medical claims specialist resume example with 5+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
  • :

Talented and high-performing college graduate with extensive experience performing successfully in fast-paced environments, offering expertise working with a diverse client base and delivering exceptional results. Committed and motivated with outstanding customer service and decision-making skills. Strong work ethic, professional demeanor and great initiative. Excellent prioritizing, multitasking and follow-through skills useful for achieving project goals. Desiring the opportunity to leverage education and experience to take on new challenges with an established company.

  • Documentation skills
  • Account management expertise
  • Regulatory compliance understanding
  • Reporting abilities
  • Administrative support
  • Business operations
  • MS Office
  • Organization
  • Team management
  • Customer service
  • Insurance billing
  • Project organization
  • Team building
  • Supervision
  • Invoice generation
  • Relationship development
  • Communications
  • Problem resolution
  • RFI Scanners
  • Inventory management
  • Planning and coordination
  • Operational improvement
  • First Aid/CPR
Medical Claims Specialist, 12/2018 to Current
Society InsuranceFond Du Lac, WI,
  • Utilize the VA-FSC medical claims processing system which incorporates an Internet authorization application, document processing functionality, optical character recognition (OCR) scanning capability and Plexis claims manager (PCM) claims processing application.
  • Input and validate medical claims data into the PCM application.
  • Analyze rejected claims data.
  • Review documentation authorizing benefits payments. Determine appropriate amount due to recipient and process all necessary payment transactions.
  • Analyze and audit any overpayments of claims.
  • Utilize Revenue Cycle Pro to access data and medical code sets, answer questions about coding, billing, coverage and reimbursement, and resolve edits, problems and issues to minimize noncompliance exposure. includes ICD-9 to ICD-10 mapping information and an enhanced APC calculator.
  • Fostered relationships with customers to expand customer base and enhance loyalty and retention.
  • Created master spreadsheet to record procedures, denials and approvals.
  • Analyzed insurance organizational structures, business and intermediaries; studied basic documents, including common clauses, policies and insurance contracts.
  • Stayed current on industry trends and changes and participated in professional development opportunities to strengthen product and service knowledge.
  • Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
General Clerk II, 08/2018 to 12/2018
Asrc Federal Holding CompanyAtlanta, GA,
  • Performs QC (quality control) on gathered information and data.
  • Chose fitting techniques from a wide assortment of systems or makes basic adjustments and understandings of a predetermined number of substantive aides and manuals.
  • Utilized a GPS to decide field site network facilities.
  • Administrative advances frequently change in sort or grouping, contingent upon task.
  • Walked across unimproved terrain in a field environment setting while carrying a laptop, GPS, field gear, and other items for data collection.
  • Operated a (Humvee) High mobility multi-purpose Wheeled Vehicle.
  • Inspected, tested, ans sampled materials, parts or products for defects and any deviations from specifications.
  • Wrote, recorded and proofread business communications, documents and data.
Senior Library Technician, 07/2015 to 01/2018
Ansbach LibraryCity, STATE,
  • Copy Cataloging: Receiving new items and verifying they are correctly processed, adding/editing/correcting items records.
  • Recognized by management for providing exceptional customer service.
  • Improved operations by working with team members and customers to find workable solutions.
  • Improved customer satisfaction by finding creative solutions to problems.
  • Answered multiple calls per daily operation to answer customer questions.
  • Earned reputation for good attendance and hard work.
  • Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations.
  • Collaborated with others to discuss new project opportunities.
  • Train new staff and ensure desk coverage.
  • Public programs: lead monthly Family Fun and Sets events.
  • Maintain library and controlled collections with 95 % accuracy.
  • Registered new patrons and cleared departing patrons.
  • Followed regulations and local policy letters.
  • Handled all delegated tasks, including library and local events.
  • Created agendas and communication materials for team meetings.
Education and Training
MBA: Business Administration And Management, Expected in 07/2020 to Walden University - Minneapolis, MN
  • 3.692 GPA
  • Major in Business Administration
Bachelor of Science: Business Administration, Expected in 05/2016 to Walden University - Minneapolis, MN
  • 3.552 GPA
  • Major in Business Administration

Certified Medical and Billing Professional

2019 NAHAEC Medical Billing Certification

95% with honors.


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Resume Overview

School Attended

  • Walden University
  • Walden University

Job Titles Held:

  • Medical Claims Specialist
  • General Clerk II
  • Senior Library Technician


  • MBA
  • Bachelor of Science

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