A Senior Claims Examiner is hired to review insurance claims, verify the investigation and report on claims of both claims’ adjusters and the claimant. The job description entails ensuring legal compliance, assisting the claims adjuster, and approving/denying the insurance claims. A well-written Senior Claims Examiner Resume mentions the following core duties and responsibilities – reviewing reports and ensuring that there are no errors, determining if the payouts are reasonable; approving or rejecting the claims; ensuring compliance with regulatory standards, company policies, and guidelines; providing assistance to claims adjusters, managing the volume of cases; and assisting attorneys and other specialists.
To become successful in this line, the following skills are required –excellent abilities to produce accurate and precise work; hands-on experience and working knowledge in claims processing; good interpersonal and communication skills; and a high school diploma.
Summary : Over 3 years of experience in a professional law firm 5 years of experience in customer service leadership role Experienced and enthusiastic team member Excellent communication and organizational skills Strong technical and team experience from employment and education.
Skills : Microsoft Office, Insurance, Claims Processing, Customer Service, Quickbooks.
Prioritized tasks based on both importance and urgency Systematically eliminate Statute of Limitation and other various deficiencies Call clients in order to gather and relay information Develop procedures to effectively eliminate losing claims.
Worked on priority cases Maintained a diary of personal injury cases for filing claims against numerous Personal Injury Trusts.
Required frequent communication with clients, Trust representatives, and co-workers to develop case information, exposure evidence, and settlement options Tracked cases, cured deficiencies and served clients by assisting in resolving claims.
Worked on time sensitive tasks which needed to be accurately done Coordinated projects across departments Developed efficient processes Assisted with technological issues Organized bulk mailings.
Provided productive feedback Audit claims and collect all information needed to qualify for the trusts Serve as Bankruptcy Claims Examiner and Asbestos Litigation Legal Assistant.
Maintained a portfolio of over two hundred clients.
Maintained case files to record actions, events, exhibits, information, and materials related to each individual case.
Bachelor Of Science
Senior Claims Examiner III Resume
Summary : Seeking a challenging position utilizing abilities developed through experience and education in the Medical Claim Analysis and Process Field, the Medical Billing Process field and/or Proofreading/Translation Field (English-Spanish).
Reviewed data entries and adjudicate claims, including but not limited to Professional, Facility, TIN, repricing, duplicates and Dental using CPT-4, ICD 9-10, HCPCS, Accuchecker, DRG, etc., for coding medical claims to eligibility for reimbursement.
Worked messages consistent to level of knowledge and experience.
Determined when to pend claims to higher Claim associated for final adjudication.
Handled all claims for members and providers in an efficient and professional manner while meeting and exceeding all departmental production .
Worked on teams to alleviate claims backlog for client companies.
We handled all types of group and individual health products and dental plans.
Applied legal format and terminology to prepare correspondence, actions, and papers for case disposition and attorneys.
Diploma In Biology
Senior Claims Examiner II Resume
Objective : Senior Claims Examiner is experienced in working with all levels of the company, from senior management to the underwriting staff. Demonstrated success in leading cross-functional teams, and has proven ability to influence and motivate others to achieve results.
Skills : Microsoft Office, Microsoft Excel, Microsoft Outlook.
Worked as a remote claims adjuster and report to the Savannah, GA office location.
Traveled to to meet with clients throughout Georgia on a regular basis.
Investigated lost time claims for compensability.
Successfully managed a claims load of 200 claims.
Managed six clients in the Georgia area and provide clients with individualized claim handling within client claim service instruction guidelines.
Provided a claims concierge service and strive to provide clients with the best customer service, responsiveness and expertise.
Maintained excellent communication with clients, attorneys, claimants and physician oces.
Senior Claims Examiner I Resume
Summary : Highly qualified Senior Claims Examiner with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and would excel in the collaborative environment on which your company prides itself.
Skills : Pt Accounting, Claims Processing, Team Leadership.
Analyzes and processes complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
Assesses liability and resolve claims within evaluation.
Negotiates settlement of claims up to designated authority level.
Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout the life of the claim.
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
Prepares necessary state filings within statutory limits.
Manages the litigation process; ensures timely and cost effective claims resolution.
Bachelors Of Science
Assistant Senior Claims Examiner Resume
Summary : Looking to make the transition from the Insurance industry back into operations management. Believe skills are exceptionally above average in both the personal and interpersonal level.
Skills : Tying Very Strong Computer Literacy Microsoft Windows.
Received and processed paid claims data, analyzed files to identify claims with recovery potential, and utilized proprietary technology for multiple claims systems, locations, and configurations.
Applied customized data mining procedure to discover all potential accident-related claims.
Searched of ICD-9 codes and initiated automated searches of over 100,000 NDC codes.
