A Senior Claims Analyst has to monitor the liability claims, verifying, and update the information of the various submitted claims and review the policies that determine the charges eligible for reimbursement and negotiate payments with parties. A well-drafted Senior Claims Analyst Resume mentions the following core duties and tasks – calculating loss adjustments, auditing losses, providing solutions for customer-related problems; providing technical expertise for all loss relating to software’s and internet programs; tracking and auditing adjuster’s proficiency; and coordinating the team who work in this department.
The most wanted job assets include – strong knowledge on industry statutes and regulations within the area; the ability to multitask, knowledge of internet and intranet functionalities; demonstrable knowledge, and experience gained in any specialized area of insurance such as medical, property, casualty and so on. A degree in the field of insurance or management is a welcome call.
Summary : Known as a leader who works independently and consistently goes above and beyond the expectations of a supervisor. Well versed in personnel issues, including evaluating, mentoring and training of staff. A supervisor who is able to develop employees through on the job training as well as established procedures.
Skills : Microsoft Office, Microsoft Excel, PowerPoint, Online Databases.
Handled multi-line claims including home owners, auto liability, property and worker's compensation claims.
Handled claims to conclusion, which included conducting account review meetings with employers and agents, and resolving conflicts between employers and employees.
Worked with doctors, case managers, attorneys and employers to resolve claims.
Managed reserves and reporting to management.
Settled auto liability and workers compensation claims as needed as well controlled litigation strategies.
Acted as President, Vice President, Treasurer and Floor Representative in the Employee Club.
Knowledged, Skills and Abilitiescapable of using Excel spreadsheets to prepare evidence, summarize financial or other data.
Medical Office Administration
Senior Claims Analyst III Resume
Objective : Seeking a Data Entry Claims Examiner Office Administration Team Lead Position(s) with a company that offers room for advancement.
Skills : Proficient In Data Entry, Customer Service.
Received several awards for achieving superior quality and production standards.
Reviewed and processed insurance claims for complex accounts, high dollar amounts, intricate carrier contracts and specialized clinical departments.
Received, researched, and resolved correspondence from all organizations and patients.
Identified problems and inconsistencies utilizing management reports, researches problems, summarizes findings, and makes recommendations.
Functioned as liaison between departments, third party carriers, and private patients.
Submited written recommendation for alerts to departments.
Functioned as resource person for designated department to answer questions and resolve problems.
Associates In Management
Senior Claims Analyst II Resume
Summary : A highly motivated professional with a verifiable record of accomplishments spanning ten years. Highly creative, recognized as a results-oriented, attention to detail, and solution-focused individual. Areas of strength include: * Accounts Payable * Collection Problems.
Skills : Claims Processing, Project Management, Risk Management, Auditing, Insurance, Operations Management, Social Media, Customer Service, Excel, Microsoft Office, Business Objects, Compliance, Compliance, Problem Solving, Problem Solving, Process Improvement, Negotiation, Legal Research, Analytical .
Spearheaded internal compliance audit, which required a report for claim analysis, with an average pool of 17,500 claims per month.
Analyzed claim handling processes and identified operational inefficiencies, which affected Company's monthly compliance ratings, and developed improvement plans.
Audited required an in depth knowledge and understanding of California Fair Claims Settlement Practices Regulations.
Provided reports on non-compliance incidents to appropriate parties.
Made recommendations for continuous improvement where appropriate, provided an average of 96 recommendations per month to assist with risk management programs, company-wide.
Developed procedures in a team environment to ensure compliance and support business initiatives, which lead to several major company-wide claims handling and operational changes.
Meticulously compiled documents for discovery and subpoenas for pending lawsuits, facilitated civil and small claims lawsuit settlements, and represented Company in civil and small claims lawsuits in 40 states, as well as depositions.
Law And Society
Senior Claims Analyst I Resume
Summary : Over 9 years of combined experience working as a Claims Analyst, New Business Analyst, and Claims Specialist, Report Developer, and Quality Analyst Tester in the healthcare field. Interested in work from home, remote, telecommute, as well as on-site opportunities.
Skills : Visio, Microsoft Project, JIRA, Reporting, Testing, Claims Processing, Analytics, Healthcare, Accounting, Business Objects, Process Improvement, Documentation, Data Analysis, Data Entry, Quality Assurance, Cognos, Change Management.
Reviewed all medical/surgical billings for reasonable and necessary charges.
Examined coding of operative reports and procedures.
Evaluated claims referred for medical management and make recommendations for further investigation or documentation as necessary.
Maintained records and prepare correspondence related to work.
Worked error reports that contain missing claim information.
Reviewed explanation of benefits(EOB)/payments (EOP) for coordination of benefits Adjust corrected claims for payment received from rendering providers or customer service.
Tested new benefits when the group amends the contract to ensure the system is working properly.
Senior Claims Analyst/Manager Resume
Summary : Dedicated Healthcare professional with more than 21 years of combined experience, as a QNXT and Facet Configuration Analyst, UAT Business System Analyst II, Quality Analyst, Claims Operations Manager, Field Operations Manager, Senior Team Lead, Senior Auditor, Recovery/Adjustment Analyst, Grievance and Appeals Specialist and Senior Claims Analyst.
