A Claims Analyst will monitor the liability status of the Client from start to finish and also verify and update the information of the submitted claims. The common work tasks depicted on the Claims Analyst Resume include the following – reviewing the policies and determining if the charges are eligible for reimbursements, negotiating payments with parties, reconciling claims adjusters estimates, ensuring payments are done, verifying if the damages get covered in the respective policy and checking the claims to ensure accuracy and completeness.
Even though the job duties vary based on the type of industry, candidates applying for the role are expected to have strong communication skills and show proficiency in mathematical calculations. Persistence and natural curiosity are also expected. The applicant should also show familiarity with computer and relevant accounting software. Detailed researching skills will be appreciated. Many employers want the candidates to be educated to a degree level.
Summary : Claims Analyst is responsible for the management of all existing and potential claims against the company’s products and services.
Skills : Strong language command and a penchant for vocabulary.
Acted as a liaison to other departments, including claims, Provider relations, customer service and enrollment.
Identified areas in the system that are not handling claims appropriately and recommending solutions to the appropriate party.
Helped to determine under-and over-payments in the claims and contracting areas.
Served as a subject-matter-expert on billing, enrollment and claims.
Identified loading errors and took the appropriate corrective measures.
Audited provider contracts to make sure that they met Medicaid guidelines to ensure that provider contracts are set up correctly in the different systems.
Worked closely with Provider Relations to enhance Provider relationships through claims analysis and education to the providers on correct billing techniques.
Analyzed contracts and contract language in regards to correct rates and fee schedules.
Disability Claims Analyst Resume
Headline : To secure a position in management, customer service, insurance and/or mortgage that will utilize my knowledge and experience that are necessary for a profession that will allow me to expand my professional talents and skills.
Skills : Proficient In MS Office, FHA Mortgage Postsale, Insurance,.
Review and analyze supplemental mortgage insurance claims to determine whether the claims should be paid, denied or returned for more information.
Successfully completed a background check and obtained HUD security clearance in order to access HUD's computer systems to retrieve claim data.
Review and analyze supplemental mortgage insurance claims submitted by financial institutions from HUD to determine the completeness, accuracy and compliance of the claim with HUD's regulations.
Based on review of the claim and supporting documentation, either pay, deny or return the claim for additional documentation.
Contact financial institutional staff to obtain missing documentation or clarification of claims submission.
Batched completed claims for submission to HUD.
Sr. Claims Analyst Resume
Objective : 5+ years extensive background in Medical Billing/ Claims Processing, Analyst and Collections working in different healthcare environments and specialties.
Skills : Data Key Entry, Creativity and innovation skills.
Audit patient treatment records for accuracy and completion.
Determine level of reimbursement by evaluating established criteria.
Audit the accuracy of all processed claims based on a comprehensive knowledge of benefit package.
Perform regular check runs to meet processing time standards.
Responsible for the accurate processing of all categories of specialty, ancillary, PCP and ER/UC claims through review and daily audit.
Develop and provide examination training based on findings from audit process.
Maintain a quality assurance program to support the total performance management.
Provides second review of bills on which providers questions the appropriateness of payments authorized Assist and advise claims examiner concerning the monitoring of claimants medical treatments.
Billing Claims Analyst Resume
Summary : To obtain a position within a company with a strong foundation that will allow me to use all of my knowledge and professional skills in the healthcare industry.
Skills : Claims Processing, Data Entry, Customer Service, Call Center, Office Administration, Microsoft Office, Leadership, Team Player, Internet, Inventory, Benefits, Computer Skills, Detail Oriented, Dependable, Email, English, Filing, Fast Learner, Faxing, W.
Provide written and verbal customer service to policyholders, agents, and brokers.
Responses must be timely, service oriented and consistent with service standards.
Contact clients to obtain missing information or data to ensure complete and accurate customer needs.
Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement.
Understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits, & healthcare terminology.
Knowledge of claims and products, including the grievance and/or re-consideration process.
Issues member refunds to correct account overages, identifies if refund requests need to be requested from provider or member.
Research prescription and medical claim accumulations and correct if needed.
Medical Claims Analyst Resume
Objective : Energetic, dedicated Revenue Analyst with strong interpersonal skills. Financial and Customer Support background. Proven ability to work effectively with people of various ages, cultural backgrounds, and socio-economic statuses.
Skills : Microsoft office, Oracle, Unet, Adp.
Performed the full range of medical claims analyst assignments including reviewing, analyzing, investigating and processing a high volume of medical claims in accordance with accounting principles and legal guidelines; Comprehensive understanding of the laws and guidelines concerning medical claims, and fully compliant with HIPPA regulations.
Adept at analyzing complicated insurance data and financial reports, working in conjunction with clients, plan participants, health care providers, insurance representatives and internal and external associates; experienced with healthcare claims management using the Electronic Medical Records (EMR) software, and direct billing to Medicaid and Medicare.
Knowledge of accounting principles, regulations, procedures, and systems.
Verifying and updated information on submitted claims, resolving discrepancies; Negotiating payment to all parties;
Monitoring payment progress Full compliancy with HIPPA and Health facility policies and regulations.
