Medical Claims Representative Resume Samples

A Medical Claims Representative is hired to determine if patients have enough insurance coverage and help them with their medical claims. Job responsibilities and duties are listed on the Medical Claims Representative Resume as – examining claims records and forms to determine if the patient has medical insurance, reviewing provisions of certificate and policy to determine medical coverage loss, negotiating claim settlements and making recommendations for legal actions, completing logs, reports, and forms; rejecting/approving documentation, adhering to all company policies, and procedures; examining medical treatment records, and police reports; ensuring all claims information remains confidential, and engaging in training opportunities when necessary.

Those seeking to work in this position should be able to demonstrate such skills as – work experience in the medical field, detail-oriented, interpersonal skills, analytical abilities, data entry skills, and knowledge of FDA health regulations. Employers pick resumes that denote a degree in relevant fields.

Medical Claims Representative Resume example

Medical Claims Representative Resume

Summary : A precise, detailed-oriented individual seeking a Medical Claims Representative position in the Medical Administrative field that utilizes my 3 years of medical office experience with medical billing, cash posting, credit balances, insurance follow up as well as insurance refunds.

Skills : Microsoft Office, Communications, Written Correspondence, Customer Service, Leadership Development, Trainer.

Description :

    1. Closed out claims to bill patient Contacted the patient for correct insurance information or to update coordination of benefits.
    2. Appealed denied medical claims with payers for payment.
    3. Utilized Clindesk/Phydo/Gaffey to obtain insurance information and medical records.
    4. Utilized insurance portals and websites for claim status.
    5. Performed appropriate follow up with payers for payment.
    6. Ensured covered services are paid according to the patients benefit plan.
    7. Ensured appropriate information is provided to the insurance carrier in a timely and accurate method.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Associate's


Medical Claims Representative Resume

Summary : To work in a dynamic Medical Claims Representative professional organization, to support the growth and profitability of an organization that provides challenges, encourages advancement and rewards achievement. This gives me the opportunity to provide my excellent customer service skills, and expertise from my prior work experience.

Skills : Customer Relations, Property Management, Banking.

Description :

    1. Determined proper policy coverage, investigates, evaluates, negotiate, and settle bodily injury claims.
    2. Prepared and submitted initial and monthly follow-up reports.
    3. Advanced knowledge of insurance theory, practice, contracts, applications, and regulations.
    4. Reviewed police reports, medical treatment records, medical bills, and physical property damage to determine the extent of liability.
    5. Examined claims forms and other records to determine insurance coverage.
    6. Interviewed or corresponded with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
    7. Prepared report of findings of investigation.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
BS In Communications


Medical Claims Representative Resume

Objective : Experienced Medical Claims Representative seeking opportunity with company to utilize an extraordinary background in the medical insurance industry.

Skills : Microsoft Office, Office Management, Knowledge And Implementation Of Confidentiality Guidelines, Creating Databases.

Description :

    1. Experienced with the Algeria 2000 Patient Account System.
    2. Verified Insurance Benefits, effective date, and coverage for Hospitals: HMO PPO, POS, BC/BS, and Commercial Accounts.
    3. Billed insurance claims using UB92's then mailed them to their designated payer.
    4. Followed up claims by contacting payer to verify when a claim will be paid, or for the reason of non-payment.
    5. Verified Medicaid/Medicare eligibility via the Internet (ThinOnline/NDAS).
    6. Experienced with Posting Payments via Algeria 2000.
    7. Experienced with Account Adjustments according to insurance payments and EOB's.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Associates Of Applied Science

Medical Claims Representative Resume

Summary : As a Medical Claims Representative, responsible for Training Started position as a Claims Representative Trainee for auto insurance claims and accepted a promotion to Medical Claims Representative.

Skills : Critical Thinker, Energetic, Organized, Computer Proficient, Fast Typer, Excellent Communication, Pays Well Attention to Detail, Quick Learner, Issue Resolution, Leader, Clutch in Serious Situations, Microsoft Office, Excel, PowerPoint Proficient, Data Entry.

Description :

    1. Plymouth, MI Completed comprehensive review of assigned medical claims, including required 2/2006 - Presented statements from all involved parties.
    2. Reviewed and investigated all claims to determine validity.
    3. Evaluated required treatment plans and assign independent review as required.
    4. Reviewed/approved invoices for payment.
    5. Selected for National Catastrophe Response Team (NCRT) duty deploying to various cities to respond to natural disasters.
    6. Managed Repair Representative Responsible for all vehicle damage estimates within assigned territory.
    7. Responsible for file ownership of all new claims assigned.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor Of Arts And Science

Medical Claims Representative Resume

Objective : Highly qualified Medical Claims Representative with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and I would excel in the collaborative environment on which your company prides itself.

Skills : Microsoft Excel, Access, ASD, Health Hub.

