation
Typing 35 wpm required. Typing must be current within one (1) year. Please contact Human Resources for testing
Successfully passed a medical terminology test
Ability to research, summarize and communicate clearly to the public, both verbally and in writing
Ability to use computer to perform assigned duties
EQUIPMENT UTILIZED: Computer, Adding Machine, Fax Machine, Photocopier, Telephone, and Typewriter
Bilingual (English/Spanish) Level I required

Claims Processor Associate Resume Examples & Samples

Determines the course of action for claims based on pre-established guidelines, routing to appropriate queues as needed
May perform outbound calls to providers to obtain information
Notifies supervisor immediately of system or other technical issues
Meets or exceeds minimum quality and production standards
Highly capable of performing repetitive tasks with excellence
Strong ability to problem-solve
Strong ability to quickly learn and retain new processes and procedures
Strong sense of concern for others
Must take pride in your work
Basic computer abilities (navigating with MS Windows and MS Internet Explorer, solid keyboard skills)
Basic MS Office skills (Outlook, Word, Excel)
Ability to quickly learn and retain knowledge of Medicare and Medicare Supplement Insurance policies
Protecting the confidentiality of our customers’ personal health information
Ability to produce quality work with little supervision
Ability to adapt and be flexible to changing priorities
Ability to consistently meet/exceeded quality and production standards
Experience with medical terminology is a plus
Experience with Medicare and Medicare Supplement Insurance is a plus

Rcis-claims Processor Resume Examples & Samples

High School Diploma or Equivalent and no prior experience required in the customer service area OR
Zurich approved Apprenticeship program including an Associate Degree and no prior experience required in the customer service area and experience with Microsoft Office
Claims experience
Agricultural experience in handling crop line of business
Analytical and organization skills

Claims Processor Associate Resume Examples & Samples

2-5 years of experience processing and adjudicating claims
Familiarity with medical and/or insurance terminology
Ability to correctly complete assignments within specified timeframes

Claims Processor Associate Resume Examples & Samples

Computer Proficient
Experience with claims and insurance concepts preferred
Demonstrated verbal and written communication skills; ability to communicate in a clear, concise and timely manner
Demonstrated commitment to meeting expectations of internal and external customers

Ipmi Claims Processor Resume Examples & Samples

Provide the highest levels of customer service, striving for first contact resolution, responding within given timelines
Adjudicate claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals
Monitor and highlight high cost claims and ensure relevant parties are aware
Monitor turnaround times to ensure your claims are settled within required time scales, highlighting to Team Leader when this is not achievable
Respond within the time commitment given to enquiries regarding claims status and perform necessary action as required, with first call resolution where possible
Build relations with internal departments to ensure all resources are utilized to the benefit of the customer, working within the regional benefits and reaching out to relevant service partners where necessary
Identify potential process improvements and make recommendations to Team Leader
A minimum of 12mths experience in medical administration, claims environment or customer service focused organization
Experience of working in a Contact Centre environment
Ability to meet/exceed targets and manage multiple priorities
Fluent in both English and French languages
Must possess excellent attention to detail, with a high level of accuracy
Strong interpersonal skills with good verbal and written communication to internal and external clients
Strong customer focus with ability to identify and solve problems
Ability to work under own initiative and proactive in recommending and implementing process improvements
Ability to organise, prioritise and manage workflow to meet individual and team requirements
Ability to quickly identify customer needs and exercise judgment in a professional and confident manner

Claims Processor Associate Resume Examples & Samples

High School diploma or equivalent is required and related work experience strongly preferred
Computer proficient (navigating with MS Windows and MS Internet Explorer, solid keyboard skills) with basic Microsoft Office skills (Outlook, Word, Excel) required
Strong communication skills (written & verbal)
Ability to adapt and be flexible to changing priorities in a fast paced environment
Ability to consistently meet/exceed quality and production standards
Experience with medical terminology and/ or medical claims are a plus
Experience with Health Insurance is a plus
Strong attention to detail & ability to problem solve
Must be able to type and use a keyboard for extended periods of time
Demonstrate ability to utilize analysis, experience and judgment to make effective decisions

Claims Processor Resume Examples & Samples

Processing and adjudicating claims from various Government Agencies for Medicare Part D members
Processing and adjudicating claims from various commercial employer and health plan clients
Maintaining integrity of claims receipts in accordance with Federal and State laws
Researching and accurately resolving claims issues as well as adjudication errors
Working within turnaround times to meet Federal CIA requirements
Identify and report trends, errors, and provide resolution
Meeting productivity and accuracy standards

Claims Processor Resume Examples & Samples

Ensures claims are entered accurately and timely
Monthly review of individual statistics to ensure accuracy rate is being met
Assist with the internal mail processes which includes batching, scanning and Laser fiche
Performs duties as assigned

Claims Processor Associate Resume Examples & Samples

Receive requests by mail, telephone, or in person regarding insurance claims/policies while operating on multiple computer applications. Respond to inquiries from policy holders, providers and/or others for information and assistance
Perform research to respond to inquiries and interprets policy provisions to determine most effective response. Mail or route claim forms and supporting documentation to various units for final processing
Independently respond to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity. May seek assistance with complex customer services issues
Ability to understand and interpret policy provisions
Contribute towards the Center's achievement of providing exceptional customer service by demonstrating stamina to successfully complete customer calls within established work hours
Meet or exceed goals associated with Average Handle Time, Schedule Adherence and Quality; while using efficient and appropriate work practices
Provide, accept and act on performance feedback from peers, business partners, leadership and customer survey results
Demonstrate willingness to learn and effectively apply new skills/techniques as customer expectations change
Maintain and recognize cultural differences/sensitivity
High School Diploma required; associate or bachelor degree preferred
Two to five years of customer service/quality/production driven environment preferred but not required
Working knowledge of basic computer functions including Microsoft products, internet research and email communication required
Capability to navigate concurrently between multiple software systems with relative ease
Knowledge of CPT, HCPCS, and ICD-9 codes and Medical terminology strongly preferred
Customer service oriented thinking, outstanding interpersonal skills
Ability to prioritize and work independently while managing time successfully
Flexibility to support business outside normal work schedule as needed
Written and verbal fluency in Spanish or other foreign language a plus