Launched automatic investigation cycle for files with pre-determined paid dollar protocols.
Connected members with Customer Service Center to verify details by telephone.
Directed analyzed and evaluated claims by interviewing claimants and witnesses, reviewing police and hospital records, and inspecting property damage to determine company liability.
Gathered information from medical specialists, agents, witnesses, and claimants.
Bachelor Of Arts
Associate Senior Claims Examiner Resume
Summary : Handled claims under employee's flexible spending account, Assisted fellow employees on difficult accounts.
Managed Active and Litigated Workers Comp Claims for the Los Angeles County Fire Department/ Caseload Average 230 Files. Coordinates vendor referrals for additional investigation and/or litigation management.
Skills : Texas Department Of Insurance Multi-Lines Adjuster.
Used appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
Worked in Claims Examining Department did adjudication of all claims submitted documentation for bills received examined information paid Hospitals .
Received promotion al growth while at company.
Provided advice on rules, regulations, and procedures applicable to asbestos litigation.
Responsible for handling confidential legal actions and documents.
Responsible for the preparation of legal correspondences such as Claim Affidavits, Work History Affidavits, Exposure Affidavits, Memorandums, and Client Letters. Assists and supports attorneys on matters relating to case management reports.
Performed legal research through manual and computer related programs and databases.
Bachelor Of Arts
Assistant Senior Claims Examiner I Resume
Summary : Senior Claims Examiner will be responsible for reviewing and adjudicating medical insurance claims for The Pinnacle Group. The Senior Claims Examiner will have primary responsibility for the review of medical insurance claims submitted to the company by physicians, hospitals, and other healthcare providers.
Skills : Brightree, Microsoft Office, Medical Billing, Medical Terminology, Medical Records, Inventory Management, Data Entry.
Lead Negotiator of multi-million dollar accounts.
Responsible for maintaining all customer relationships in the Mid-Atlantic region.
Managed 5,000 + accounts.
Responsible for overall servicing of a diverse clientele.
Renewaled of existing business.
Recruited staff in accordance with a company's terms and conditions of employment.
Presented reports and information to a client.
Bachelor Of Science
Associate Senior Claims Examiner I Resume
Summary : Seeking employment with an established company where can utilize experience in the insurance industry. a team player that can motivate people to achieve goals. Proficient in problem solving and utilizing trouble shooting techniques to assist others. Self motivated hardworking with the ability to handle complicated situations and complaints. Knowledge of WordPerfect, MS Word, MS Mail, MS Access, Excel, Paradox, PowerPoint, Luminx, Mapstar, Computer Aided Dispatch (CAD), Vesta, and Impact.
Skills : Property Insurance, Casualty Insurance, Customer Service, Multicultural Understanding, Public Speaking, Problem Solving.
Analyzed medical, dental and vision claims for eligibility of reimbursement via contract interpretation.
Handled claims for clients covered under Medicare, Medicaid and other insurance carriers to determine the secondary carriers liability.
Pre-screened hospital bills to determine if they were candidates to refer to our outside audit vendor.
Processed Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) claims for reimbursement of benefits.
Utilized knowledge of medical and dental terminology to determine eligibility of services.
Interpreted contract provisions, state and federal laws and court decisions that affected health care reimbursements.
Demonstrated excellent communication skills, written and oral, with clients and insured members.
Senior Claims Examiner/Analyst Resume
Summary : To obtain a flexible position with a growth oriented company offering a challenging opportunity for advancement and professional development.
Skills : Claims Processing, Customer Service, Medical Terminology.
Investigated and determined compensability working with Municipalities within the State of Colorado.
Investigated and determined compensability on workers' compensation claims from small claims up to larger claims.
Set reserves to cover the cost of medical treatment and indemnity benefits.
Proactived management of workers' compensation claims.
Completed all state filings within the mandatory time frames.
Directed medical and vocational case management.
Developed and assisted in early return to work programs.
Worked with legal counsel to resolve disputed claims, direct attorneys in handling of litigated files.
Graduated In Travel Industry
Senior Claims Examiner Resume
Objective : Patient-oriented Medical Receptionist with strong attention to detail, professional telephone etiquette and.
Skills : Customer Service Oriented, Claims, Billing And Coding, Detail Oriented, Ability To Work Independently Or With A Team, And Research And Analysis.
Precisely completed appropriate claims paperwork, documentation and system entry.
Correctly coded and billed medical claims for various hospital and nursing facilities.
Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).
Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
Adeptly managed a multi-line phone system and pleasantly greeted all patients.
Verified patients' eligibility and claims status with insurance agencies.
Prepared patient charts accurately and neatly for the clinic.
Determined prior authorizations for medication and outpatient procedures.
Maintained strict patient and physician confidentiality.