Description :

    1. Took calls in regards to medical expenses and flex spending accounts, handled any issues with flex spending accounts.
    2. Maintained detailed records about individual accounts and answered general questions.
    3. Handled authorizations and overrides for medications, worked with pharmacies to assist patients with processing prescription claims.
    4. Handled payment for medication mail order delivery.
    5. Advised patients of the status of their mail-order account and deliveries.
    6. Sent and received faxed forms from medical providers in regards to medication authorizations.
    7. Handled issues with medical claims, in regards to the process of how providers received payments, and how medical procedures are covered.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
High School Or Equivalent

Medical Claims Representative Resume

Headline : Conscientious and detail-oriented Medical Office Specialist with an excellent background in managing complex and high-volume clerical work. Mindful of all standards and practices pertaining to health, safety, and patient confidentiality. Superb team player as well as a strong independent worker.

Skills : Microsoft Word, Planning Skills.

Description :

    1. Determined requirements by working with customers.
    2. Answered inquiries by clarifying desired information; researched, locating, and providing information.
    3. Resolved problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
    4. Fulfilled requests by clarifying desired information; completing transactions; forwarding requests.
    5. Maintained call center database by entering information.
    6. Kept equipment operational by following established procedures; reporting malfunctions.
    7. Updated job knowledge by participating in educational opportunities.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
MS

Medical Claims Representative Resume

Objective : Medical Claims Representative who collects patient payments after the insurance company makes a payment on OB-Gyn visits at the Management Services Office. I am most interested in helping others and providing satisfaction to clients and customers.

Skills : Customer Service, Insurance, Healthcare.

Description :

    1. Identified and resolve customer and patient billing issues.
    2. Reviewed accounts regularly for insurance or patient follow-up.
    3. Performed various collection actions including contacting patients by phone, correcting and resubmitting claims to third-party payers.
    4. Reviewed patient bills for accuracy and completeness and obtain any missing information.
    5. Followed up on unpaid claims within the standard billing cycle time frame.
    6. Checked each insurance payment for accuracy and compliance with contract discount.
    7. Called insurance companies regarding any discrepancy in payments if necessary.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Bachelor Of Science

Medical Claims Representative Resume

Objective : Seeking an outstanding career opportunity that will offer a rewarding work environment along with a winning team that will fully utilize management skills.

Skills : Medical Billing, Epic, Authorization, Medical Terminology, Microsoft, Reimbursement, Claims Processing, Medical Eligibility.

Description :

    1. Entered medical insurance claims data into the system and processed claims.
    2. Interpreted the medical history of the client.
    3. Resolved problems resulting in claim settlement and performed audit of claims.
    4. Followed adjudication policies and procedures.
    5. Delivered timely service to members and billing departments.
    6. Processed claims above timely manner for payment.
    7. Used Working independently, prioritizing workload, how to process medical claims.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
GED

Medical Claims Representative Resume

Headline : To obtain a Medical Claims Representative position where I can utilize my skills and abilities for the community's enhancement, and thrive in an atmosphere conducive for professional growth in Social Services.

Skills : Medical Claims Processing, Post Payments, Customer Service, Data Entry, Receptionist.

Description :

    1. Provided customer service to class members and claimants in a call center atmosphere.
    2. Performed data entry using Microsoft word and excel to facilities project.
    3. Coordinated meetings.
    4. Drafted correspondence for internal and external use.
    5. Managed executive calendars Entering vendor's time into time tracking system called Timesolv.
    6. Researched a project for Medical Monitoring in different states to compare variables based on the Medicaid program in the United States.
    7. Researched Medical liens on personal property claims.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Master In General Psychology

Medical Claims Representative Resume

Headline : Strong organizational and communication skills with the ability to concurrently direct multiple business affairs. A multitude of versatile skills transfer unto any administrative setting to create and maintain high levels of efficiency and productivity. Advanced understanding of customer needs with diligent attention to detail resulting in superior customer service and high levels of client satisfaction. Broad understanding of healthcare data. Capable of analyzing problems. Trusted liaison and assistant.

Skills : Customer Service, Data Entry.

Description :

    1. Independently processed hospital/physician claims to ensure that there is no missing or incomplete information in accordance with company polices, regulation and applicable laws.
    2. Reviewed and researched assigned claims by navigating multiple computer system and platforms and accurately capture the data necessary for processing.
    3. verified pricing, prior authorizations etc.) Responsible for maintaining current knowledge of billing and coding, CPT, HCPCS, Revenue Codes and proper use of Modifiers.
    4. Tracked and reported revenue cycle data for trends and issues.
    5. Provided customer service by responding to and documenting telephone and or written inquires.
    6. Provided back-up on other hospital/physician accounts as necessary.
    7. Consistently met established performance standards including quantity and quality claims processing standards.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
MS