Claims Processor Resume Examples & Samples

Process claims meeting department performance standards for production and quality
Report claims adjudication and/or claims system issues to management
Proactively identify client service improvement opportunities.As appropriate, work in collaboration with the unit supervisor(s) to resolve problems
Contribute to a team environment by consistently exhibiting excellent interpersonal skills and demonstrating flexibility with daily operations/function

Medical Claims Processor With Tapestry Resume Examples & Samples

Timely and accurate adjudication of all types of claims from assigned workflow queues
Compliance with state, federal and contractual requirements to Claims Administration
Performance standards of 15 claims/hour with 97% or above financial and procedural quality & accuracy rates
Demonstrate a thorough knowledge of the Plan's claims processing procedures as provided in training materials and proficiency with the core and ancillary system applications
Demonstrates the ability to think analytically to resolve complicated claim issues and identify appropriately when to escalate issues for review
Demonstrates a thorough knowledge of regulatory requirements, individual plan benefits, provider contracts, policies and procedures for product assignment
Claim analysis of coding and billing compliance, potential third party liability, accurate coordination of benefits (COB), benefit application including limitations and restrictions, pre-existing conditions, subrogation, medical necessity and other claim investigation as appropriate
Accurate and timely review of claim pricing to facilitate manual pricing as necessary, working with various Health Plan provider networks
Complete all mandatory claims training/refresher courses
Effectively communicates with members and providers verbally and in writing regarding claim issues including claim adjudication, subrogation, and overpayments or billing problems
Actively participates and supports department and organization-wide efforts to improve efficiencies while supporting departmental goals and objectives
Complete all mandatory compliance and corporate training
Must be able to adapt to a changing work priorities and requirements and perform other duties as directed to support the overall functions of Claims Administration and support of staff without boundaries within the Plan

Claims Processor Resume Examples & Samples

Processes and documents claims decisions within established timeframes according to company standards and guidelines, obtaining instruction as necessary, from the Adjusters, Claims Specialist or Unit Manager, Claims. 40%
Collects, organizes and prioritizes information required by the Adjuster to evaluate new and existing losses to support department service objectives. 20%
Interacts with the Financial Services Commission of Ontario (FSCO) or other legislative authorities, partner brokers, vendors, other Regional Centres and claims departments at other companies to resolve claims related issues. 15%
Gathers information, produces and updates management reports and assists with data management to support the achievement of department objectives. 15%
Other duties as assigned. 10%

Claims Processor Associate Resume Examples & Samples

Manual identification, sorting and redistribution of misdirected correspondence
Data entry of claims into PCRS or ECS application for auto-pricing
Manual pricing/handling of claims for retailers and their customers
Process all new claim pricing inventory in manual mailboxes for dual platform/networks
Pricing identification of errors and management of resolution with provider contracting/maintenance internal teams
Identifies steps necessary to process a varying complexity of contracts for pricing accuracy
Researches, analyzes and calculates claims in accordance with provider contracts
Works with internal matrix partners to resolve pended claims issues
Utilizes SRS to route work items to matrix partners and external retailer claim administration staff
Follow audit protocols and workflows to ensure quality goals
Work in NetworX application to correct claims due to matching errors
Manage pended and open claim reports to ensure timely processing
Special pricing projects as requested by retailers
Partners with matrix organizations to ensure that appropriate action is taken to identify and implement high potential process improvements
1 to 2 years experience in claim operation environment, preferably pricing claims
Knowledge of contracting terms, fee schedules, rates
Accurate keyboarding and data entry skills
System knowledge or application experience in NetworX or Facets a plus
Analytical, attention to detail and quality oriented
Strong written communication skills
Knowledge of MS applications with exposure to Access and Excel programs
Able to manage multiple tasks and work under pressure in a fast paced environment

Senior ITS Claims Processor Resume Examples & Samples

Supports training and documentation creation and implementation
Acts as first a Subject Matter Expert for all ITS Claims processing queues
May review the work of team members and provide coaching and best practice solutions

Claims Processor Resume Examples & Samples

1-3 years professional claims processing
3 or more years of combined experience in healthcare administration, medical coding, data entry, and customer service
*Applicants must be currently authorized to work in the United States on a full-time basis***

Claims Processor Associate Resume Examples & Samples

Examines and processes claims; determine whether to pend, deny or pay claims within policies
Independent use of claim analyses tools for desk management
Follows established departmental policies and procedures, operating memos and corporate policies to resolve claims and claims issues
Follow processes and work independently to ensure ability to meet or exceed Key Performance Indicators (attainment and/or productivity targets) aligned with specific function/application
Adapt to and positively influence change by accepting feedback and capitalizing upon opportunities to continuously improve

Claims Processor Associate Resume Examples & Samples

Active knowledge of English: fluent
Passive knowledge of other languages ( French, german or another third language etc.)
Policies cover
Skilfull in taking decisions: takes the right action on allocated files based on the available information
Skilfull with numbers: likes to work with numbers
Accurate: works accurately on the input of data, aims to work faultlessly
Discipline: pays attention to procedures, agreements and document flows
Efficient: finds a good balance between quality and quantity
Team player: Able to work in a team
Skilfull with computer programmes: readily learns the ropes in the use of current office applications
Discreet: works discreetly with confidential (medical) information

Claims Processor Resume Examples & Samples

Processing and adjudicating commercial paper claims
Maintaining integrity of claims receipts in accordance with standard claims operating and adjudication procedures
Accurately resolving pending claims using state and federal regulations and specific health plan criteria
Working within turnaround times to meet client performance guarantees for claims processing

