Medical Claims Examiner Resume

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Here is the Medical Claims Examiner Resume example:

James Burden

840 Woodbridge Lane

Detroit, MI 48219

(555)-555-5555

[email]

Job Objective Seeking work as a Medical Claims Examiner where my expertise can be utilized to their fullest potential to help company meet short and long-term goals.

Highlights of Qualifications:

Remarkable experience in processing medical claims
Good understanding of medical terminology, HCPCS, PDR , CPT and ICD-9 codes
Extensive knowledge of appropriate health insurance principles
Thorough knowledge of subrogation, reinsurance, workman compensation, third party liability and coordination of benefits claims
Ability to analyze claims, set reserves, determine compensability and settle claims
Ability to resolve difficulties quickly
Ability to make decisions and institute change when appropriate

Professional Experience:

Medical Claims Examiner, August 2005 – Present

Apollo Health Street, Detroit, MI

Adjudicated medical and dental claims.
Processed all types of pended claims.
Handled customer service calls for both medical and dental claims status and coverage questions.
Handled provider demographic up-dates to claims system.

Medical Claims Examiner, May 2000 – July 2005

Aerotek, Detroit, MI

Examined, data enter, calculated and adjudicated insurance claims complying with federal, state and county laws, plan policy and company procedures.
Entered codes and verified data for computer processing.
Maintained individual production count.
Updated and maintained policy manual timely.

Education

Bachelor’s Degree in Business Administration, Northern Michigan University, Marquette, MI