Insurance Claims Specialist Resume Samples

Insurance Claims Specialist will take charge of reviewing the client’s claims to determine if they are covered under the policy or not. The job description entails evaluating the extent of settlement to be received from the insurance companies. Typical job duties mentioned on the Insurance Claims Specialist Resume include all these – ensuring proper filling procedures are followed, assisting insurance adjusters with complicated claims, determining if the treatment gets covered under the policy or not; approving and denying claims, examining complex or unusual claims, authorizing claim payment, setting reserves on payment, conducting investigations on insurance claims, and consulting with attorneys, doctors and agents for disposition of complex claims.

Core qualifications expected on a resume are – extensive knowledge of insurance risk management, strong experience in investigating unusual and complicated claims, the ability to communicate well with attorneys and other professionals. Successful resumes mention a bachelor’s degree in insurance and risk management.

Insurance Claims Specialist Resume example

Insurance Claims Specialist Resume

Objective : Experienced Medical Biller exhaustively thorough, complete detailed investigation skills, eager and able to serve clients in a conscientious and pleasant manner. Outstanding oral & written communication skills. Extensive knowledge of Data Entry, Inventory and multi-line telephone systems.

Skills : Drawing Blood, Specimen Collection, Urinalysis, Appointment scheduling, Answering Phones, Answering Phones, Billing & Coding, Epic, Insurance Verification, Auditing.

Description :

    1. Reconciled insurance general ledger account to the balance owed insurance companies.
    2. Made monthly payments to an insurance company for premiums due.
    3. Processed loan payments for disability and death claims.
    4. Performed maintenance on client accounts, this included applying for payment correctly to interest and principal.
    5. Reconciled indirect dealer accounts and gave the information to Accounts Payable so they could correctly process the payments.
    6. Suggested using ACH function to save time and money on processing indirect dealer accounts.
    7. Responsible for addressing inbound questions and concerns for customers regarding Insurance Claims Address administration questions.
    8. Performed effective follow-up on open accounts in which claims have been submitted to appropriate payers in a timely and accurate manner, reviews and reports status of billing, audits accounts as needed and respectfully works with patients or payers to resolve account issues.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Masters In Accounting


Jr. Insurance Claims Specialist Resume

Objective : Over ten years of successful customer service experience. Recognized for excellence in building rapport, listening attentively, and resolving customers' concerns. Able to work well with others and thrive in a fast-paced environment.

Skills : Microsoft Office, Medical Terminology, Pharmacology,.

Description :

    1. Maintained multiple work queues of denial and no response to insurance claims within current timely standards.
    2. Reviewed and appealed denials with appropriate information and within contracted timely filing limits.
    3. Contacted insurances for follow up of claims and if accepted for payment or denied.
    4. Fixed registration errors regarding patient and insurance information.
    5. Submit new claims and file corrected claims to various insurances.
    6. Included monitoring outstanding insurance claims and submitting appeal letters as needed to insurance companies.
    7. Assisted with payment posting, charge posting, and administrative duties of the billing office.
    8. Responsible for performing loss draft and property damage requirements including processing 75-100 checks daily, processing documents, calling customers, ordering and reviewing inspections, and evaluating exceptions.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Diploma


Asst. Insurance Claims Specialist Resume

Summary : Looking to obtain a position as an IT Security Analyst with a company/organization that will allow to turn passion into career,Seeking an Administrative / Customer Service position in an office environment with the opportunity to grow with your company. More than 12 years of Customer Service and Administrative office skills, along with knowledge of computers and computer software.

Skills : Microsoft Office, Customer Service, Medical Terminology, Pharmacology,.

