Sample Medical Claims Processor Resume

Posted in Processor Resume Examples

Elizabeth Landa
1152 Stroop Hill Road
Atlanta, GA 30309

Job Objective To obtain the Medical Claims Processor position within your company and provide excellent service.

Highlights of Qualifications:

  • Wide experience in data entry and medical claim processing
  • Profound knowledge of codes applicable in CPT, HCPC, Revenue and ICD-9 systems.
  • Deep knowledge of Red Book, ASC Groupings, DRGs, Health Maintenance Organization (HMO) and IPA claim payments adjudication.
  • Familiarity about rules and regulations at DMHC and CMS.
  • Proficient in submission and editing claims electronically and other on-line systems for claim processing and problem registration
  • Skilled at decision-making, effective communication, analytical and research oriented tasks.
  • Ability to process claims for surgery, radiology, lab and medicine for CMS 1500 and CMS 1450 claim forms
  • Ability to comprehend DFRs and related benefits

Professional Experience:

Medical Claims Processor
Southwest Service Administrators Inc., Atlanta, GA
August 2007 – Present

  • Engaged to input data into processing system after interpreting medical coding and knowing terminology used in medicine professions in respect to procedures and diagnoses.
  • Ensured to process assigned claim forms and inspect apt allocation of co-pays, deductibles, reimbursements and co-insurance.
  • Complied with all judgmental policies and processes to assure appropriate claim payments.
  • Provided excellent customer service to all providers, members, insurance companies and billing department.
  • Maintained written record of phone calls in system and adhered with issues as required.
  • Solved all issues related to claim adjudication and customer complaints and queries as received over telephone.
  • Researched and analyzed claim overpayments and funds requirements.

Medical Claims Processor
Benefits Administration Corp., Inc., Atlanta, GA
May 2004 – July 2007

  • Ensured to take minimum assistance for processing complex claims.
  • Researched and processed different sets of medical plans as well as benefits.
  • Replied to inquires received in written format from participants and providers in relation to medical benefits.
  • Entered medical claim related information into PCM application.
  • Evaluated claim database which had been rejected earlier.
  • Calculated apposite amount to be paid to recipient and processed crucial payment transactions accordingly.
  • Performed and managed routine follow up activities.


Bachelor’s Degree in Health Care Management
Woodbury Institute of Champlain College, Montpelier, VT

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