claims auditor resume example with 20+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - : - -
Professional Summary

Detail-driven accounting professional experienced in examining and analyzing accounting records, financial statements and financial reports to assess accuracy and compliance with generally accepted accounting principles and standards. Proven to analyze accounting processes, identify deficiencies and formulate and implement corrective action plans to achieve compliance and mitigate risk.

  • GAAP Accounting Practices
  • Financial Reporting & Analysis
  • General Ledger Accounting
  • Accounts Payable & Receivable
  • Accounts Reconciliation
  • Effective Time Management
  • Analytical
  • Strong Organizational Skills
  • Dedicated Team Player
  • SAP
  • Quickbooks
  • Microsoft Office
  • Effective and Professional Communication
  • Financial Projections
  • Report Preparation
  • Judgement and Decision Making
  • Critical Thinking and Analysis
  • Financial Statements
  • Business Operations and Forecasting
  • Tax Return Preparation
  • Journal Entries
  • Balance Sheet
Work History
05/2016 to 08/2021
CLAIMS AUDITOR Metroplus Health Plan Newark, NJ,
  • Conducted detailed audits to ensure claims were processed in accordance with Medicaid compliance and company policies and procedures
  • Conducted post payment claims audits on adjudicated medical bills
  • Utilized all available resources to maximize identification and recovery of overpayments and complied with all company policies/procedures and state and federal laws during the investigation process
  • Performed administrative tasks required for the invoicing and recovery process
  • Created and maintained files in accordance with management policies and guidelines by obtaining and attaching all appropriate documentation to clearly identify an audit trail for the audit performed
  • Researched, documented, and reported audit error findings to leadership
  • Provided a detailed summarized analysis report to report audit errors identified
  • Reviewed and analyzed error trends in processing
  • Managed multiple projects to make sure deadlines were met within assigned budgets
  • Ensured accurate monthly, quarterly and year to date performance reporting of all audit related reports
  • Prepared and downloaded claim samples for audit team.
  • Provided high level of professionalism when speaking with customers or responding to emails to promote company's dedication to service.
  • Researched issues related to claims processing to identify origins and implement corrective solutions.
09/2014 to 05/2016
STAFF ACCOUNTANT 2-10 Home Buyers Phoenix, AZ,
  • Prepared balance sheets, profit and loss statements and other financial reports
  • Analyzed and verified information for accuracy and reported, identified, and corrected errors made by both internal and external personnel
  • Maintained and updated records and reports for profit and loss, taxes, liabilities and assets
  • Prepared payments by accruing expenses, assigning account numbers, requesting disbursements, and reconciling accounts
  • Answered accounting and financial questions by researching and interpreting data
  • Supported timely monthly, quarterly, half-year, and year-end financial close, including assigned journal entries, balance sheet account reconciliations, accruals, and overall maintenance of all operational management accounts
  • Prepared special financial reports as requested by management
  • Protected organization's value by keeping information confidential.
  • Performed testing of audit areas for fixed assets and accounts payable.
  • Increased efficiency, support and documentation of accounting processes by creating detailed schedules for journal entries.
  • Projected future costs and revenues by closely analyzing ongoing costs, business operations and incoming revenue in balance sheets.
07/2001 to 07/2015
  • Greeted patients providing a high level of customer service
  • Obtained benefit quotes from insurance companies for services
  • Verified insurance eligibility and confirmed and collected co-pays as applicable per insurance requirement
  • Completed insurance claims billing and claims payment process
  • Researched and followed up on denied and incorrectly processed insurance claims
  • Troubleshot non-payments or delayed payments
  • Followed up on unpaid patient bills
  • Collected, reviewed, and organized billing paperwork
  • Sent medical records when requested
  • Reconciled electronic and other payments when received from both insurance companies and self-pay patients
  • Provided accurate data entry into billing software
  • Performed accounting and finance duties such as accounts receivable and payable, reconciling bank statements and ledger accounts, and creating budgets and forecasts for management
  • Managed and maintained accurate records of clinic patients to ensure patients are called for due follow-up
  • Kept supplies ready by inventorying stock, placing orders and verifying receipt
  • Performed other related office duties as assigned.
11/2007 to 09/2014
CUSTOMER SERVICE PROFESSIONAL American International Group San Antonio, TX,
  • Provide operational support to customers based on assigned accounts to increase retention rate
  • Effectively handled high-volume of customer orders
  • Processed, clarified and confirmed customer purchase orders using SAP
  • Communicated with customers on all order related topics (incl
  • Tracking, delivery, shipping, storage &invoicing)
  • Coordinated internal processes (drop-shipment routing, purchasing, stockroom, shipping, receiving clarification)
  • Checked inventory and release orders on stock arrival (bi-weekly report, action, delivery reliability)
  • Initiated and supervised rush orders
  • Supported the order management team
  • Implemented process improvements
  • Actively engaged with customers to monitor customer satisfaction
  • Advocated internally working with key partners to address customer concerns/satisfaction issues.
Expected in 07/2016 to to
Master of Business Administration: BUSINESS ADMINISTRATION in ACCOUNTING
Expected in 12/2013 to to
Bachelor of Business Administration: BUSINESS ADMINISTRATION in ACCOUNTING
Additional Information
  • Authorized to work in the US for any employer

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School Attended


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  • Master of Business Administration
  • Bachelor of Business Administration

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