Description :

    1. Processed homeowner insurance claims for Regions Mortgage.
    2. Worked dealing with homeowners, contractors and insurance companies regarding claims and claim funds.
    3. Deposited claim funds into restricted escrow accounts and disbursed funds upon inspection and completion of repairs.
    4. Worked with homeowners and contractors on request for repairs, ordered inspections of work as work progressed and when work completed.
    5. Endorsed claim checks under $10,000 and returned checks to homeowner to pay for repairs.
    6. Created and maintained spreadsheets of all daily claims; created and maintained files for each claim.
    7. Disbursed hazard insurance payments to insurance companies from customer escrow accounts.
    8. Filed claims with insurance companies on bank-owned foreclosed properties, worked with insurance companies to recover payment for damages on foreclosed properties.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Diploma

Insurance Claims Specialist/Analyst Resume

Summary : Accomplished professional interested in continuing working in areas to promote efficiencies, cost effectiveness in an Business office department Dynamic professional motivated, self starter, analytical and detailed oriented. With excellent organizational, communication and decision making skills, Value customer satisfaction and relationships. Excellent project management with high level of electronic proficiency.

Skills : Computer Literate, Quickbooks, Macola, Peachtree, Bilingual Eng/Spanish, International Accounting.

Description :

    1. Responsible for patient billing, collections, and accounts receivable activity for all payor sources, including all SHI activities in accordance with established policies and procedures.
    2. Ensures that payments from all payor sources are posted timely and accurately.
    3. Reviews the aging reports and ensures appropriate follows-up for past due claims.
    4. Payors shall include Primary, Secondary, Self-Pay, and if appropriate filing of Probate as directed by Management.
    5. Prepares monthly billing Patient Care Data Bases for all Payor Sources.
    6. Reviews all payor sources monthly billing registers and underlying supplementary data for accuracy.
    7. Ensures that all electronic and paper billing to all payor sources is submitted timely.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Information Management

Insurance Claims Specialist/Supervisor Resume

Headline : A highly talented Billing Specialist with 21 years of experience in performing a variety of complex clerical and accounting functions for patient billing in, Medical, Prosthetics, and Home Health Care including verification of Benefits, invoice information, maintenance of third party billing records, and resolution of a variety of problems.

Skills : Strong Analytically And Problem Solving Skills, Great.

Description :

    1. Managed 150 or more inbound calls daily in high volume phone queue.
    2. Entered customer data into files and various systems and explain company insurance benefits and products.
    3. Processed customer payments for their claim and or policy.
    4. Maintained current knowledge of company's basic products, services and solutions in order to assist customers.
    5. Investigated, analyzed and resolved outstanding issue to achieve customer satisfaction and takes responsibility for following through and bringing issues to closure.
    6. Addressed and resolved customer product complaints professionally.
    7. Verified eligibility for insurance and process claims.
    8. Interfaced with customers via telephone, written correspondence, fax, web, and or electronic mail responding to routine inquires and resolves concerns.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Diploma

Insurance Claims Specialist/Coordinator Resume

Headline : Eager for a career with a leading organization as a sales professional; utilizing my strengths and experience working with customers to accomplish goals of succeeding as an integral asset to the team.

Skills : Microsoft Office, Powerpoint, Excel.

Description :

    1. Reconciled insurance general ledger account to a balance owed insurance companies.
    2. Made monthly payments to insurance companies for premiums due.
    3. Processed loan payments for disability and death claims.
    4. Performed maintenance on client accounts, this included applying for payment correctly to interest and principal.
    5. Reconciled indirect dealer accounts and gave the information to Accounts Payable so they could correctly process the payments.
    6. Suggested using ACH function to save time and money on processing indirect dealer accounts.
    7. Data entry and financials Skills Used Microsoft office, formatting excels spreadsheets, running reports, check to process.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Masters In Accounting

Insurance Claims Specialist/Executive Resume

Summary : Organized and detail-oriented insurance professional dedicated to improving efficiency, productivity and profitability through continuous process improvement. Analytical thinker skilled at developing innovative solutions to complex problems.

Skills : Electronic Medical Charts, Penchart, Centricity, Docstar, RMS, Kodak x-ray software Emedom and National Electronic Attachmet.

Description :

    1. Reviewed field inspections and coordinated all insurance claim audits.
    2. Evaluated insurance policies and analyzed damages to determine coverage.
    3. Compared data from surveillance footage to data on medical reports.
    4. Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
    5. Successfully eliminated claimant, premium and provider fraud.
    6. Synthesized data into comprehensive quarterly written reports for management.
    7. Directed and coordinated various investigations conducted by field investigation team.
    8. Developed a company-wide quality assurance program Ran special projects and initiatives at both the local and regional level.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Associate Of Arts

Insurance Claims Specialist/Consultant Resume

Summary : Efficient medical Administrative Assistant skilled in tackling administrative and patient-oriented tasks in a fast paced environment and Billing Medical Receptionist with over 5 years experience in a private medical office.

Skills : Claims Executive, Claims Analyst.

Description :

    1. Accurately determines investor guidelines and processes claims by reviewing and evaluating loan documentation.
    2. Replaces damaged/lost items by reviewing repair contracts, estimates and documentation received from homeowners.
    3. Documents the nature and scope of the claims.
    4. Promptly responds to member/inspection service and authorized third party inquiries regarding their insurance claims.
    5. Authorizes and processes repair fund releases.
    6. Requests reports of selected accounts for review, processing and remittance to insurance companies.
    7. Effectively responds to all billing and payment issues.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Bachelor Of Arts

Jr. Insurance Claims Specialist Resume

Objective : To acquire a position with the potential for advancement where can utilize knowledge and experience.

Skills : MS Office, MS Excel.

Description :

    1. Assume the responsibility of receiving and sorting incoming payments with the attention to credibility.
    2. Manage the status of accounts and balances and identify inconsistencies.
    3. Issue and post bills, receipts, and invoices.
    4. Update accounts receivable database with new accounts or missed payments.
    5. Ensured all papers are properly filled out and input into the system.
    6. Entered and verified that all patient demographics and billing information is correct at the time of check-in.
    7. Answered telephone and transferred calls to appropriate personnel.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
General Studies

Insurance Claims Specialist/Representative Resume

Summary : Interested in a position with a company that promotes personal growth with possibilities of advancement through education and training.

Skills : Medical Terminology, Pharmacology,.

Description :

    1. Initiate communication with physician's offices ,insurance companies, and patients to resolve billing issues.
    2. Perform follow-up procedures on claims by contacting insurance carriers via website or telephone.
    3. Work outstanding balance reports to determine cause.
    4. Complete and submit insurance forms to process denied and unpaid claims as required by third party payers.
    5. Correct invalid CPT and ICD-9 codes on insurance claims Research claim denials.
    6. Answer phone calls from physician, clients, and patients.
    7. Respond to letters from insurance companies.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Information Technology

Lead Insurance Claims Specialist Resume

Summary : To utilize skills in a challenging and rewarding position in the Health Care Industry that will offer advancement and professional growth.

Skills : Finance, Insurance.

Description :

    1. Initialed behavioral health triage of members in a call center environment.
    2. Quoted and explained benefits to members and providers of care.
    3. Sent referrals for outpatient services such as mental/behavioral health and substance abuse.
    4. Answered benefit questions, authorized routine outpatient services.
    5. Responsible for documenting all contacts and answering risk questions.
    6. Verified provider status, whether they're in or out-of -network.
    7. Loaded providers and members information into computer database to ensure accuracy.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Consultant
Education
Education
Business Administration

Insurance Claims Specialist Resume

Objective : Seeking an Administrative / Customer Service position in an office environment with the opportunity to grow with your company. More than 12 years of Customer Service and Administrative office skills, along with knowledge of computers and computer software.

Skills : MS Office, MS Excel.

Description :

    1. Providing customer service in the name of the client.
    2. Contact customers via telephone in attempt to collect payment on medical bills.
    3. Communicate accurate information to customer in a clear, concise and professional manner.
    4. Review patient account and document customer's interaction and feedback.
    5. Negotiate appropriate and reasonable payments with customers.
    6. Set up customer payments via check, electronic transfer or credit card.
    7. Responsible for understanding and complying with all policies and HIPAA Laws.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
General