Medical Claims Examiner Resume Sample

Medical Claims Examiners review and evaluate insurance claims in a medical setting. Their duties include investigating, evaluating, or settling insurance claims, determining whether insurance policies cover losses claimed, negotiating claims, authorizing payments, ensuring claims are not fraudulent, and contacting doctors about questionable claims.

For many, writing a resume can be daunting. If you are working on your own, it is easy to become overwhelmed with the amount of information you need to include and how best to present yourself.

The sample resumes below provide great examples of how to write an effective resume.

The Best Medical Claims Examiner Resume Samples

These are some examples of accomplishments we have handpicked from real Medical Claims Examiner resumes for your reference.

Medical Claims Examiner Resume Sample 1

  • Processed claims promptly according to correction and replacement manuals; observed company policy; utilized technology; office administration; successfully opened and closed accounts opened.
  • Collaborated with the supervisor to develop procedures for handling claims quality assurance and claims adjustment.
  • Achieved superior rating as a member of the Claims Adjuster Team as documented by correction and replacement manual scoring.
  • Received outstanding performance award based on meritorious performance review scorecards.
  • Earned appreciation from the supervisor as a claims team member who consistently adhered to company policy guidelines.

Medical Claims Examiner Resume Sample 2

  • Enriched the team by enforcing all pertinent IT policies and procedures.
  • Maintained strict compliance with confidentiality and privacy policies while ensuring that medical information is treated securely and confidentially.
  • Ensured that all data is accurately processed, received, and entered.
  • Created a thorough process for managing subcontractors; established guidelines for subcontractors to ensure proper processing of claims.
  • Produced exceptional performance reviews which resulted in an award for outstanding honorable mentions and earned employee recognition awards.

Medical Claims Examiner Resume Sample 3

  • Processed over 3,500 physician claims with a very complex database.
  • Trained and directed co-workers on a new computer program that contained a series of new functions. Also directed and supervised a new staff member who was highly creative and positive in attitude.
  • Recognized as a top performer by several nurses on the unit. Demonstrated all aspects of medical billing, payer education, insurance billing training, and techniques necessary to maintain quality patient care.
  • Scheduled units for testing by physicians at the local College Hospital. Set up appointments for physicians with office staff to discuss office procedures, insurance coverage questions, documentation needs, etc…
  • Co-Coordinated and catered a fundraising event for the American Diabetes Association; The program raised $1,200.00 to help fight this disease plaguing our youth and adults.

Medical Claims Examiner Resume Sample 4

  • Maintained a high level of productivity while working with a response time of one minute or better during the busy season.
  • Acquired award for superb responsiveness during the time of crisis; nearly eliminated backlogs and processed claims for patients’ approval.
  • Developed a working relationship with referral sources based on excellent communication skills, commitment to excellence, and outstanding customer service.
  • Achieved recognition as an Exceptional Customer Service Agent; provided prompt and courteous attention to customers’ needs and concerns.
  • Received accolades from department manager for improving communications within the department; acted as liaison between employees and the public, while expediting processing of claims forms.

Medical Claims Examiner Resume Sample 5

  • Achieved Excellence in Coding & Imaging for medical insurance coverage.
  • Achieved delegate of multi-code medical claim responsibility for professional staff.
  • Meritorious performance in medical insurance coverage with special recognition exceeding expectations of self and customer.
  • Accomplished outstanding overall performance by identifying savings over pre-established budget standards by identifying cost-saving opportunities.
  • Projected progressive growth by meeting, exceeding, and exceeding expectations.

Medical Claims Examiner Resume Sample 6

  • Resolved coverage questions from physicians, hospitals, and medical personnel regarding insurance claims.
  • Investigated claim services to ensure policy benefits were upheld.
  • Authored correspondence to physicians and hospitals requesting missing information pertaining to adjudicated claims.
  • Aided in reducing operating expenses by utilizing processing procedures that decreased redundancy of claims submissions.
  • Performed statutory reporting duties accurately and on time; received a perfect score on all audits conducted by corporate compliance officers.

Medical Claims Examiner Resume Sample 7

  • Recognized by O’Connor Plumbing & Heating, Inc. for outstanding service; developed relationships with customers.
  • Responsible for processing work order claims at the same level of quality attained by experienced claims examiners.
  • Achieved award for completing one thousand hours of work in thirty days; developed relationships with employees and customers; recognized by Regional Manager for superior performance; awarded employee of the month.
  • Demonstrated excellent customer service skills to resolve claims issues quickly and efficiently; effective at handling customer issues confidentially, dispute resolution, and settlements.
  • Demonstrated excellence in meeting deadlines; improved productivity through adopting best practices in claim processing.

