Insurance Claims Validator resume example with 20+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,
Professional Summary

Qualified Data Entry Clerk/Records Clerk with high experience compiling and inputting data into systems. Committed to data integrity and accurate payment processing. Extensive experience with complex, AS400: Database, and Systems.

  • Saving the county large amounts of funds by implementing cost-saving initiatives that addressed long standing problems, after approval from the County Attorney and Judge for reimbursement court costs.
  • Multi-tasking
  • Scanning and Imaging
  • Office equipment
  • Shredding documents
  • High attention details
  • Data Entry
  • Excellent Customer Services
  • Confidentiality
  • Computer skills
  • Medical Records
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  • CPT and ICD- 10 Coding understanding
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  • Insurance verifying
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  • Medical insurance knowledge
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  • Scheduling expert
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  • Payment collection
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  • Ability to follow up with 3rd party payors for claims and appeals
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  • Patient demographics & Patient care and confidentiality
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  • Skill in interpreting UB04/CMS claim data
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  • Ability to audit accounts and payor Explanation of Benefits
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  • Documentation review
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  • Documentation abilities
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  • Organization and Time management
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    Work History
    09/2021 to Current Flex Worker Hy-Vee | Indianola, IA,
    • Offered exceptional customer service to all guests.
    • Adhered to company policies, safety procedures and performance standards.
    • Frequently inspected production area to verify proper equipment operation.
    • Memorized store layouts and planograms to fulfill orders using shortest, most efficient route.
    • Placed completed orders in labeled, temperature-appropriate storage pending customer pick up.
    • Maximized efficiency by scanning items quickly and completing as many as [Number] orders per hour.
    • Updated opening and closing procedures to decrease downtime by 100 % and optimize productivity.
    • Reviewed customer orders closely to locate desired items and checked app regularly to identify any changes.
    • Consulted with customers on food selections and custom order requests.
    • Kept vehicle clean and neat to offer professional impression to every customer.
    • Picked quality and accurate items daily customer orders.
    • Maintained work areas by cleaning and straightening for maximum productivity and safety.
    09/2020 to 06/2021 Insurance Claims Validator Arthur J Gallagher & Co. | South Bend, IN,
    • COB and Insurance Eligibility claim processing, which includes: primacy rules for priority payment, integration of benefits, Medicare training, secondary insurance, end stage renal disease.
    • Established & understanding of reason codes: dependent not covered, payment prior to coverage, terminated coverage, lapse of coverage.
    • Established & understanding of Medical terminology: Medical Terminology Certification.
    • Established understanding of terms, example: advanced beneficiary notice, prior authorization, timely filing, non participation provider, participating provider, remittance advice.
    • Documentation of each account for accuracy in reference to details of eligibility.
    • Being in compliance with HIPAA on all accounts.
    • Documented entire validation process, noting changes or alterations completed.
    03/2020 to 09/2020 Third Party Liability Claims Researcher City Of Auburn | Auburn, WA,


    • Contacting attorney's offices, representatives of insurance carriers, insurance carrier adjusters, and workmen's compensation carriers for medical claims to determine if there is potential case for third party liability.
    • Established and updating all account information to ensure that all information is accurate for future referencing.
    • Performance compliance with HIPAA on all accounts.
    • Performing coordination of benefits with auto and third party auto carriers.
    • Performing documentation of each account for accuracy in reference to details for managing account and medical expenses.
    • Establishing and obtaining information from attorney's offices, insurance adjusters, and workmen's compensation by letters for determination of interests on when necessary.
    • Managing over 35 calls per day.
    • Worked closely with team members to deliver project requirements, develop solutions and meet deadlines
    10/2018 to 04/2019 Customer Service Associate Walgreens | City, STATE,
    • Politely assisting customers and responding resourcefully to requests and request concerns.
    • Issuing credit(s) and refunds after approval by management. Placing items in correct area for reporting on defective or damage items resulting from shipping process.
    • Processing and managing over 100 purchases per day and handling transactions through POS system.
    • Increasing customer service by decreasing waiting times.
    • Stocking, rotating, and removing items near expiration date from all locations to ensure items are used within recommended time frames.
    • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
    • Maintained clean personal appearance of store when by stocking shelves, organization and arrangement of merchandise.
    06/1991 to 10/2017 Records Clerk Dodge County Court | City, STATE,
    • Developed and initiated monthly payment plans for customers on outstanding accounts, both small and large accounts.
    • Communicating with customers about their account(s) and collecting outstanding balances.
    • Researched and resolving any questions or concerns on account balances for customers immediately.
    • Posting payments, providing change back when necessary and issuing receipts.
    • Clerical duties and tasks, including: scheduling, directing phone calls, filing, batching mail, weekly postage outgoing mail for office, taking messages for appropriate staff members, and greet visitors.
    • Maintaining attorney database accounts weekly by keeping accounts in good standing.
    • Bi-weekly attorney billing.
    • Cashiered, balancing daily cash drawer, and cash handling.
    • Receiving and routing medical records to appropriate files for scanning.
    • Maintained current and accurate medical records for over 300 juvenile court cases per year.
    • Creating and preparing legal drafts by organizing and assembling information for legal documents and forms.
    • Professional customer service in friendly, efficient manner ,
    • Scanned paper documents into computer and assigned identification numbers to simplify tracking process updating records with new information.
    • Sorted all paperwork and documents alphabetically and according to dates and significance.
    • Updated records with new information.
    • Assisting with typing, data entry and answering incoming calls as required.
    Expected in 07/2021 Certification | Medical Billing Specialist American Academy Of Professional Coders, Cincinnati, OH, GPA:
    • ANTICIPATION COMPLETION OF CERTIFICAITON of Medical Billing Specialist expectation of July, 2021.
    • Medical terminology certification.
    • Continuing course work in Medical Billing Training.
    • ICD-10 Book Course
    • On-line Course work
    Expected in 05/1989 Bachelor of Science | Business Administration And Management Midland Lutheran College, Fremont, NE, GPA:
    • Medical Terminology Certification December 3, 2019

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    Resume Overview

    School Attended

    • American Academy Of Professional Coders
    • Midland Lutheran College

    Job Titles Held:

    • Flex Worker
    • Insurance Claims Validator
    • Third Party Liability Claims Researcher
    • Customer Service Associate
    • Records Clerk


    • Certification
    • Bachelor of Science

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