Sample Claims Processor Resume

Posted in Processor Resume Examples

Christopher Semmes
687 Stoney Lonesome Road
Kingston, PA 18704
(333)-331-3365
[email]

Job Objective In search of work as a Claims Processor.

Highlights of Qualifications:

  • Substantial experience in medical billing, data processing and claims submission
  • Profound knowledge of medical terminology, codes applicable in CPT, ICD-9 and HCPCS systems
  • Deep knowledge of benefit plans and processing of medical claims
  • Familiarity about universal billing forms and billing processes in electronic system
  • Solid understanding of claim processing for healthcare industry
  • Proficient with Health Solutions Plus suite of applications and Microsoft Office products
  • Ability to respond to customers’ requirements in adherence with company policies
  • Ability to complete assigned multiple tasks effectually in changing environment

Professional Experience:

Claims Processor
Centene Corporation, Kingston, PA
August 2007 – Present

  • Investigated, verified and processed billing invoice forms provided by transportation provider on time.
  • Interacted with transportation providers effectively and efficiently as needed.
  • Identified and solved issues related with billing invoice forms from transportation provider.
  • Conversed and performed tasks in collaboration with Abuse and Fraud department.
  • Identified protocols of claim processing and provided accurate claim policies.
  • Adjudicated claims accurately on basis of insurance, benefits included and provider contracts.
  • Interacted with clients over phone, email and in person effectively and efficiently.
  • Maintained and preserved confidential aspect of claim information effectually.

Claims Processor
Retreat Capital Management, Inc., Kingston, PA
May 2004 – July 2007

  • Revised process claims to complete estimates resolution.
  • Ensured to make payments on estimated completed as prompt as possible.
  • Provided assistance to appraisers with details as provided in claims system.
  • Complied with customers’ requirement as needed to assure repairs satisfaction.
  • Identified and took decision to accept, return, deny or approve claims as per established rules.
  • Inspected and processed claims made on paper or electronically.
  • Identified steps and stages as required for claim adjudication.
  • Complied with set departmental standards, corporate policies and operating memo to solve claims and related issues.

Education

Associate Degree in Business
Gateway Community College, New Haven, CT

We know how to prepare a professional resume!