Claims Processor Resume Examples & Samples

Duties and Responsibilities
Perform post-foreclosure servicing functions as required by MI, investor, insurer, and internal guidelines including
HS Diploma or Equivalent
1+ years’ experience
Default-related experience is preferred
An aptitude for data, reporting, and working with numbers, is desired
Familiar with GSE, and Insurer servicing guidelines

FSA Claims Processor Resume Examples & Samples

BA/BS Degree preferred or minimum of 1-3 years work experience (preferably FSA/QME/PRA claims processing)
Possess basic understanding of wide variety of benefit issues including health and welfare and retirement
Experience with reimbursement claims systems helpful Experience with reimbursement claims systems helpful
Experience with reimbursement claims systems helpful
Proficient in Windows and Microsoft programs with excellent navigational skills
Able to prioritize and manage multiple competing responsibilities
Show initiative including anticipating needs, suggesting improvements, and follow-up on work items
Projects positive, professional attitude
Detail-oriented and superior organizational skills
Works independently and with minimal supervision

Claims Processor Resume Examples & Samples

Logging (Data Entry) and editing of claims via the Claims Editor and Claims Payment system, Research submitted claims if applicable
Quality Standard- Must meet and maintain the quality rate
Teamwork- Rating is based upon individual contribution to both the group and the goals of the group. This area will be rated using the outcome of team goals
Overall performance accountability (attendance, communication, flexibility, adaptability, interpersonal skills, teamwork and cooperation)

Occupational Health Claims Processor Resume Examples & Samples

Answer and screen incoming phone calls for the department
Transfer charges to the appropriate KP Health Connect patient account
Schedule appointments for workers' compensation patients
Interact with internal/external customers to schedule appointments or obtain information
Consolidate or corrects duplicate accounts by using appropriate system functions
Reviews subpoena requests
Review KP internal systems to ensure that duplicate visits are not captured
Clear designated Health Connect work queues daily
Type various documentation as required in our current KP systems
Payment and collection for OHSS services, as required
Minimum of one (1) year relevant clerical and customer service experience in Workers' Compensation
Cash handling experience
All testing must be completed by the end of posting period
Knowledge of Workers' Compensation claims Processing
Equipment Utilized: Computer, Adding Machine, Fax Machine, Photocopier, Telephone and Typewriter
Workers' Compensation Knowlege

Claims Processor Resume Examples & Samples

Requires working knowledge of medical terminology, ICD-9 and CPT coding & HIPAA guidelines
Strong data entry skills including 10-key ability & at least 35-wpm typing
Computer literacy is necessary along with Microsoft Office applications knowledge
Good communications skills as light telephone work may be required

Claims Processor Resume Examples & Samples

Enters data into the Claim System and adjudicates claims including corrected, coordination of benefits, member liability denials, provider denials and resolving pended claims
Follow up on outstanding claims that are pended to internal departments
Process claims daily meeting established accuracy and production standards and regulatory timelines for processing
Process claims that are received through Electronic Data Interchange (EDI) clearing house, fax, and paper
Keep Team Lead and Claims Manager informed of issues as they arise
Procedure (CPT) and ICD-10 diagnosis coding knowledge
Function in an administrative role to insure timely and accurate data entry of all types of paper and electronic claims
Responsible for maintaining department accuracy and production standards
Strong interpersonal skills and good written and verbal communication skills
Advanced computer skills required, including working knowledge of MS Office: Word, Excel, and PowerPoint

Claims Processor Resume Examples & Samples

Hiring Claims Processorsat $14 per hour
Performance bonuses
Flexible scheduling
Paid time off
Full benefits (medical, dental vision etc.)
Opportunity for additional advancement/promotion
Successfully completes training to become knowledgeable in tax-advantaged spending and saving accounts, such as: Flexible Spending Accounts; Dependent Care Accounts; Transit and Parking programs; Health Savings Accounts; and Health Reimbursement Arrangements
Follows company procedures and IRS guidelines in the review, verification, and processing of employee benefit claims
Accurately enters claim data into system by selecting the appropriate options from drop-down lists, check-boxes, and other available data classification options
Ensures that sensitive information remains confidential and adheres to company guidelines regarding the appropriate handling of private and sensitive data and materials
Regular attendance, punctuality, and schedule adherence are required
Ability to use a computer and web-based tools to perform work is a job requirement
Accuracy in data entry is critical to this role
Critical thinking skills and strong attention to detail are necessary for success
Ability to work independently, in a solitary manner for long periods of time is essential
An aptitude for math and basic math skills is required
The ability to maintain the confidence of sensitive information is essential

Lead Claims Processor Resume Examples & Samples

Adjudicate or submit claims and adjustments as required
Track and trend performance of root cause analysis and provide additional training as needed
Resolve claims edits and suspended claims
Maintain and update required reference materials to adjudicate or submit claims
Continuously identify process improvements that impact quality and service results; recommend solutions
Serve as a resource (buddy) for newly hired associates and/or assist with remedial training for existing associates as needed. Prepare feedback and review for Supervisors and Managers
Handle all types of requests, inquiries and complaints accurately and timely, to include written correspondence and phone inquiries from internal customers
Assist with the maintenance and updating of the business unit?s reference materials

Claims Processor Resume Examples & Samples

Minimum 1 year plus experience in a customer service environment, with an emphasis in providing exceptional customer service
This is a fast-paced, high-volume position, so the ability to handle multiple and competing priorities simultaneously is needed
Excellent communication skills, both verbal and written
Employees will work in a collaborative team environment, but should possess the skills to be able to make independent decisions
This position resides in a heavy phone volume environment where the ability to gather and process information quickly is important. (Mainly outbound calls or return phone calls from customers)
Establish and maintain effective relationships with internal and external customers, while consistently demonstrating honesty, integrity, courtesy and respect when interacting with others
Effective decision making ability is a must, including strong critical thinking and analytical skills
Obtain and maintain licensing to handle claims in required states. Hartford provides training and pays for cost to obtain and maintain state licensing
Knowledge of and proficiency with MS Office
A post secondary degree or equivalent work experience is strongly preferred

