medical claims processor resume example with 9+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000 - Cell: - - : - -
  • Supervised ten HR interns and provided assistance in resume building, training and career path development.
  • Promoted to supervisor after two years of employment.
  • Developed departmental handbooks that presented criteria on how to navigate various departments.
Professional Summary
Human Resource Generalist, Medical Biller, & Administrative Assistant who is an expert communicator and negotiator with strong conflict resolution skills. Extensive background in recruitment and retention, mediation and records management, customer service, medical billing, and administration support.
  • Performance management strategies
  • Employee relations
  • Manager coaching and training
  • Benefits administrator
  • Event management
  • Independent judgment and decision making
  • Promotes positive behavior
  • Independent judgment and decision making
  • Supervisory training
  • Employee handbook development
Work History
01/2013 to 05/2013
Medical Claims Processor Kemper Booth, AL,
  • Monitoring itemized billings for excessive charges, duplications, unbundling, and medical coding.
  • Determining prior authorization/precertification of services paid via system and/or health services.
  • Requesting and reviewing medical records as needed for basic information to validate billing information.
  • Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated.
  • Meeting and exceeding performance measurements for Claim Examiners as required by department to meet regulatory compliance.
  • Ability to operate PC-based software programs or automated database management systems.
  • Strong communication skills with excellent analytical and problem- solving skills.
  • Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-9, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge.
05/2010 to 2013
Administrative Assistant Ridout Lumber Company Little Rock, AR,
  • Drafted meeting agendas, supplied advance materials and executed follow-up for meetings and team conferences.
  • Managed the receptionist area, including greeting visitors and responding to telephone and in-person requests for information.
  • Served as central point of contact for all outside vendors needing to gain access to the building.
  • Maintained an up-to-date department organizational chart.
  • Supplied key cards and building access to employees and visitors.
  • Managed the day-to-day calendar for the company's senior director.
  • Received and screened a high volume of internal and external communications, including email and mail.
  • Cooperated with Medicare, Medicaid and private insurance providers to resolve billing issues.
  • Managed daily office operations and maintenance of equipment.
06/2000 to 02/2007
Human Resource Specialist Maximus, Inc. Rochester, NY,
  • Explained human resources policies and procedures to all employees
  • Worked closely with HR business partners to facilitate year-end talent reviews and articulate team strengths
  • Created job descriptions to attract a targeted talent pool within the market wage range
  • Managed over 100 personnel files according to policy and federal and state law and regulations
  • Generated employee tracking reports each month Offered consistent payroll disbursement with accurate record keeping of employee PTO and vacation accruals
  • Helped training and development staff with all aspects of training coordination
  • Organized employee schedules, department phone lists and business card orders.
Expected in 2013 to to
Associate of Science: General Studies
Pima Community College - Tucson, AZ
  • Coursework in Business Management
  • Coursework in Financial Accounting
  • Coursework in Health Services Administration and Business
  • Coursework in Healthcare Administration

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • Pima Community College

Job Titles Held:

  • Medical Claims Processor
  • Administrative Assistant
  • Human Resource Specialist


  • Associate of Science

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: