Medical Claims Analyst Resume Samples

Insurance companies hire a Medical Claims Analyst to verify and audit the medical claims, and also to check the accuracy of the company’s reimbursement payments. A well-drafted Medical Claims Analyst Resume indicates the following duties – performing data entry of claims, tracking data entry claim receipts; accessing and utilizing department mail, scanning claims, communicating with payers and patients to follow up and resolve claims; processing denials, refunds and claim status; creating reports and documentation for regulatory bodies and lawyers; analyzing database and contracts to make adjustments.

The most sought-after skills for the post include the following – accuracy and speed, great attention to details, knowledge of identifying errors and discrepancies, vast understanding and experience of medical terminology, billing laws and insurance policies; and excellent math skills to reconcile all documentation. While a degree is mandatory, successful resumes mention as well, a medical coding vocational program certificate.

Medical Claims Analyst Resume example

Medical Claims Analyst Resume

Objective : Seeking a Medical Claims Analyst position in clerical administration, where to maximize skills in the field of customer service in the health care industry.

Skills : MS Office, Management.

Description :

    1. Assisted medical providers with medical claims status and patient eligibility/ benefits information.
    2. Responded to providers requests regarding Explanation of Benefits (EOB) by using Right Fax.
    3. Handled escalated irate calls and made sure their needs were being met from a supervisory perspective.
    4. Coached and trained team members as a team lead.
    5. Reviewed insurance policy to determine coverage and provided quality service.
    6. Prepared insurance claim forms or related documents and review them for completeness.
    7. Provided customer service, such as limited instructions on proceeding with claims or referrals to medical providers.
    8. Organized or worked with detailed office records, using computers to enter, access, search or retrieve data.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Administration


Sr. Medical Claims Analyst Resume

Summary : Seeking a Medical Claims Analyst position in a fast paced environment, providing accelerated responsibilities, career growth opportunities and the ability to utilize skills.

Skills : Microsoft Office, Google Analytics.

Description :

    1. Reviews medical claims and patient eligibility.
    2. Processes claims within a five day turn around.
    3. Works with both physicians and insured individuals.
    4. Answers phones and written correspondence.
    5. Works with internal departments within the company to process claims quickly and accurately.
    6. Experiences with primary and secondary insurance, and correct coordination of these benefits.
    7. Researches overdue accounts and follows up by mail and/or phone to insurance carriers or customers on delinquent payments.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Associate


Jr. Medical Claims Analyst Resume

Objective : To become aMedical Claims Analyst vital asset to a company's organization while allowing the opportunity to grow.

Skills : MS Office, Management.

Description :

    1. Processed claim forms, adjudicating for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
    2. Followed adjudication policies and procedures to ensure proper payment on claims.
    3. Requested and reviewed medical records to ensure claims meet medical necessity criteria.
    4. Provided prompts customer services to members, providers, billing departments, and other insurance companies regarding claims.
    5. Documented phone calls in system and following up on issues as needed.
    6. Resolved problems resulting from client adjudication and customer service phone calls.
    7. Audited randomly selected claims to ensure quality processing.
    8. Researched claim overpayments and requesting refunds.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Bachelor's

Medical Claims Analyst I Resume

Objective : To pursue a challenging and rewarding Medical Claims Analyst position that will utilize skills for the betterment to their company.

Skills : Microsoft Office, Typing, 10 Key BT, Phones/fax, Copier/printer.

Description :

    1. Reviewed & processed medical claims submitted by paper/electronically by providers for payment.
    2. Answered phones from providers answered questions, helped them get claims paid or reprocessed.
    3. Called primary insurances for eligibility/benefits.
    4. Trained incoming employees/answered questions.
    5. Helped supervisor on special projects.
    6. Processed of claims was exceptional & appreciated.
    7. Responsible for rapour with local offices to get claims paid that were denied in error or only a partial payment.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Bachelor's

Medical Claims Analyst II Resume

Headline : Responsible for providing the Director of Claims Administration with analytical support necessary to ensure regulatory and business, claim administration, compliance.

Skills : MS Office, Management.

