Claims Auditor Resume
Headline : To obtain a position where can maximize skills in the medical field, customer service skills, and contribute to the success of a winning team. A creative results oriented professional with extensive experience.
Skills : Microsoft Office, Google Classroom, Promethean Board.
Description :
- Assisted customers with any questions or problems that they might have had.
- Provided customers with any information that was needed in order to solve any problems that they may have.
- Called customers and requested that they send in the correct documentation in order to continue the process of paying their claim.
- Faxed paperwork, using the computer, and the copier. Paying claims for national and international packages that are lost or damaged by UPS.
- Interacted daily with co-workers answering and asking questions that are viable to do the job correctly.
- Performed routine and special audits of par and non-par provider claim to determine payment accuracy for Medicare and Commercial plans.
- Utilized Excel and Access to launch theoretical claim queries into the system.
Experience
5-7 Years
Level
Executive
Education
Masters
Claims Auditor I Resume
Objective : To obtain a full-time position as a claims processor or claims auditor within an established company where knowledge, skills and experience can be utilized to their full potential.
Skills : Recruiting, Screening, Auditing, Payroll.
Description :
- Audited the claims processors audit all facility, high dollar, sniff, home health, and claims.
- Able to meet daily production while maintaining a high level of accuracy. Able to process and audit according to company policies and procedures.
- Able to use several different applications in order to do the job correctly.
- Worked using, facets, on base, Emdeon, med assets, priced claims manually using burgers.
- Processed and audited commercial, Medicare, and Medicaid claim.
- Served the needs of AFLAC's Puerto Rico clients by auditing medical insurance claims and processed approvals per worker compensation guidelines.
- Consistently exceeded quota set by management by more and served as a translator.
Experience
2-5 Years
Level
Junior
Education
Medical Terminology
Claims Auditor III Resume
Summary : Seeking a position to utilize specific knowledge of accounting as well as general knowledge of business management. Ideally, would like to find a position that holds the potential for long-term growth.
Skills : MS-Word, Excel, Power point.
Description :
- Oversaw employee benefits processing and disbursement.
- Collected and audited claim submissions and disbursement process.
- Produced an Explanation of Benefits and Claims Settlement payments.
- Managed claim research, processing, and payment. Excellent written and verbal communications.
- Audited post-payment physician and facility claims for payment accuracy, governmental regulation compliance.
- Possible fraud scenarios on multiple client accounts within various states for Medicare, Medicaid, and commercial products.
- Provided on-site audit services of Medicare Advantage plans to ensure CMS payment and policy adherence as part of the ongoing.
Experience
10+ Years
Level
Senior
Education
Diploma
Claims Auditor/Representative Resume
Summary : To further career, by obtaining a position that will utilize knowledge, skills, and leadership qualities that have developed through work, scholastic and other experiences.
Skills : Office work, Computers.
Description :
- Audited worker's compensation claims to verify that all information is correct and insures claims are re-priced and paid in a timely manner.
- Researched both UB-92 and claims not found in the Power Track system.
- Contacted the Sedgwick coordinator to obtain information on the claimant that will help locate a valid account number.
- Claimed to follow to commercial insurance companies to check status on filed claims.
- Contacted Juris Coordinator if the previous steps are not successful, to have claim re-queued in the system.
- Hard copy claimed that for various reasons are not able to be scanned.
- Peer- trained with newer employees, answering any questions they may, so they can pay claims correctly.
Experience
7-10 Years
Level
Management
Education
Diploma
Claims Auditor/Representative Resume
Summary : Energetic and enthusiastic insurance professional motivated to succeed in a fast-paced and deadline-driven professional environment. Comprehensive knowledge of claims adjustments.
Skills : Excel, Accounting, Auditing, Financial analysis.
Description :
- Based on client specifications, administer the claim process including matching claim to Prior Approvals, auditing the claim, data entry and verifying input.
- Updated and maintained customer profiles and contact information in the SalesForce database.
- Confirmed correct documentation/proof of performance was submitted; confirming amounts requested for payment based on invoices submitted.
- Ran and verified all client reports; run and verify customer statements and detail reports; run and verify letters.
- Worked in a fast-paced environment while auditing claim batches that can exceed.
- Translated multiple documents and invoices to help identify and convert currencies and apply international tax rates.
- Professional Qualifications and Skills Microsoft Office, proficient at Word and Excel.
Experience
7-10 Years
Level
Management
Education
Applied Science
Claims Auditor II Resume
Headline : To obtain a position where may continue to learn and expand knowledge while utilizing skills and expertise in ways that will prove an asset to employer.
Skills : Microsoft Word, Microsoft excel, System Operator.