Comprehensive understanding of the laws and guidelines concerning medical claims.
Analyzed complicated insurance data, working in conjunction with insurance representatives and monitoring payment progress.
Specialized in data entry, filling out insurance paperwork and the software that is specific to the industry.
BA In Accounting
Special Claims Analyst Resume
Objective : Looking to obtain a position where I can maximize my diverse set of healthcare, administrative, insurance, accounting, and claims analyzing experience with opportunities for advancement.
Skills : MS office and MS Projects, Project Management, Claims Processing, Multisite team management and coordination, Presentation skills.
Review and analyze claims for Long Term Care insurance policy holders.
Process new claims and disseminates the appropriate reimbursement(s).
Write written correspondence for approval and denial letter(s).
Train new employee(s) on policies and procedures.
Ensure all claims payments are issued in a timely and accurate manner for state variances.
Assist in identifying exposures to the company and report to senior-level management on pending claims and litigation that may have an adverse impact on the corporate goals.
Communicate effectively with internal and external policyholders and providers.
Assisted with IBM DataCap to help oversee with indexing of all incoming mail for the claims department.
Associates In Accounting
Assistant Claims Analyst Resume
Objective : Responsible for Ensuring proper and effective claim management through professional communications with the claimant and their providers, as well as internal and external parties (i.e., attorney's, account managers).
Skills : Microsoft Word, Microsoft Outlook, Customer Service, Inventory Management, Data Entry, Report Writing, Management, Keyboarding, Sales.
Perform data entry into an electronic claiming system.
Review all medical/surgical billings for reasonable and necessary charges.
Verify the validity of medical claims submitted by the physician's office, hospitals and patients.
Access all medical/surgical claims to ensure they adhere to current healthcare industry regulations and policies; and are on compliance with insurance procedures and allotted benefit coverage.
Analyze medical claims received to provide accurate claims payments to providers or third parties in accordance to all Plan provisions.
Helped to reduce medical claim backlog to become current in accordance to industry standards.
Review claims processing procedures and update as needed.
High School Diploma
Claims Analyst/Business Analyst Resume
Headline : A team oriented Claims Analyst with more than 12 years of claims and customer service experience. Excellent business communication, organizational and interpersonal skills. Comfortable interacting with all levels of the organization and public. Able to problem solve quickly, accurately and efficiently. Committed to quality and excellence.
Skills : Communication, Analytical, Data Entry.
Responsible for developing a solid understanding of assigned client's process in order to strategically review and analyze their A/R functions.
Conduct regular audits of representative claim work for accuracy and quality.
Provide direction to client leads on claim audit corrections and resolution.
Prepare and analyze reports of audit review and performance issues with a focus on identifying trends, instituting continuous quality improvement initiatives, and identifying and providing on-going training opportunities for representatives - by utilizing Business Intelligence.
Provide 2nd tier review on advanced and escalated claims issues to a satisfactory resolution.
Log all client issues encountered in internal tracking system, including enhancement requests, bugs, errors and inquiries.
Make management aware of any client issues or problems.
Participate in continuing education of applicable software and hardware.
Claims Analyst II Resume
Headline : Knowledge of Microsoft Windows operating systems. Microsoft Office and other specialty software. Highly skilled in professional administrative and office procedures. Ability to achieve immediate and long term goals and meet operational deadlines. Exceptional interpersonal, organizational, and communicative skills with high attention to detail.
Skills : Call Center Experience, Medical Terminology, Patient Scheduling, Medical Billing.
Provide claims research utilizing Fiscal Intermediary Shared System (FISS) to process Medicare claims to determine what was denied and the reason for claims denial.
Communicate claims research findings and return cases to nurse after obtaining denial information in FISS.
Perform case tracking, productivity and quality statistics.
Utilize computers for spreadsheet, word processing database management, and other applications.
Prepare reports memos, letters of completed claims and other documents in accordance with company procedures.
Electronically sort and compile text and numerical data, retrieving, updating and merging documents as required.
Perform data entry activities, verifying data with source documents, validating information and checking to prevent errors.
Compute and verify totals on report forms, requisitions, or bills using adding machine or calculator.
Warranty Claims Analyst Resume
Summary : Mature professional with excellent computer skills. Ability to be flexible and enjoy challenges. I am dedicated to getting the job done Summary of Qualitications Terminology-Anatomy/Physiology-CPT Coding ICD-9 Coding-Detail Oriented-Organizational Skills-Team Player as well and to Work Independently.
Skills : Microsoft Office Suite, SAP, Oracle Software.
Responsible for answering live calls, voicemails, emails and written correspondence from customers regarding quality and liability claims of filters manufactured by UCI-FRAM.
Communicate with customers in regards to progress/tracking current and past claims.
Evaluate and disposition claims in the lab.
Extensive customer service and quality assurance among customers and within corporation.
Track/Process all customer claims/complaints using Microsoft Excel, Access and Oracle, Sharepoint, SAP and Master Document systems.
Produce weekly claims analysis reports and track trends.