Claims Processor Associate Resume Examples & Samples

Passive knowledge of other languages ( French, german or antother third language etc.)
Skilful in taking decisions: takes the right action on allocated files based on the available information
Skilful with numbers: likes to work with numbers
Skilful with computer programmes: readily learns the ropes in the use of current office applications

OHS Claims Processor Resume Examples & Samples

Reviews patient's medical records to locate & transpose the history, treatment & prognosis & other medical information relevant to reporting of the patient's industrial condition
Ability to interpret & abstract source documents & transfer into appropriate reporting format
Checks for proper authorization, consults w/ treating physicians, obtains physician's signature & files reports
Review of medical chart to investigate potential industrial cases including liens
Knowledge & experience required w/ client profiles & processing differences for non-member clients w/ regard to treatment
Data entry of relevant information into appropriate KP electronic systems
Interviews patients & gathers information, contacts employers/carriers to obtain authorization for treatment
Schedules and/or assists w/ follow-up appointments in Occupational Health Services & specialty areas, reports status to employers, carriers & expedites needed referrals
Audits all patients' medical & hospital records, including outside charges & ancillary records
Audits include identification of secondary medical conditions which may require consultation w/ the treating physician
Accesses & screens KP systems to identify & process billable services provided/paid for by Kaiser
Completes routinely required workers compensation employer/carrier forms
Provides personalized & professional customer service
Occasionally provide back-up for OHS clerical duties
DISCLAIMER: The above statements are intended to describe the general nature & level of work being performed by individuals assigned to this position & as such are not intended to be construed as an exhaustive list of responsibilities, duties, & skills required of personnel so classified
One (1) year recent (within last two (2) years); Workers' Compensation claims processing, filing physicians reports & knowledge of the rules & regulations of Workers' Compensation
Two (2) years experience in the health care field required
Requires medical terminology certificate
Typing 40 wpm. Typing must be current within one (1) year. Please contact Human Resources for testing
Equipment Utilized: Computer, Adding Machine, Fax Machine, Photocopier, Telephone, Typewriter
Work Comp experience Needed

Resolutions Claims Processor Resume Examples & Samples

Perform claims adjustments/recoupment on claims incorrectly adjudicated, reflecting the corrected adjustment in the MIS system with corresponding documentation
Adjustments include but are not limited to; refunds, voids, grievances, under/overpaid claims, audit results, provider referrals, COB Referrals, phone calls, reinsurance splits and any other adjustment that is necessary
Provide summaries of trends from the CRCT submissions to the Claims Supervisor, providing solutions and/or research needed to find solutions to avoid future errors
Trends are communicated to the appropriate supervisor/trainer
Properly adjust claims that were incorrectly adjudicated previously
Properly document all claim calls received
Maintain production standards set by leadership
Ability to process all claim types
Claims are processed timely and accurately, and in compliance with applicable regulations and authorities
Provide trending and education to the claim processing team
Appropriate documentation is maintained regarding adjustments and encounters
Trends are reported to Claims Supervisor to promptly address issues, and develop/implement process improvements for increased effectiveness and efficiency
Approximately one (1) year claims processing (internal candidates only)
At least one (1) year data entry of 10-key by touch

Claims Processor Resume Examples & Samples

Enter claim data accurately and timely, in alignment with departmental production and quality goals
Ensure claims payments are made within time frames as reflected in contractual agreements
Correctly adjudicate claims for contracted/non-contracted providers
Refer claims that have already encountered to the State for adjustments when applicable
Maintain a minimum of 97% accuracy at all times
Pre-screen all claim types for appropriate coding and documentation (including but not limited to CPT, HCPCS, ICD-9, ICD-10 coding)
Verify that billed services are covered services
Review respective coding (i.e. CPT, HCPCS, ICD-9, ICD-10) to ensure that claims are billed in compliance with CMS and Correct Coding guidelines
Verify presence of all required data fields and that applicable medical records are included/reviewed (where required)
Adjudicate claims submitted via electronic submissions
Identify and refer third party liability or coordination of benefits issues to the COB/TBL Coordinator
Refer claims for medical claim review as necessary/applicable
Identify and refer potential fraud and abuse cases to the Grievance Department/ Compliance Department
Identify opportunities for provider education and process improvements
Communicate identified trends to the Claims Department Supervisor for use in development of provider training programs
Claim Types mastered: 1500 Professional, Dental, Outpatient, Inpatient
Provider satisfaction is achieved and maintained
Communicated opportunities for provider education and process improvements result in overall increased effectiveness and efficiencies across departments
At least one (1) year claims processing (external candidates)

Claims Processor Resume Examples & Samples

Adjudicate claims and adjustments as required
Maintain and update required reference materials to adjudicate claims
Provide backup support to other team/group members in the performance of job duties as assigned

Claims Processor Resume Examples & Samples

Provide general claims support by reviewing, researching, processing and adjusting claims
Prepares daily reports for claims management team
Review trend analysis of edits/audits to identify issues
Perform periodic reviews on edits/audits activities to assess conformance with approved procedures; document findings and recommendations
Assist Claims Manager, Claims leads and Clerk II Claims Processors as needed
Assist the team in consistently meeting established productivity and quality standards
Updates and maintains claims tracking reports
Answer questions for claims clerks or other departments
Assists in training or mentoring new and existing staff members
Obtain necessary documentation and provide to Claims Manager upon their request for reporting and audit purposes
1+ years of previous experience in Medicare Claims Processing
1+ years of experience in an office setting environment using a computer as the primary instrument to perform job duties
Ability to operate PC based software programs or automated systems preferred
Strong communication, analytical, and problem solving skills
Knowledge of: medical terminology; standard claim forms and physician billing coding; standard reference materials
(CPT, ICD-9/IDC10); coordination of benefits
Ability to self-manage in a fast-paced, detail-oriented environment

