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Medical Claims Examiner Resume Example

Resume Score: 80%

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MEDICAL CLAIMS EXAMINER
Summary

Driven Medical Claims Examiner trained in all aspects of insurance claims and collections. Employs high-level negotiation skills in resolving claims to the satisfaction of all involved parties. Analytical thinker and innovative problem solver.

Highlights

Thrives under pressure

Organized

Self-motivated

Customer advocate

Complaint handling and resolution



Microsoft Word

Microsoft Excel

Medical coding

Facets 5.0.1

Experience
Medical Claims Examiner08/2001 to 01/2015
Healthnow Administrative ServicesBlue Bell, PA
  • Processes Bluecard Medical, Dental, and Flexible Spending Account (FSA) Claims.
  • Processes Adjustments Of Claims
  • Manages Correspondence.
  • Maintains Production And Quality Standards By Ensuring All Claims, Correspondence And Adjustments Are Processed In Accordance With Company Guidelines
  • Responds To Routine Request From Providers, Claimants, Brokers, And All Interest Parties, In Writing Or Orally
  • Able To Verify Coverage In Accordance With Company Guidelines And All State And Federal Laws
  • Verify And Request Medical Information From The Insured, Claimants And Medical Providers

Data Entry Operator - Pre Processor07/1999 to 08/2001
Healthnow Administrative ServicesBlue Bell, PA
  • Enter Health Insurance Policy Information Into The Network Data Base.
  • Data Entry (12,000 Keystrokes)
Data Entry/Coding Specialist11/1997 to 05/1999
United National GroupBala Cynwyd, PA
  • Processed The Issuance Of New Policies
  • Trained & Instructed Coding Department Utilizing The Wins AS400 Computer Network System
  • Ability To Enter Both Property & Liability Policy Information Processed All Incoming & Outgoing Policy Cancellations

Record Maintenance Clerk05/1996 to 11/1997
United National GroupBala Cynwyd, PA
  • Handling of Heavy Mail Flow.
  • Date Stamped & Processed All Incoming and Outgoing Mail.
  • Delivered Mail Throughout Claims Department.
  • Processed Incoming & Outgoing Faxes
  • Pulled Incoming & Outgoing Policies by Color and Number Codes.
  • Accounted for over 12,000 Company Records
  • Assisted In The Implementation Of Automated Record Tracking System That Increased Productivity by 25%
Military Experience
Inventory Management/Operations Specialist12/1991 to 12/1995
United States Air Force

SECRET Security Clearance

Honorable Discharge

  • Earned Numerous Awards, Medals, And Commendations Including Good Conduct Medal
  • Trained Personnel In Standard Base Supply System Computer Operations And The Core Automated Maintenance Systems Operations
  • Awarded Airman of the Year, 335th Fighter Squadron, 1992.
  • Awarded Technician of the Year, 335th Fighter Squadron, 1993.
Education
Sociology, EducationBloomsburg UniversityBloomsburg, PA

Sociology Education Completed 72 Credit Hours

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Resume Overview

Companies Worked For:

  • Healthnow Administrative Services
  • United National Group
  • United States Air Force

School Attended

  • Bloomsburg University

Job Titles Held:

  • Medical Claims Examiner
  • Data Entry Operator - Pre Processor
  • Data Entry/Coding Specialist
  • Record Maintenance Clerk
  • Inventory Management/Operations Specialist

Degrees

  • Sociology, Education

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