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insurance claims processor resume example with 5+ years of experience

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

Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines.

Skills
  • Premium Collection
  • Insurance Carrier Applications
  • Coverage Determination
  • Past Due Balance Management
  • Office Operations
  • Transactions Reconciliation
  • Insurance Claim Forms Review
  • Accounts Payable and Accounts Receivable
  • Authorization Verification
  • Payments Posting
  • Client Correspondence
  • Deductible Collection
  • Patient Account Management
Work History
11/2021 to 07/2022
Insurance Claims Processor Always Best Care Glencoe, MN,
  • Evaluated and settled complex insurance claims in strict timeframes.
  • Affirmed or denied coverage fairly based thorough verifications process.
  • Evaluated accuracy and quality of data entered into agency management system.
  • Established positive and trusting relationships with clients, administering efficient customer service and processing claims quickly.
  • Reported policy changes and company conditions affecting customer satisfaction.
  • Modeled exceptional customer service skills and appropriate diagnostic techniques to team members.
  • Checked documentation for accuracy and validity on updated systems.
  • Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
  • Verified client information by analyzing existing insurance information on file.
  • Generated, posted and attached information to claim files.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Posted payments to accounts and maintained records.
  • Maintained confidentiality of patient finances, records and health statuses.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Calculated adjustments, premiums, and refunds.
  • Followed up with customers on unresolved issues.
01/2018 to 04/2020
Home Health Care Aide Premise Health Gainesville, FL,
  • Assisted patients with handling daily chores and errands by transporting to appointments, cleaning personal spaces and purchasing supplies.
  • Assisted patients with dressing, grooming and feeding needs, helping to overcome and adapt to mobility restrictions.
  • Interacted kindly with patients and families and displayed positive, outgoing attitude, resulting in establishment of long-term, professional relationships.
  • Encouraged patients to participate in safe physical activity to help boost mood and improve overall wellness.
  • Provided patients with assistance in completing daily tasks, reducing daily burden on family members.
  • Kept close eye on behavior and emotional responses of clients to address concerns and protect each person from harm.
  • Developed rapport to create safe and trusting environment for care.
  • Assisted disabled clients to support independence and well-being.
  • Supervised daily activities and provided assistance to staff.
  • Traveled to clients' homes to complete healthcare services and promote continuity of care.
  • Provided transportation and appointments management.
  • Reported unusual or urgent circumstances in patients' condition or environment immediately to nurse supervisor.
  • Completed medical and program reports and maintained records following clinic standard operating procedures.
08/2015 to 11/2017
Dental Office Receptionist Mattoon Dental Associates LLC City, STATE,
  • Prepared insurance claim forms, explained benefits and outlined pricing details for procedures and services.
  • Scheduled, rescheduled and cancelled appointments for dental patients.
  • Greeted visitors and patients to determine needs, check appointments and direct accordingly.
  • Helped patients complete necessary medical forms and documentation.
  • Secured sign-in sheets, dental charts and encounter forms to safeguard sensitive data and information.
  • Adhered to strict HIPAA guidelines to protect patient privacy.
  • Understood dental terminology and insurance breakdowns to communicate with patients.
  • Completed patient referrals to other medical specialists.
  • Referred patients to dental triage to treat severe or unusual symptoms or complaints.
  • Answered telephone calls to offer office information, answer questions and direct calls to staff.
  • Received, recorded and addressed incoming and outgoing communication via telephone and email.
  • Carried out front office duties utilizing data entry skills in framework of medical database.
  • Organized and maintained patient chart filing system to promote quick data finding for staff.
  • Obtained payments from patients and scanned identification and insurance cards.
  • Completed administrative patient intakes with case histories, insurance information and mandated forms.
  • Placed new supply orders, managed inventory and restocked clerical and dental hygiene spaces.
  • Managed office bookkeeping with insurance billing and patient payments.
  • Collaborated with assistants and hygienists to prepare and set up rooms with adequate supplies and equipment.
Education
Expected in to to
High School Diploma:
Danville High School - Danville, IL,
GPA:

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Resume Overview

School Attended

  • Danville High School

Job Titles Held:

  • Insurance Claims Processor
  • Home Health Care Aide
  • Dental Office Receptionist

Degrees

  • High School Diploma

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