claims associate resume example with 1+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,
Professional Summary
Seeking an entry level assignment in Bpo organization of high repute, Growth oriented organization preferably in Any Sector; to work for an Esteemed Organization where I can enhance my knowledge & Skill's there by contributing towards the achievement of the Organization's Goals. I hereby declare that the above written particulars are true to the best of my knowledge and belief. (Jessica Claire) Adaptable healthcare administrator accustomed to the integration of new healthcare delivery systems and restructuring of work in an increasingly complex regulatory environment. Accomplished [Job Title] who proudly maintains a highly productive, efficient and quality-driven environment at all times. Innovative, customer-oriented healthcare administrator with background in managed, ambulatory and long-term care. Strong background in quality assurance, claims analysis and management principles and practices. Seeking a leadership role within an integrated delivery system. Highly analytical healthcare management professional combining more than [number] years of work in long term care with proficiency in financial management, leadership and positive clinical outcomes. [Job Title] skilled at communicating, organizing and solving problems to raise the stature and rankings of health care facilities. Well-trained [Job Title] offering vast experience in medical operations, excellent interpersonal communication skills and the organizational savvy to run a hospital facility smoothly.
    Windows-XP, Windows 98, Tally9
  • Strong presentation skills
  • Strategic planning capability
  • Planning and development
  • Analytical thinker
  • Talented interviewer
  • Accomplished leader
  • Independent judgment and decision making
Work History
05/2014 to 10/2015 Claims Associate Midfirst Bank | Century City, CA, India
  • Worked with UHG health care process, Overall 17 months Experience in BPO sector.
  • Processing the claims on various reviews for united health group.
  • Finding out possible duplicates of claims.
  • Working on aged claims for release of payment within Timely Filing Limit.
  • Verifying correct notifications and attaching notifications to the claims.
  • Finding out medical necessity for the claim and process accordingly.
  • Sending inaccurately processed claims to Field services for adjustments and corrections.
  • Deep observation on provider selection and specialty as per ICD and CPT codes.
  • Processing claims and sending claims for next level of processing (Payment Issue Department) Top performer for every month.
  • In college and school level actively participated in debate and essay competition and received appreciation from higher levels.
  • Ability to work hard.
  • Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations.
  • Developed and achieved financial and growth goals.
  • Achieved high staff morale and retention through effective communication, prompt problem resolution, proactive supervisory practices and facilitating a proactive work environment.
  • Supervised and managed the daily activities of a clinical team consisting of [number] physicians, nurses and support staff.

Languages Known : English, Hindi, Telugu & Marwari
Expected in 2017 to to MBA | Finance Buds and Flowers High School, Hyderabad, India GPA:

Expected in to to M.B.A | Finance Georgia Christian University, , GPA:
Expected in 2013 to to Bachelors of Commerce | Accounts,Marketing,Finance,Management Accounting,Fundamentals of Information Technology St. Joseph's Degree and P.G College, hyderabad, India GPA:

Expected in 2010 to to Intermediate | Mathematics,Economics,Commerce Sri Chaitanya Jr. College, Hyderabad, India GPA:

Expected in 2008 to to S.S.C | Buds and Flowers High School, , GPA:

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Resume Overview

School Attended

  • Buds and Flowers High School
  • Georgia Christian University
  • St. Joseph's Degree and P.G College
  • Sri Chaitanya Jr. College
  • Buds and Flowers High School

Job Titles Held:

  • Claims Associate


  • MBA
  • M.B.A
  • Bachelors of Commerce
  • Intermediate
  • S.S.C

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