5 Amazing medical claims examiner Resume Examples (Updated 2023) + Skills & Job Descriptions

medical claims examiner

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medical claims examiner: Resume Samples & Writing Guide

Employment history

Jr. Medical Claims Examiner, Walmart Bentonville, Arkansas

July 2022 – April 2023

Review medical claims for accuracy and completeness
Prepare reports and documents related to claims processing
Analyze medical records and other documentation to determine coverage and benefit eligibility

Education

University of Texas, Austin, Texas

Doctor of Human Resources Management, May, 2022

University of Texas, Austin, Texas

Bachelor of Science in Medical Office Administration, May, 2018

Skills

Interpersonal

Adaptability

Documentation

Social Media

Coding

Microsoft Excel

Multi-tasking

Claims Processing

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Professional Summary

Highly experienced Medical Claims Examiner with a strong attention to detail and excellent organizational skills. Proven ability to efficiently process and review medical claims while ensuring accuracy and compliance with established regulations.

Employment history

Lead Medical Claims Examiner, JPMorgan Chase New York, New York

June 2011 – Present

Maintain current knowledge of changes in the healthcare industry
Maintain records of claims activity
Process claims according to established guidelines

Medical Claims Examiner, Amazon Seattle, Washington

June 2010 – May 2011

Identify potential fraud and abuse
Prepare and submit appeals for denied claims
Contact providers and other third parties to obtain information

Junior Medical Claims Examiner, CVS Health Woonsocket, Rhode Island

November 2009 – May 2010

Verify insurance coverage and eligibility
Resolve discrepancies and investigate complex issues
Ensure compliance with applicable laws and regulations

Education

University of Maryland, College Park, Maryland

Master of Arts in Human Resources Management, September, 2009

University of Maryland, College Park, Maryland

Bachelor of Arts in Business Administration, September, 2005

Skills

Flexibility

Accounting

Communication

Public Speaking

Interpersonal Communication

Insurance Verification

Claims Processing

Time Management

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Professional Summary

Highly organized and detail-oriented Medical Claims Examiner with extensive experience in the administrative and clerical field. Skilled in accurately and efficiently processing medical claims with a focus on compliance and customer service.

Employment history

Senior Medical Claims Examiner, Google Mountain View, California

April 2012 – Present

Analyze medical records and other documentation to determine coverage and benefit eligibility
Identify potential fraud and abuse
Reconcile claims and payments

Associate Medical Claims Examiner, General Electric Boston, Massachusetts

April 2011 – March 2012

Identify potential fraud and abuse
Ensure compliance with applicable laws and regulations
Contact providers and other third parties to obtain information

Junior Medical Claims Examiner, Bank of America Charlotte, North Carolina

September 2010 – March 2011

Process claims according to established guidelines
Maintain records of claims activity
Ensure compliance with applicable laws and regulations

Education

Stanford University, Stanford, California

Master of Arts in Office Administration, August, 2010

Stanford University, Stanford, California

Bachelor of Arts in Medical Office Administration, August, 2006

Skills

Communication

Professionalism

Interpersonal

Risk Management

Medical Records

Insurance Claims

Microsoft Office

Insurance Verification

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Professional Summary

Highly organized and detail-oriented Medical Claims Examiner with expertise in administrative and clerical tasks. Proven track record of accurately scrutinizing and processing medical claims with a strong commitment to customer service.

Employment history

Senior Medical Claims Examiner, Walmart Bentonville, Arkansas

July 2009 – Present

Respond to customer inquiries regarding claims
Process claims according to established guidelines
Reconcile claims and payments

Associate Medical Claims Examiner, Walmart Bentonville, Arkansas

January 2009 – June 2009

Ensure compliance with applicable laws and regulations
Verify insurance coverage and eligibility
Resolve discrepancies and investigate complex issues

Junior Medical Claims Examiner, Microsoft Redmond, Washington

January 2008 – December 2008

Reconcile claims and payments
Maintain records of claims activity
Review medical claims for accuracy and completeness

Education

Cornell University, Ithaca, New York

Bachelor of Science in Medical Office Administration, November, 2007

Skills

Mentoring

Documentation

Supervisory

Emotional Intelligence

Coding

Data Entry

Customer Service

Filing

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Employment history

Senior Medical Claims Examiner, Amazon Seattle, Washington

December 2020 – Present

Ensure compliance with applicable laws and regulations
Prepare and submit appeals for denied claims
Analyze medical records and other documentation to determine coverage and benefit eligibility

Medical Claims Examiner, Bank of America Charlotte, North Carolina

June 2020 – November 2020

Analyze medical records and other documentation to determine coverage and benefit eligibility
Contact providers and other third parties to obtain information
Maintain records of claims activity

Junior Medical Claims Examiner, Apple Cupertino, California

June 2019 – May 2020

Maintain records of claims activity
Prepare and submit appeals for denied claims
Respond to customer inquiries regarding claims

Education

University of Michigan, Ann Arbor, Michigan

Office Administration, April, 2019

Skills

Social Media

Problem Solving

Technical

Conflict Resolution

10-Key

Microsoft Office

Multi-tasking

Medical Terminology

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medical claims examiner Job Skills

For an medical claims examiner position, your job skills are a key factor in demonstrating your value to the company and showing recruiters that you're the ight fit for the role. It's important to be specific when highlighting your skills and ensure that they are directly aligned with the job requirements, as this can greatly improve your chances of being hired. By showcasing your relevant skills and experience, you can make a compelling case for why you're the best candidate for the job.

How to include technical skills in your resume:

Technical skills are a set of specialized abilities and knowledge required to perform a particular job effectively. Some examples of technical skills are data analysis, project management, software proficiency, and programming languages, to name a few.

Add the technical skills that will get hired in your career field with our simple-to-use resume builder. Select your desired resume template, once you reach the skills section of the builder, manually write in the skill or simply click on "Add more skills". This will automatically generate the best skills for your career field, choose your skill level, and hit "Save & Next."

Data Entry
Medical Terminology
Coding
Medical Billing
Claims Processing
HIPAA Compliance
Typing
Insurance Verification
Data Analysis
Microsoft Office
Medical Records
Filing
Insurance Claims
Microsoft Excel
Interpersonal Communication
Customer Service
Multi-tasking
10-Key
Problem Solving
Time Management

How to include soft skills in your resume:

Soft skills are non-technical skills that relate to how you work and that can be used in any job. Including soft skills such as time management, creative thinking, teamwork, and conflict resolution demonstrate your problem-solving abilities and show that you navigate challenges and changes in the workplace efficiently.

Add competitive soft skills to make your resume stand-out to recruiters! Simply select your preferred resume template in the skills section, enter the skills manually or use the "Add more skills" option. Our resume builder will generate the most relevant soft skills for your career path. Choose your proficiency level for each skill, and then click "Save & Next" to proceed to the next section.

Communication
Interpersonal
Leadership
Time Management
Problem Solving
Decision Making
Critical Thinking
Creativity
Adaptability
Teamwork
Organization
Planning
Public Speaking
Negotiation
Conflict Resolution
Research
Analytical
Attention to Detail
Self-Motivation
Stress Management
Collaboration
Coaching
Mentoring
Listening
Networking
Strategic Thinking
Negotiation
Emotional Intelligence
Adaptability
Flexibility
Reliability
Professionalism
Computer Literacy
Technical
Data Analysis
Project Management
Customer Service
Presentation
Written Communication
Social Media
Troubleshooting
Quality Assurance
Collaboration
Supervisory
Risk Management
Database Management
Training
Innovation
Documentation
Accounting
Financial Management
Visualization
Reporting
Business Acumen
Process Improvement
Documentation
Relationship Management.

How to Improve Your medical claims examiner Resume

Navigating resume pitfalls can mean the difference between landing an interview or not. Missing job descriptions or unexplained work history gaps can cause recruiters to hesitate. Let's not even talk about the impact of bad grammar, and forgetting your contact info could leave your potential employer hanging. Aim to be comprehensive, concise, and accurate.

Employment history

Lead Medical Claims Examiner, Bank of America Charlotte, North Carolina

January 2019 – May 2022

Analyze medical records and other documentation to determine coverage and benefit eligibility
Respond to customer inquiries regarding claims
Contact providers and other third parties to obtain information

Associate Medical Claims Examiner, CVS Health Woonsocket, Rhode Island

July 2018 – December 2018

Review medical claims for accuracy and completeness
Ensure compliance with applicable laws and regulations
Prepare and submit appeals for denied claims

Junior Medical Claims Examiner, Google Mountain View, California

July 2017 – June 2018

Education

Cornell University, Ithaca, New York

Master of Science in Accounting, May, 2017

Cornell University, Ithaca, New York

Bachelor of Science in Human Resources Management, May, 2013

Skills

Organization

Self-Motivation

Process Improvement

Documentation

Microsoft Excel

Insurance Verification

Filing

Multi-tasking

Unexplained Year Gaps and Missing Job Experiences are a No-no

Gaps in your resume can prevent recruiters from hiring you if you don't explain them.

Key Insights

It's okay to have gaps in your work experience but always offer a valid explanation instead of just hiding it.
Use the gap to talk about positive attributes or additional skills you've learned.
Be honest and straightforward about the gap and explain it using a professional summary.

How to Optimize Your medical claims examiner Resume

Keep an eye out for these resume traps. Neglecting to detail your job roles or explain gaps in your career can lead to unnecessary doubts. Grammar blunders can reflect negatively on you, and without contact information, how can employers reach you? Be meticulous and complete.

Employment history

Entry Level Medical Claims Examiner, CVS Health Woonsocket, Rhode Island

March 2022 – December 2022

Resolves discrepencies and investigates complex issues
Responds to customers inquiries regarding claims
Ensures compliance with applicable laws and regulations.

Education

Cornell University, Ithaca, New York

Bachelor of Arts in Medical Office Administration, January, 2022

Skills

Financial Management

Documentation

Planning

Coaching

Microsoft Office

HIPAA Compliance

Interpersonal Communication

Time Management

Avoid Spelling Mistakes and Include your Contact Information

Missing contact information prevents recruiters from understanding you're the best fit for the position.

Key Insights

Make sure you're not missing contact information on your resume. That should include your full name, telephone number and email address.
Make sure to use a professional email address as part of your contact information.
Highlight your contact information and double check that everything is accurate to help recruiters get in touch with you.

medical claims examiner Cover Letter Example

A cover letter can be a valuable addition to your job application when applying for an medical claims examiner position. Cover letters provide a concise summary of your qualifications, skills, and experience, also it also gives you an opportunity to explain why you're the best fit for the job. Crafting a cover letter that showcases your relevant experience and enthusiasm for the Accounts Payable role can significantly improve your chances of securing an interview.

Associate Medical Claims Examiner
Google
Mountain View, California

Greetings Google Hiring Team

I am a results-driven Medical Claims Examiner with 1 years of experience in Administrative & Clerical. I am excited to submit my application for the Associate Medical Claims Examiner role at Google, where I believe I can make a valuable contribution to your team.

Throughout my life, I have pursued my passion for Data Entry and sought out opportunities to learn and grow. My experience in Administrative & Clerical has given me valuable skills such as Interpersonal and Adaptability that have allowed me to improve professionally and personally. I am excited to bring these skills and my passion as a Medical Claims Examiner to the position and work with a team of like-minded individuals to achieve our common goals.

Thank you for considering my application for the Associate Medical Claims Examiner position. With my skills and the amazing team at this organization, I am assured that I can contribute to your organization's success and make a meaningful impact. Looking forward to a future where we can work together.

Best regards,
Bernie Nelson
723-732-5504
nelson.bernie@inbox.com

Bernie Nelson

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