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Claims Processor resume example with 11+ years of experience

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

Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking entry-level opportunities to expand skills while facilitating company growth.

Skills
  • Teamwork and Collaboration
  • Verbal and Written Communication
  • Problem-Solving
  • Client Interviews
  • Customer Service
  • Critical Thinking
  • Active Listening
  • Time Management
  • Decision Making
  • Attention to Detail
  • Recordkeeping Organization
Experience
02/2022 to 06/2022
Claims Processor Lowe's Companies, Inc. Oklahoma City, OK,
  • Verified claim data correctness in preparation for processing.
  • Reviewed history records to determine benefit eligibility for services.
  • Researched medical claims for validity to resolve discrepancies.
  • Maintained comprehensive database for enrollment data, claim submission and payment information.
  • Addressed customer inquiries to provide information and explanations on coverage and terms, expediting claims.
  • Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
  • Conducted and documented comprehensive investigations to negotiate settlements or deny claims.
  • Analyzed contracts and claim systems to apply appropriate benefit amounts.
  • Coordinated benefits with medical insurance plans and Medicare providers.
  • Built rapport and trust with injured insureds through effective customer service techniques which involved fair and prompt processing of claims.
  • Collaborated with appraisers, facility managers, body shops and salvage vendors.
  • Coordinated and planned investigations of claims to confirm compensability and coverage.
  • Prepared and reviewed insurance-claim forms and related documents for completeness.
12/2019 to 12/2021
Medical Assistant Sollis Health Santa Monica, CA,
  • Performed preliminary physical tests to accurately record results in patient history summary.
  • Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
  • Scheduled appointments for patients via phone and in person.
  • Interviewed and engaged patients to obtain medical history, chief complaints and vital signs.
  • Prepared treatment rooms for patients by cleaning surfaces and restocking supplies.
  • Educated patients about medications, procedures and physician's instructions.
  • Organized charts, documents and supplies to maintain team productivity.
  • Contacted pharmacies to submit and refill patients' prescriptions.
  • Secured patient information and maintained patient confidence by completing and safeguarding medical records.
  • Assessed, documented and monitored vital signs for patients within outpatient setting.
  • Maintained inventory, vaccination and product expiration logs to record updated documentation for tracking purposes.
  • Collaborated with local pharmacies to resolve and clarify issues with patient medication.
  • Conducted insurance verification and pre-certification and pre-authorization functions.
  • Cleaned and maintained medical equipment following procedures and standards.
  • Followed principles of asepsis and infection control to meet patient safety guidelines.
  • Assisted with diagnostic testing by collecting and packaging biological specimens for internal and laboratory analysis.
  • Measured vital signs and took medical histories to prepare patients for examination.
  • Labeled and completed lab requisitions using ICD and CPT coding.
  • Incorporated outside records into charts and EHR.
  • Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
  • Documented notes during patient visits.
  • Responded to patient callbacks and phone-in prescription refill requests.
  • Administered rapid tests for COVID and strep to help clinical staff assess conditions.
07/2014 to 12/2019
Medical Assistant Sollis Health 135 East 57Th St. 4Th Floor, NY,
  • Answered phones, scheduled appointments, greeted patients and ordered supplies.
  • Conducted patient interviews to gather health history, vital signs and information about current medical issues.
  • Kept facility stocked with necessary supplies, equipment and instruments.
  • Verified appointment times with patients, preparing charts, pre-admission and consent forms.
  • Oversaw patient registration, insurance verification, form completion and appointment scheduling to maintain operational efficiency.
  • Cleaned and sterilized instruments and disposed of contaminated supplies.
  • Collected, labeled and stored laboratory specimens properly prior to testing.
  • Conducted routine laboratory tests and sample analyses to monitor diseases.
  • Communicated with pharmacies for prescription refills on behalf of supervising physician.
  • Supported administrative staff by processing payments.
  • Positioned patients properly during examination or treatment for comfort and safety.
  • Prepared treatment rooms for patient examinations.
  • Explained treatment procedures and physicians' instructions.
  • Contacted medical facilities to schedule patients for admission.
  • Administered medications under physician's supervision.
  • Operated x-ray and electrocardiogram (EKG) to administer diagnostic tests.
  • Handled general office duties to support administrative staff during peak hours.
  • Processed orders for medical supplies and lab equipment.
  • Changed dressings on wounds to prevent infection and check for healing.
  • Completed and submitted clinical documentation in accordance with agency guidelines.
  • Assisted back office patient processes to reduce office wait times.
05/2009 to 05/2013
Medical Assistant Sollis Health Beverly Hills, CA,
  • Incorporated outside records into charts and EHR.
  • Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
  • Documented notes during patient visits.
  • Assisted with diagnostic testing by collecting and packaging biological specimens for internal and laboratory analysis.
  • Followed principles of asepsis and infection control to meet patient safety guidelines.
  • Cleaned and maintained medical equipment following procedures and standards.
  • Measured vital signs and took medical histories to prepare patients for examination.
  • Labeled and completed lab requisitions using ICD and CPT coding.
  • Organized charts, documents and supplies to maintain team productivity.
  • Contacted pharmacies to submit and refill patients' prescriptions.
  • Secured patient information and maintained patient confidence by completing and safeguarding medical records.
  • Assessed, documented and monitored vital signs for patients within outpatient setting.
  • Maintained inventory, vaccination and product expiration logs to record updated documentation for tracking purposes.
  • Collaborated with local pharmacies to resolve and clarify issues with patient medication.
  • Conducted insurance verification and pre-certification and pre-authorization functions.
  • Responded to patient callbacks and phone-in prescription refill requests.
  • Administered rapid tests for COVID and strep to help clinical staff assess conditions.
  • Performed preliminary physical tests to accurately record results in patient history summary.
  • Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
  • Scheduled appointments for patients via phone and in person.
  • Prepared treatment rooms for patients by cleaning surfaces and restocking supplies.
  • Interviewed and engaged patients to obtain medical history, chief complaints and vital signs.
  • Educated patients about medications, procedures and physician's instructions.
Education and Training
Expected in 05/2008
High School Diploma:
Douglas High School - Douglas, AZ
GPA:
Expected in
: CERTIFICATION MEDICAL ASSISTANT
APOLLO COLLEGE - TUCSON,
GPA:
Languages
Spanish:
Native/ Bilingual
Negotiated:
English:
Native/ Bilingual
Negotiated:
Certifications
  • Certified Medical Assistant (CMA)

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Resume Overview

School Attended

  • Douglas High School
  • APOLLO COLLEGE

Job Titles Held:

  • Claims Processor
  • Medical Assistant
  • Medical Assistant
  • Medical Assistant

Degrees

  • High School Diploma
  • Some College (No Degree)

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