Utilize knowledge of automotive technology, as well as technology in other product applications on a daily basis.
Process requests for payment of claims through accounting as well as Third Party Adjustors.
Marketing And Management
Lead Claims Analyst Resume
Objective : Examined evidence and evaluated its validity and acceptability. Adjudicated claims for benefits and made entitlement decisions. Negotiated and settled claims within authority. Conducted investigations, including sensitive and difficult interviews to obtain additional information in preparation of litigation. Attended depositions and mediations. Answered questions and provided guidance on other programs such as Return to Work and Medical Management.
Reviews and analyzes claims and loss expense reserves established by insurance carriers.
Acts as liaison between the insurance carriers and insurance broker to maintain loss expense reserves.
Processes new claims and disseminates the claims to the appropriate insurance carrier.
Acts as liaison between corporate and field offices to facilitate the gathering of information that will facilitate proper response to claim losses and legal documents.
Oversees and performs administrative support tasks for the Director of Risk Management.
Takes and transcribes dictation Composes and prepares confidential correspondence reports and other complex documents.
Claims Analyst/Adjustor Resume
Objective : Seeking a Billing Specialist position with NW Cardiovascular Institute using knowledge of medical terminology along with ability researching and working accounts receivable including both patient and insurance balances.
Skills : Microsoft Office, Marketing, Research.
Basic claims adjudication and review Investigate and apply contract benefits.
Identify and report any irregularities or trends in claims processing.
Log all pertinent information into claim notes during the adjudication and review Contribute to the efficiency of department by being flexible and cross-trained on other functions.
Maintain and promote a productive and positive work environment that is free from harassing or disruptive activity or behavior.
Responsible for quality and continuous improvement within the job scope.
Follow all guidelines as outlined in the most current version of the PH Tech Personnel Handbook.
Read and follow all required policies and procedures.
Associates Of Applied Science
Health Claims Analyst Resume
Objective : Seeking a position with an organization that will benefit from my capabilities as a leader as well as a team player and allow me to utilize my sales, customer services, and strong administrative skills with the potential to grow within the Houston industry. Logistics coordination Ability to work under pressure, effective Inventory control listening and communication skills, Proficient in shipping/receiving courteous and respectful, works well with Internet Literate others, reliable, cooperative a problem solver Proficient in RFMS, Microsoft Office: Word, who thinks outside the box.
Skills : Selling, customer service, marketing, and insurance industry.
Review and analyze claims loss and expense due to defective material caused by the manufacturer.
Act as an Liaison between Flooring Services and Vendors to maintain loss expense that are reflective of the company's exposure.
Process new claims and disseminates the claims to the appropriate Vendor.
Act as an Liaison between Builders/Homeowners and Field Contractors to facilitate the gathering of information that will allow the response to claim losses and legal documents.
Act as the liaison to Sales Representatives, Vendor Representatives and Inspectors investigating any incidents/issues that may result in a win/loss.
Organize movers, cleaners, lodging and handles Per Diems in the result of a replacement due to defective material.
Takes and transcribes dictation and composes and prepares correspondence, reports and other complex documents.
Catalogs and records job files for storage.
Claims Analyst Representative Resume
Objective : Claims Analyst Representative Professional with several years of claims experience, seeking a challenging position with your company that requires good judgment and exceptional knowledge of insurance with an opportunity for growth and advancement.
Skills : Advanced Computer Skills. Skilled In Using All Of Microsoft's Software. I Am Able To Problem Solve Most PC Problems Without Calling The IT Department. I've Built Several Computer Systems For Family And Friends.
Investigate and adjust Proof of Claims (POC)/Notice of Determination (NOD) submitted to the company.
Allocated Loss Adjustment Expense (ALAE) Project.
Investigate and adjust invoices/bills submitted to the company.
Set/Update reserves as needed for construction defect, property damage, liability and auto property damage claims.
Access multiple data systems to matching POCs to coverage and existing claims; setting up new claims; determining location of existing claims; entering data into POC Systems.
Make recommendations regarding coverage of claims.
Handle complex and high exposure liability claims.
Participate in special projects as assigned by Claims Manager and/or Department Head.
Claims Analyst Resume
Objective : Nearly 4 years of total experience with exposure to the business processes of the loan/ mortgage industry as well as exposure to project management in the civil industry. I have experience as a loan processor for the 571-Claims process. I have extensive exposure to the escrow process under the 571-Claims having worked for nearly 1 year for the KPO of a large lending company based in Phoenix.
Skills : Dentrix, Dexis, Microsoft outlook, Eden.
Managed a weekly desk load of 100-130 disability claims while maintaining consistent excellence in audits.
Surpassed the individual claim limit and assigned a desk load of an average of 300 claims per week.
Was part of a pilot team for senior analysts and managed a desk called complex claim desk. I was the go to person in my team for claims and complex claims.
Provided exclusive and exemplary customer service to major clients Handled international claims from specific policies through successful bilingual communications.
Address and transition complex situations across multiple claim management software and operating systems.
Multitask and managed multiple tasks at the same time.
Assisted team members in the handling and interpretation of complex policy language and special handling.