Hospital Claims Processor Resume Examples & Samples

Process unvalidated claims as provided and assigned for all three facilities in a timely manner
Respond to TRAC Work list requests following established procedures
Comment all accounts with intelligible verbiage conducive to effective collection activity
Demonstrate personal ownership for accurate and timely completion of duties as assigned
Attention to detail and following departmental policies is key to ensure billing compliance
Experience in handling billing and account receivables
Training or background in ICD-10 Diagnosis Codes / CPT Codes preferred
Ability to understand accounting terminology
Knowledge of medical terminology and billing practices preferred
Good communication skills required both oral and written
Proficiency in Microsoft Professional Office software and comprehensive knowledge of personal

Claims Processor Resume Examples & Samples

Two years current claims processing experience in an HMO or indemnity insurance setting (HMO preferred)
Working knowledge of medical terminology and RVS/CPT/ICD-9 coding
Knowledge of standard insurance procedures (pricing, exclusions, etc.)
Ten key by touch
CRT keyboard skills

Claims Processor Resume Examples & Samples

Minimum 4 years of experience in Managed Care (HMO, Medicare, Covered California, Medi-Cal) with demonstrated performance that consistently exceeds expectations
Proven knowledge of CPT, HCPCS, ICD-9/ICD-10, DRG’s, RBRVS codes and medical terminology for both electronic and paper claims
Proven knowledge of processing Provider Dispute Resolutions

OHS Claims Processor Resume Examples & Samples

Answer and screen incoming phone calls
Greet patients/visitors and determine nature of visit; assist patients in completing demographic information on Doctors' First Report of Injury/Supplemental Report forms; contact employer/carrier for authorization/notification of treatment; request medical chart for the OHS physician appointments or if necessary in order to compile accurate information for reporting purposes
Schedule appointments for workers' comp patients and participating outlying clinics and other related functions to appointment scheduling
Interact with internal departments as well as outside carriers/employers to schedule appointments; make rounds to certain internal departments to retrieve paperwork as necessary
Request, obtain and copy medical records and other medical and claim information for completion of lien and non-lien cases
Process and prepare incoming/outgoing correspondence
Create and prepare file for further processing/billing purposes; filing as required
Create patient accounts; add/update in computer systems as applicable
Manage potential workers' compensation work queue
Disclaimer: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position and as such are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified. It is the intent of this position to serve as an entry point to the career ladder for the OHS Claims Processor II and III positions
Clause: This position may only be filled by a candidate to be stationed at 5055 California Avenue in Bakersfield. Please use represented Job Code 18554 when posting this position for any other Bakersfield location. Should you have questions please contact your local HR, Labor Representative or Regional Compensation Consultant
Minimum of one (1) year relevant clerical experience
Typing 35 wpm required
Certificate of completion of a course in Medical terminology within 6 months

Hospital Claims Processor Resume Examples & Samples

Recognized as a subject matter expert (SME) in the areas of billing policies and procedures
AAHAM – Certified Revenue Cycle Specialist – Institutional preferred
Knowledge of ICD-10 Diagnosis Codes / CPT Codes
Knowledge of medical terminology and billing practices

Claims Processor Resume Examples & Samples

Determine if claim information is complete and correct. Enter/verify claims data
Resolve claim edits, review history records and determine benefit eligibility for service. Review payment levels to arrive at final payment determination
Meets all production and quality standards. Attends all required training classes
Elevates issues to next level of supervision, as appropriate
Maintains accurate records, including timekeeping records
A High School Diploma or GED required
2 years of claims processing
Ability to take direction and to navigate through multiple systems simultaneously
Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records
Ability to use mathematics to adjudicate claims
Ability to solve problems within pre-defined methods and guidelines
Knowledge of operating systems specific to claim processing
Typing speed of 60 words per minute

Payment Protection Claims Processor Resume Examples & Samples

Receives new and continuing claims submitted, determines coverage under Payment Protection, sets them up in the systems, and prepares/disburses the claim files to the Examiners
Creates claim payments in the system, enters claim notes in the systems, maintains carrier transaction reports, and balances such for each carrier to ensure accuracy with the issuance of payments
Takes incoming phone calls to assists claimants, financial institutions, and carriers to include documenting such within claim files and in the claims system
Requests missing information to establish new claims from the claimants and financial institutions
Trains and assists the Claims Processing Clerk
Maintains Monthly Outstanding Balance insured listing reports for every financial institution and requests any missing reports from premium processing; and prepares files for storage and maintains reference material used by the department such as listing of financial institutions
Runs various claim reports and maintains the letters within the claims correspondence system by creating new template letters and making changes to existing

Claims Processor Resume Examples & Samples

Complete projects consisting of adjustments and perform root cause analysis
Serve as a resource (buddy) for newly hired associates and/or assist with remedial training for existing associates as needed
Assist/backup for Team Lead in their absence

Default Claims Processor Resume Examples & Samples

Two to four years of experience in administrative support activities
Good verbal, grammatical and written communication skills
Proficient PC skills, especially Microsoft Office applications and graphics

Claims Processor Resume Examples & Samples

Able to handle more complex claims
Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits, and healthcare terminology
Good working knowledge of claims and products, including the grievance and/or re-consideration process
Excellent knowledge of the various operations of the organization, products, and services
Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement
Researches and analyzes claims issues
Responds to inquiries, may involve customer/client contact
Must meet production and quality standards
Requires a HS diploma or equivalent; 2-5 years of claims processing experience; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.); or any combination of education and experience, which would provide an equivalent background
Claims adjudication experience a must
Experience with Medicaid, Medicare and/or Medi-Cal claims highly preferred
Knowledge of contracts, CPT, HCPCs, ICD-9/10 and Medicare billing guidelines
High School diploma or any combination of education and experience, which would provide an equivalent background
Ability to effectively apply knowledge gained in training
Detail oriented. Good PC skills including MS Word and MS Excel
Ability to identify problems and logically research with minimum assistance to locate answer through appropriate reference materials
Maintains positive and cooperative working relationships with co-workers and other associates