Medical Claims Examiner Resume Sample 8

  • Worked with subordinates to assess the status of assigned cases and balance outstanding balances of medical providers.
  • Mentored and train new employees, achieving high levels of customer satisfaction.
  • Upheld reputation as a dependable and efficient employee; timely filed appeals and researched significant issues for future reference.
  • Reviewed physician documentation for accuracy; managed staff members efficiently and effectively; used skill sets to quickly determine issues that required immediate resolution.
  • Maintained an understanding of company policies as well as state and federal regulations pertaining to insurance claim practices; implemented changes as needed within the organization to ensure compliance with these regulations.

Medical Claims Examiner Resume Sample 9

  • Worked with a team of individuals to resolve customer complaints in a timely and professional manner.
  • Corrected medical claims with superior speed and accuracy.
  • Suggested new procedures that improved the way the office processed claims and prevented errors in the future.
  • Received award for resolving difficult problems in a satisfactory manner by working in close cooperation with others.
  • Received an award for finding a solution to a complicated problem by working with others.

Medical Claims Examiner Resume Sample 10

  • Provided customer service for a large healthcare company.
  • Competently answered customer inquiries and complaints by providing information, clarifications, and follow-up.
  • Aided in locating lost members for membership programming.
  • Completed training courses on a regular basis to remain current with industry standards and advances in technology.
  • Achieved award for excellent performance in generating sales; developed contacts for possible sales leads.

Medical Claims Examiner Resume Sample 11

  • Worked with multiple insurance companies including, life, accident, dental, vision, group dental plans.
  • Compiled documentation for verification of claims.
  • Originated new applications for insurance companies.
  • Contributed to the fast-paced office environment by keeping up to date with new forms and policies.
  • Verified eligibility of policyholders and applicants by obtaining and verifying information.

Medical Claims Examiner Resume Sample 12

  • Examined and reviewed medical claims to adjust for the correct level of care.
  • Utilized computer software to ensure accurate input of adjusted data relating to medical claims.
  • Provided customer service for patients, physicians, and other health care providers; answered questions and provided additional information when needed.
  • Discovered billing error; alerted supervisor; fixed error in the system; generated correspondence when necessary.
  • Special projects: evaluated proposed changes in the company’s database program; generated lists and tables in spreadsheet software to analyze business data.

Medical Claims Examiner Resume Sample 13

  • Accurately code and verify physician claims; identified duplicate claims and recouped over $20,000.
  • Remodeled evaluation forms to ensure that physicians were appropriately informed of the need for new equipment; saved company $30,000 by resolving problems at the source.
  • Increased productivity by developing customized forms for direct billing of insurance plans; saved company $250,000 annually.
  • Researched new methods of billing insurance companies on behalf of physicians; discovered savings of $300,000 annually.
  • Implemented edits to prevent duplicate payments to physicians on behalf of insurance companies; eliminated unnecessary payments and ensured accuracy on claims.

Medical Claims Examiner Resume Sample 14

  • Researched insurance benefits for patients to determine if they were eligible for partial or full reimbursement of their medical expenses.
  • Analyzed data to determine reimbursement amounts based on Americans with Disabilities Act requirements.
  • Determined eligibility for reimbursements under Medicare, Medicaid, and HMO policies.
  • Conducted follow-up phone calls with patients to assess compliance with payment plan agreements.
  • Achieved award for meeting customer satisfaction guidelines based on customer survey ratings from patients who had applied for prescription drug coverage under public assistance programs.

Medical Claims Examiner Resume Sample 15

  • Corrected clerical errors within 48 hours of receipt of data.
  • Received the highest score among co-workers for excellent customer service.
  • Worked with Co-Workers to provide quality service to customers.
  • Worked to improve the quality of the office’s documentation procedures for claims.
  • Worked with Co-Workers regarding issues regarding prescription forms, processing claims, and workflow procedures.

Medical Claims Examiner Resume Sample 16

  • Reviewed assigned medical claims to ensure accuracy and completeness of documentation.
  • Monitored the timely closing of open claims, according to CMS standards.
  • Developed a template for internal use, which increased efficiency within the department.
  • Completed a project that saved the company $2 million annually in fraud loss reserves.
  • Identified a trend that led to an audit settlement saving the company $500,000 against fraud charges.

Wrap Up

To work as a Medical Claims Examiner, you need a high school diploma typically for entry-level claims examiner, but some employers prefer hiring someone with a Bachelor’s degree. Medical Claims Examiners must demonstrate good analytical skills, communication skills, attention to detail, interpersonal skills, math skills, interpersonal skills, and logical thinking.

Resumes are a crucial aspect of any job search. In order to make a good first impression, it is important that your resume be formatted and written professionally. To create the perfect resume, think about what skills and qualities you want your future employer to see.

Hope these samples gave you an idea of what your resume should look like and some tips on how to make sure that your resume stands out from the rest.


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