Skills : Medical Terminology,Electronic Medical Records.
Coordinated Benefits and verify eligibility.
Examined coding of operative reports, procedures, and multiple and complicated surgeries.
Evaluated claims referred for medical management for documentation as necessary.
Trained and assisted claims staff on all aspects of medical claims processing.
Assisted and advised claims examiners concerning the monitoring of departmental quality and production goals.
Maintained records and prepares reports and correspondence related to the work.
Received telecommunication from providers and members regarding the status of a claim.
Assistant Senior Claims Analyst Resume
Headline : Join a growing company with a collaborative team dedicated to giving excellence in customer service. Claims Analyst is responsible for the day-to-day claims process. From claims decisions to claim resolution, the Claims Analyst is responsible for all aspects of the process. This includes managing claims, researching and evaluating claims trends, and providing real-time reporting on claims activity.
Skills : Claims Processing, Microsoft, Word, Word.
Promoted to Senior Claims Analyst after showing self determination and a positive attitude as team player.
Lead a team of willing and determined examiners that made crucial moments easier.
Maintained a motivated department that did not allow deadlines to seem undeliverable.
Assisted the department with projects and employee training.
Implemented new ideas which decreased error rate by 78%.
Severed as liaison between claims and customer service.
Worked with senior management in the process of evaluation and time management.
Certificate In Business
Assistant Senior Claims Analyst I Resume
Summary : Obtain a challenging leadership position within a growing industry that will allow me to demonstrate vast knowledge, and where can apply creative problem solving and assist with improving organizational ability to exceed goals. Abilities Team player Excellent communicator Extensive research abilities Interpersonal skills Leadership trained for various settings Problem solving abilities.
Skills : MS Office, Customer Service, Detail Oriented, Human Resources, Internet, Logistics, Medical Terminology, Negotiation, Risk Management, Team Player.
Initiated claims on checking and savings for online banking transfers, wire transfers, billing error disputes and ATM deposit corrections for both fraud and nonfraud situations.
Handled escalate calls when a manager is needed or requested.
Built special relationships through immediate response and resolution.
Used extensive knowledge to resolve complex situations.
Analyzed and reviewed collateral documentation within strict time frames.
Ensured exceptional customer service, identified risk, recommended claims for payment, and reviewed guidelines and policies.
Analyzed an average of 650 claims per month and independently issued decisions on claims up to $100K.
Senior Claims Analyst/Specialist Resume
Objective : Great thinking requires hard work and not one to shun away from a little dirt. Work to make significant gains and encourage teams to think and act intellectually. Platform is business and innovation and while study performance and measure players, love to think strategically and to be part of radical innovation and risk no matter what position hold.
Skills : Microsoft Excel, Microsoft Word.
Managed and monitored the overall quality of services provided, analyzing and reporting claim and incident data as appropriate.
Compiled and interpreted data, identifying trends and communicating results to team members and management.
Minimized loss experience and identified potential fraudulent claims, monitoring compliance with insurance carriers and third-party vendors.
Developed and reported analytics to support project initiatives, improving processes and overall business practices.
Incorporated and demonstrated the mission, vision and values of corporate organization regarding claim and incident data interpretation.
Provided back up for various departmental claim analysis functions, assisting other team members in development of program assessment tools.
Reviewed project assignments and approved budgets and timelines.
Master Of Business Administration
Lead Senior Claims Analyst Resume
Objective : Accomplished Administrative Professional with over 20 years in customer service, production and sales operations experience, with the skills and motivation to be your next Star.
Skills : Quickbooks, Quicken, Microsoft Office, Google Docs, Excel, Word, Ten Key.
Became central point of contact for Claims reprocessing, Preauthorization inquires as well as Customer Service Department requests for Claims guidance.
Praised for Complaint and Reconsideration resolution, organizing the flow of correspondence and the communication flow with other departments, underwriters, policy holders and healthcare providers to ensure timely and accurate decisions.
Assisted heavily in the training and cross training of peers.
Created daily, weekly, and monthly activity reports.
Met and exceeded daily, weekly, and monthly productivity quotas.
Prepared and process refunds, adjustments, managed accounts receivable, and payment posting.
Managed claims processing for physician specialty networks.
Bachelor Of Science In Pre
Senior Claims Analyst Resume
Summary : Accomplished Administrative Professional with over 20 years in customer service, production and sales operations experience, with the skills and motivation to be your next top performer.
Skills : Microsoft Office Suite, Communication, Listening, Research.
Provided administrative support to the Network Manager.
Implemented training course for new recruits - speeding profitability.
Ensured swift resolution of customer issues to preserve customer loyalty while complying with company policies.
Processed medical and dental claims.
Assisted claims manager in reviewing surgical procedures for R & C.
Worked reinsurance/stop loss reports quarterly.
Worked with clients by phone handling problems resolutions related to claims in accordance to company policy Account manager of 8 groups achieving 99.