Claims Processor Resume Examples & Samples

Reviews paperwork for signatures, dates, accuracy and other considerations to ensure that claims are paid accurately
Monitors entry/processing to ensure data integrity and to avoid potential systematic issues
Communicates with agents, adjusters to obtain information needed to process claims quickly and accurately
Responds to questions and addresses issues
Associate's Degree or equivalent experience preferred
1-3 years of insurance experience is preferred
Customer service experience is required
Microsoft office product experience is required

Claims Processor, Rcis Crop Claims Resume Examples & Samples

Build a working knowledge of crop hail insurance policy and claim procedures
Work with more experienced team members on complex claims as appropriate; monitor and process suspended hail claims and ensure that the required information is received and timely processed in accordance with established SOPs and procedures
Ensure all required documentation has been gathered to approve claim suspensions and edits, and coordinate with adjusters as needed for additional information
Process incoming claims from adjusters on a first-in/first-out basis
Monitor reports and research to ensure claims are processed accurately and timely
Provide superior customer service by logging into the claims processing team queue and responding to policy and procedure questions that are basic to moderately complex from agents and field staff
Create and maintain HEAT tickets to document software issues or enhancement requests
Assist other departments during peak workloads as directed by manager
Demonstrate superior customer focus while maintaining the highest level of professionalism to ensure the customer's needs are met
High School Diploma or Equivalent and no prior experience required in the office environment or customer service area
Experience in an office environment
Agricultural or Crop Claims Experience
Computer Proficient including basic Microsoft skills
Experience collaborating across work groups
Ability to adapt to a changing environment

Claims Processor Resume Examples & Samples

Minimum 2 years of experience in Managed Care (HMO, Medicare, Covered California, Medi-Cal) with demonstrated performance that consistently exceeds expectations
Knowledge of CMS- 1500, UB04 forms, CPT, HCPCS, ICD-9/ICD-10 Codes
Medical terminology for electronic and paper claims

Associate Claims Processor Resume Examples & Samples

Determine if claim information is complete and correct. Enter/verify claims data
Resolve claim edits, review history records and determine benefit eligibility for service. Review payment levels to arrive at final payment determination
Meets all production and quality standards. Attends all required training classes
Elevates issues to next level of supervision, as appropriate
Maintains accurate records, including timekeeping records

Claims Processor Resume Examples & Samples

Processing claims through online system for transportation and logistics department
Reconciliation and closure of claims
Reporting of claim results
Assisting with continuous improvement

Claims Processor Resume Examples & Samples

Review all claim types to determine completeness and appropriateness for payment, according to existing policies and procedures
Adjudicate claims to completion whether paid or denied, meeting or exceeding department standards relative to production and accuracy
Perform data entry of paper claims when directed
Review system outputs to ensure correct adjudication.Re-adjudicate or have claims adjusted as necessary
Perform research on pending claims until resolution is reached in order to pay or deny according to policies and procedures
Respond to requests and inquiries from the Customer Service Engagement Center to investigate claims issues per provider calls
Communicate with internal customers as necessary to obtain information
Communicate with external customers when directed to help resolve issues
Complete any projects or additional assignments as directed
Familiarity with health care claims and HIPAA regulations helpful
Must be willing to communicate with external customers when necessary (mainly through telephone) to help resolve issues regarding claims
Must meet department standards regarding productivity and accuracy, and be willing to complete any additional projects or assignments as directed from management

Lead, Claims Processor Resume Examples & Samples

Independently review and evaluate routine and complex electronic and paper claim work flow process in accordance with plans. Ensure correct data entry, correct provider coding information and appropriateness of reported services
Oversee daily colleague workflows including claims production flow and day to day colleague client workflows
Conduct in-depth research to resolve claims issues and rejected claims from batch and EDI error reports
Respond to and resolve escalated claims related issues and questions
Oversee the ECHO check process including voiding, adjusting and solving check issues
Research claims issues to identify root cause and determine corrective actions. Communicate and document findings for future use
Identify and communicate benefits administration systems issues, quality issues and training needs
May assist with developing and facilitating training programs
Lead and perform system testing
Assist with new client implementation processes
Develop and run management reports for the claims department
Audit claims to ensure correct processing. Create and maintain audit reports
Performs miscellaneous other duties as needed
High school diploma required plus two years of college in business or administrative discipline or two additional years of relevant experience
Five or more years’ experience processing health insurance claims is required. This experience must be inclusive of electronic data interchange (EDI), batch/auto adjudication, and error report resolution. Medicare claims experience preferred
2+ years’ supervisory experience desired.In-depth knowledge of all aspects of benefits claims processing, claims adjudication principles and procedures, medical terminology and procedures, and ICD-10 and CPT coding
Extensive knowledge of HIPPA regulations

Citi Commercial Bank-junior Claims Processor Resume Examples & Samples

2 yrs. of banking experience with preference for commercial banking experience
Computer knowledge (e.g. Excel, Adobe etc.)
Administration and documents handling experience
Well-developed communication skills
Written and spoken English and Cantonese