Description :

    1. Validated information on all medical claims from patients and providers seeking for payments for services rendered.
    2. Reviews to ensure that there is no missing or incomplete information.
    3. Keeps meticulous records of claims and follow up on lapsed cases.
    4. Reviews all medical/surgical billings for reasonable and necessary charges.
    5. Examines coding of operative reports, procedures, and multiple and complicated surgeries.
    6. Prepares and handles billing for accounts to ensure timely reimbursement.
    7. Researches overdue accounts and follows up by mail and/or phone to insurance carriers or customers on delinquent payments.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Diploma

Medical Claims Analyst III Resume

Summary : Medical Claims Analyst serves as a brands main editorial voice and demonstrates how to successfully complete claim (fact) checking, check changes, and submission tasks for a variety of clients and brands.

Skills : Management, Organizing.

Description :

    1. Responsible for processing 135 HCFA and UB90 claims for patients who receive care through contracted/non-contracted physicians within the John Muir health and John Muir Medical Center facilities rendered out of area and emergency care.
    2. Determined patients' eligibilities within specific limits.
    3. Responsible for processing tracers that are sent in for providers' and patients' inquiries.
    4. Responsible for coordinating multiple benefits that consist of Medicare, PPO, and other medical groups within the John Muir Health Systems.
    5. Made phone calls to referring physician staff for verification of referred patients to out of network/out of area providers.
    6. Performed other duties such as entering priority claims into the system by loading information from the live claims that were sent for processing.
    7. Monitored & reviewed pended claims in order to stay within compliance guidelines.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Medical

Asst. Medical Claims Analyst Resume

Objective : Over twenty years of progressive health care financial services experience, combined with insightful analysis and fiscally responsible decision making ability. Relied upon heavily to administer fully functional bilingual communication services in all aspects of service delivery.

Skills : MS Office, Management.

Description :

    1. Reviews and processes insurance claims for accounts, high dollar amounts.
    2. Receives researches and resolves correspondence from all organizations and clinical department.
    3. Identifies problems and inconsistencies, researches problems from patients accounts.
    4. summarizes findings Send patient statements for balance due after all resources have been exhausted.
    5. Complete special projects as assigned by management.
    6. Edits and adjusts claims paying as required.
    7. Contacts to all insurance companies and government agencies, enter data of information received to resolve edits and process claims.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Bachelor's

Associate Medical Claims Analyst Resume

Headline : Senior Billing and Training Account Specialist with experience supporting many medical facilities. Expertise includes surgical coding and billing for in-patient, out-patient, and emergency room procedures for in and out of network providers, Safety Compliance training, Maintaining State and Federal guidelines training.

Skills : Proficient With Project Management, System Setup, Implementation.

Description :

    1. Proficiently processed Medical Claims from providers and insurance plans, including hospitals.
    2. Responsible for data entry and processed denial letters.
    3. Facilitated excellent customer service to members and corresponded within HIPAA requirements.Efficiently worked within the Medicare Guideline's using ICD-9 codes, CPT codes, and contractual agreements.
    4. Successfully implemented refund requests for providers, health plans, and patients.
    5. Accountable for processing denial letters and medical claims from providers, insurance plans, including hospitals.
    6. Implemented refund requests for providers, health plans, and patients.
    7. Worked within the Medicare Guideline's using ICD-9 codes, CPT codes, and contractual agreements.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
AAS

Lead Medical Claims Analyst Resume

Summary : To obtain a challenging Medical Claims Analyst career using the skills that have acquired from experience.

Skills : Project Management, Medical Terminology, Management.

Description :

    1. Audits medical claims for insurance companies resulting in overpayments.
    2. Responsible for Daily customer service with subscribers, members, and groups.
    3. Meets all quarterly goals in overpayments and recoveries.
    4. Maintains a high-quality score.
    5. Mentors for a new hire.
    6. Prepares and handles billing for accounts to ensure timely reimbursement.
    7. Answers calls from providers and employees regarding questions about claims processed or verification of benefits.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Associate

Medical Claims Analyst Resume

Headline : Administrative support professional with over 12 years experience in clerical and office support. Focused on detailed projects, client satisfaction and a high level of productivity.

Skills : Customer Services, Typing.

Description :

    1. Examined and processed medical, dental, vision and short term disability claims according to the plan documents.
    2. Worked with HCFA 1500, HCFA 1450, UB92's and generic claims.
    3. Experienced with Supplement to Medicare and coordination of benefits, pre-existing clauses, subrogation and stop loss.
    4. Worked with ICD-9, CPT, and HCPC coding.
    5. Reviewed medical records and compile all information for medical review.
    6. Documented examination High volume data entry High volume customer service Customer and client satisfaction.
    7. Ensured the highest quality of medical and scientific content in client submissions.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Bachelor's