Medical Claims Processor Resume Sample


The following Medical Claims Processor Resume Sample covers all aspects which should be present in a Medical Claims Processor Resume. Modify this sample resume as per job requirements.

Medical Claims Processor Job Description

This position is responsible for processing medical claims for the individuals and assuring proper payment in keeping the insurance benefit plan. He or she provides customer service for plan benefits, provider networks and accessible services. Resolve claim issues for members and providers.

Medical Claims Processor Resume Sample

Jennifer Smith
33 Example Street, Syracuse NY 32644
Contact #, Email Address

Objective: Seeking a position of Medical Claims Processor in Syracuse, where i will be able to utilize my skills and qualifications.

Summary of Qualifications (Tip: Select only 5)
• Over 1 year experience in claims processing
• Highly skilled in coding and processing claims forms for payment ensuring all information is supplied previous to eligible payments are made
• Thorough understanding of medical terminology in relation to diagnoses and procedures
• In-depth knowledge of verifying unrecognized characters and flags quality issues as they arise
• Proven record of completing and maintaining production logs
• Demonstrated ability of communicating to customers in a timely, polite manner
• Comprehensive knowledge for meeting targets for staff and unit performance
• Substantial knowledge of generating proper correspondence to ensure compliance of state and federal regulation policy and procedure
• Able to perform data entry of all interactions
• Able to Clean and maintain equipment

• Detected potential frauds in claims processing
• Successfully completed on the job training

Work Experience
May 2010 – July 2011
Kelly Services – Syracuse, NY 32658
Medical Claims Processor
• Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements
• Entered claims data into system
• Resolved problems resulting from claim settlement
• Performed audit of randomly selected claims to ensure quality processing
• Researches claim overpayments and requests funds
• Followed adjudication policies and procedures to make sure proper payment of claims
• Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims
• Logged telephone calls in system and followed up on issue

High School Diploma or equivalent

Special Skills and Abilities
• Excellent communication skills
• Outstanding telephone etiquette
• Effective interpersonal skills to handle several inquiries in a diplomatic manner
• Excellent data entry skills
• Demonstrated computer skills in MS Word, Excel, Email and Internet
• Ability to provide professional customer service in hectic situations


Available on request