Claims Processor Resume Examples & Samples

Reconciles servicing expenses/corporate advances as required by mortgage insurance, investor, insurer and internal guidelines including: foreclosure fees and costs, eviction requirements, property inspections and preservation, HOAs, taxes, hazard insurance and expenses during the default process
Ensures reviews are performed in a timely manner in accordance with established procedures and investor guidelines
Maintains and updates various databases to meet departmental and QA requirements
Performs second reviews of work performed by others while helping resolve problems and difficult situations
Assists in identifying and resolving error trends noted during the QA evaluation
Ensure data accuracy
Achieve key metrics associated with the process and meet departmental monthly goals
Mortgage default-related experience required
Demonstrated aptitude for data, reporting, data reconciliation desired
Familiarity with FHA, VA, USDA, MI and GSE Insurer servicing guidelines
Must have experience with auditing and/or filing claims for FHA, VA and/or USDA adhering to the Investor/Insurer’s guidelines
Will work in a leadership role. Ability to work effectively with upper management as well as with Claim Processors and other QA personnel
Proven track record at delivering timely and accurate information in a fast-paced environment
Excellent critical thinking, problem solving, mathematical skills and sound judgment
Financial Services and, if possible, mortgage industry experience preferred
Strong business acumen and ability to interface with executive management
Minimum Years of Experience 3+ years

Dental Claims Processor Resume Examples & Samples

Correspond with providers & patients in regards to claims issues
Process self-funded and BM dental claims
Support customer service personnel with questions they have regarding dental benefits
Oversee weekly printing of client and provider pending letters and pre-determinations
Edit correspondence from dental, customer service, and COBRA departments
Provide back up for dental customer service
Perform Dr. Galla reviews
Support accounting on 125 reimbursement requests regarding dental charges

Claims Processor Resume Examples & Samples

Conducts Data Entry for fitness and/or medical claims in an accurate and timely manner
Conducts edit corrections including Indemnity and Managed Care
Consistently achieve desk level quality and productivity standards
Process all suspense in an accurate and timely manner in order to maximize performance levels
Identify and investigate system discrepancies and follow through with proposed resolution
Provide a high level of service to both internal and external customers
Exhibit a spirit of teamwork and contribute ideas for division and company success
Identify system/benefit discrepancies and recommend solutions
Managed Care processing knowledge a plus
Working knowledge of RTMS & NASCO preferred
Demonstrated ability to process a high volume of claims in a fast-paced environment
Recent work history that supports excellent organization, problem-solving communication, teamwork and interpersonal skills
Demonstrated flexibility and willingness to change as business needs change within the organization
Proven written and verbal communications skills are essential
PC skills a plus
Prior Experience in a Health Insurance Processing Environment required

Claims Processor Resume Examples & Samples

Conducts data entry for fitness, and/or medical claims
Process all work items in an accurate and timely manner in order to maximize performance levels
Create worksheets for member submitted claims
Recent work history that supports excellent organization, problem-solving, communication, teamwork and interpersonal skills
Demonstrated flexibility and willingness to adapt to changing business needs

Immediate Need for a Medical Claims Processor {west Houston} Resume Examples & Samples

Review and research incoming healthcare claims for patient-s (clinics, etc.) by navigating multiple computers systems and platforms and verifies the data/ information necessary for answering any and all questions regarding their claim
Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures benefit plan
Communicate and collaborate with patient to resolve issues, using clear, simple language to ensure complete understanding of their bill/ statement
Review and sign all written instruction for any and all duties, duties will be subject to change and ample notices will be given
. Initiates and conducts follow-ups via proficient use of claims systems and related business systems
. Determines and initiates appropriate requests for medical and non-medical information needed to properly pay claims
. Determines applicable coverage, medical necessity and appropriateness of charges related to injury claim
Research, appeal, and resolve unpaid insurance claims
Actively follow up and collect on all electronic claims, including resolution of any billing errors assigned following established procedures
Respond to correspondence from insurance carries
Perform other duties as assigned by department manager
ICD-10 Coding
CPT-4 Coding
Regulations - Regarding all insurance carriers
Contract Billings
Schedule management
Spreadsheet development
Claims appeal procedures knowledge
Insurance processing
Current Procedural Terminology (CPT)
Patient charting knowledge
Insurance eligibility verification
Inventory systems
Medical billing

Claims Processor Resume Examples & Samples

Typical experience may range from 1 year of general office experience to several years in a Claims processing role
Must be comfortable handling money transactions
Moderate to advanced skill in using Microsoft Office products required
Strong verbal communication skills, telephone and written communication skills required
Moderate knowledge of computers and inside cashiering system necessary
Good typing skills essential
Requires ability to prioritize and multi-task, while maintaining a high level of detail and accuracy
Good interpersonal skills required

Claims Processor Resume Examples & Samples

Detailed oriented with ability to multi-task and meet production and quality standards
Good analytical and decision making skills
Must have ability to work in team environment, however, also have the ability to make independent decisions
Superior customer service and communication skills both verbally and written (proficient typist)
Knowledge of Word, Excel, and AS400 (a plus) and other computer applications
High School degree required with some College or a College Degree a plus
2+ years’ experience in insurance industry

Claims Processor Associate Resume Examples & Samples

Researches and computes provider contracts using basic math skills and multiple programs for claim allowed amounts
Locates and interprets complex information from a number of databases in order to process claims
Completes tasks quickly with the ability to understand complex written directions, instructions, and technical information
Ability to take personal ownership for meeting/exceeding all Key Performance Indicators as well as quality standards
Understands and utilizes all Management Operating System tools to include Daily Production Log and Performance Profile
Maintains established schedule adherence and compliance standards
Demonstrates ability to

Claims Processor Resume Examples & Samples

Make contact with employer and injured worker (and other relevant parties) to discuss liability and any other issues
Assess worker’s time lost and return to work possibilities
Pass onto different segment if required
Authorise payment of entitlements, for example medical treatment
Keep filing of claims portfolio up-to-date
Understanding of the applicable legislation
Proven customer service experience with focus on customer satisfaction
Concern for others & Customer Service skills
Ability to follow rules and regulations
Computer skills - Microsoft Office (Word and Excel)
Intermediate to advanced knowledge of claims software

Claims Processor Resume Examples & Samples

Prior healthcare claims processing experience preferred
Understanding of HIPPA regulations
Excellent attention to detail and time-management skills
Resolve simple issues and follow through with complex claims with department leadership
Identify and communicate opportunities for process improvement to management
Work professionally and confidentially with patient information
Takes initiative on completing assignments

Claims Processor Resume Examples & Samples

Process claims in accordance with Network Health's policies and procedures
Must have experience with ICD9, CPT Codes and HCFA 1500
Maintain department production and quality requirements
Investigate and respond to providers regarding their claim issues
Assist in developing recommendations for improvements to the claim processing system
Interact with various operational departments to assure accurate and timely payment of claims in accordance with the plan's policies and procedures
Participate in special claim projects, as needed

Trade Claims Processor Resume Examples & Samples

Receive, process, and attach a high volume of customer claims backup documentation to corresponding claims in a timely and efficient manner
Review new claims and initiate claims workflows following a defined process
Manage deduction e-mail box processing a high volume of email communication and documentation for the department. Ensure e-mail box is organized and maintained according to department procedures
Ensure customer provides adequate information to process claims. Routes incomplete claims to the appropriate internal and external stakeholder groups to gain complete and required claim information
Communicate and work closely with the Trade Claims Specialists to ensure sufficient understanding of the customer base
Ensure all activities are completed within established SOP timelines
Track data and communicate issues to management
Continuously make suggestions and recommendations for improvements of all processes and systems within functional area
Work effectively and in cooperation with the Trade Claims Specialists
At least one year of experience in a high volume transactional processing environment required (examples include Claims Processing, Data Entry Operator, A/P, A/R, Payroll)
Prior experience working in an enterprise management system (e.g. SAP) preferred
Must be detail oriented, possess strong organizational skills, and possess the ability to produce a high volume of work output
Strong communication skills; written and verbal
Strong computer skills, particularly with desktop computing programs including Excel and Outlook
Ability to work effectively and in cooperation with various departments
Ability to prioritize work, manage multiple tasks and effectively produce a high volume of work output within department guidelines
Willingness and ability to work in an environment with a high level of repetition of tasks
Willingness and ability to work overtime as business needs require

Claims Processor Resume Examples & Samples

Consistently process entry level and intermediate claim queues with 99% or greater accuracy rate
Responsible for entry level adjustments to claims enterprise wide as necessary to meet corporate goals
Serve as back up to call center during peak periods to ensure corporate wide service levels are met
Previous claim processing experience a plus
Cooperative, professional and effective interaction skills with co-workers, company staff and visitors
Strong math competency
Ability to efficiently operate computer
Ability to use Microsoft Office (Word, Excel, Outlook)
Understanding of general insurance principles
Able to follow verbal and written instructions
Ability to read and comprehend at a high school level
Ability to communicate in an active office environment
Ability to sit for more than 90% of an 8 hour day

Claims Processor Resume Examples & Samples

Accurately review, research and resolve suspended claims, adjustments and/or correspondence per guidelines, supporting documentation and performance standards
Actively collaborate with our customers to ensure department goals and timelines are met to achieve the best results for quality of services
Maintain productivity expectations
Maintain quality expectations
Identify and communicate process improvements
Interpret, understand and retain detailed information and
Computer skills and keyboard proficiency
Flexible demeanor to adapt to change
Attention to detail and accuracy are KEY
Ability to comprehend detailed information
Must be proficient with claims/adjustments and/or correspondence processing

Temporary Claims Processor Resume Examples & Samples

Process claims for all lines of business daily meeting established production standards
Review and audit each batch of claims entered to identify entry errors prior to processing the claims
Process emails to completion that are sent to the various Claims email boxes, such as faxes. And distribute accordingly
Train new claim entry staff and quality assurance (QA) of their work. Provide feedback as needed
Other office duties as assigned
Proficient in MS Excel is a plus

Claims Processor Resume Examples & Samples

Work closely with various lenders, attorneys, and other clients to process claims
Prepare claims on all agency acquired properties or investor acquired properties that have Mortgage Insurance within 20 days of the sale or completion of short sale/deed in lieu
Prepare claims for Incentives
Present all claims prepared for filing to the supervisor for quality review
Make payment decisions and complete system tasks for Tax and Insurance approvals daily as needed
Maintain clear records and reports for management review regarding claims filed and non-recoverable items
Update appropriate workstations for claim filings
Follow up and track payment of filed claims
Miscellaneous research, filing and mailing
Working knowledge of accepted business practices in the mortgage industry and or strong understanding of claims process
LPS-MSP (Mortgage Servicing Platform) experience preferable, but not necessary
Six (6) months job-related course work or paralegal studies
Working knowledge of claims processing preferable

Claims Processor Resume Examples & Samples

Knowledge, skills and abilities as normally obtained through two years of experience in medical billing
Knowledge of CPT-4, ICD-9, and HCPCS codes, and CMS 1500 and/or UB04 forms
Knowledge of Health Plan policies and/or AHCCCS regulations and IDX system
Data-enters and adjudicates internal and external claims on a timely basis in accordance with departmental policies, procedures and standards
Researches resubmitted or corrected claims and pend appropriately. Adheres to governmental guidelines for processing claims
Refers fee schedule, vendor contract, plan problems or concerns to manager or senior level processors for intervention. Enters Siebel requests for provider updates, medical review, enrollment review, and coding review. Trouble shoots, identifies, and resolves special handling requirements related to pricing, contracting, and system issues. Processes CMS 1500 and/or UB04 claims

100

Dental Claims Processor Resume Examples & Samples

Meet established goals through effective administration of Insurance A/R for assigned offices, including
Minimum 2 years experience in claims processing role
Previous experience in dental office preferred

101

Claims Processor Resume Examples & Samples

High School Diploma/GED required for all levels
2-5 years of related experience
Typing speed of at least 60 words per minute
Knowledge, Skills and Abilities (This section describes additional preferred characteristics)

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