Description :
- Developed tend analysis and reporting mechanisms for the unit.
- Constructed methods of communicating trends via written procedures and provides training for the unit and/or individuals.
- Provided accurate audit results with clear explanations of any errors or issues identified in the audit.
- Worked closely with management to customize individual internal audit reporting for claims and customer service.
- Constructed gives and receives feedback concerning the quality of work.
- Provided monthly trend reports that fully summarize audit data to allow management to quickly understand the quality of work.
- Assisted the manager by providing written procedures for identified areas of improvement.
Experience
5-7 Years
Level
Executive
Education
Medical Office
Claims Auditor II Resume
Headline : Excellent written and verbal skills. Highly organized and detail oriented. Excellent problem solving skills and analytical skills. Resourceful in multitasking and working under pressure.
Skills : MS-Outlook, MS-Access, Encoder, Quicken, Code link.
Description :
- Reviewed Medicare claims to ensure it was processed correctly.
- Responded to inquiries from the compliance team regarding eligibility, claims, provider network, service area, grievances, and appeals.
- Audited the following claim types, DRG, Inpatient, Skill Nursing, Inpatient Rehab, Inpatient Mental Health, Long Term Acute Care.
- Conducted training classes for all claim types.
- Conducted telephone and video training classes for team India for all claims types.
- Conducted training classes for providers on CIP claims submission process.
- Checked member eligibility status on the MARX system.
Experience
5-7 Years
Level
Executive
Education
Medical Assistant
Asst. Claims Auditor Resume
Objective : Seasoned and resourceful candidate, offering significant experience in the insurance and customer service fields. Commitment to creating a strong team environment while strengthening.
Skills : Technical Skills, MS-Office.
Description :
- Reviewed client systems to determine if claims were paid per coordination of benefits.
- Revamped accounting quality system to prepare for important audits.
- Communicated with Medicare, Patients, and Employers. Audited claim forms and cataloged insurance claims.
- Constructed training manuals and implementations of new clients.
- Audited and processed medical and dental claims, Interpreted and applied plan sponsor benefits and medical contracts.
- Processed medical claims for two separate accounts, one with over lives.
- Handled all benefits and claims status calls for both clients as well as all inquiries from insureds.
Experience
2-5 Years
Level
Junior
Education
Business Management
Associate Claims Auditor Resume
Objective : To seek a challenging position with an organization in search of a self-motivated, enthusiastic financial and accounting professional with experience and a strong commitment to the success of the organization.
Skills : Microsoft Office, Communication Skills.
Description :
- Responsible for claims examination procedures, information and data management.
- Performed extensive audits on health insurance and Medicaid claims, audit documentation, audit report draft documentation, and error write-up.
- Researched and determined settlement or denial of medical and pharmaceutical claims.
- Ensured claims are audited in accordance with contract provisions related to potential processing and payment errors.
- Ensured the quality and integrity of data of internal and external sources.
- Researched medical claims with heightened alerts to identify fraud schemes and accurately documented and reported identified fraud activities.
- Demonstrated strong analytical and data interpretation skills.
Experience
2-5 Years
Level
Junior
Education
Information Science
Asst. Claims Auditor III Resume
Summary : To utilize strong clerical and interpersonal skills in order to allow employers to successfully examine and operate their organization at its full potential.
Skills : Communication Skills, Management.
Description :
- Acted as a liaison between insurance companies and auto body shops.
- Negotiated vehicle estimates for insurance companies and assists body shops in the complete payment of vehicle repairs.
- Created program management scorecards to see who were our best performing body shops and referring that information to the insurance companies.
- Reported analytics to track the information that matters most to our customers.
- Provided solutions that are compatible with the customer's current client systems.
- Processed up to estimates a day while the average is about estimates a day.
- Audited led to an average saving in claims.
Experience
10+ Years
Level
Senior
Education
Bachelor Of Arts
Claims Auditor Resume
Objective : To obtain a challenging position with a company that will allow to use varied knowledge and skills for career and personal growth.
Skills : Technical Skills, Management.
Description :
- Performed to resolve errors by communicating with the Production Manager or Supervisor.
- Audited member liability denials to assure the quality of the claim.
- Ensured the accuracy of payment/rejection based on contractual policies and procedures.
- Reviewed medical claims to detect unlawful or incorrect Medicare Payment.
- Conducted quality assurance assessments and reviewed statistical samples.
- Utilized CPTS ICD-9/ICD-10 and other coding systems with an emphasis on compliance and regulatory standards.
- Performed audits specifically targeting and evaluating procedural diagnosis code selection.
Experience
0-2 Years
Level
Entry Level
Education
Diploma
