Claims Adjudicator Resume

Samantha Gray

North Highlands CA 95660

(916) 987-6543

[email protected]

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Job Objective

Claims Adjudicator with excellent skills and the ability seeking to work for your company.

Highlights of Qualifications:

  • Excellent experience in processing claims for general accounts
  • Sound knowledge of insurance procedures and accounting processes
  • Profound knowledge of management utilization techniques
  • Ability to multitask and maintain accuracy in high pressure environment
  • Ability to coordinate with team members for various activities
  • Familiarity with claims processing, accounts payable, general accounting

Professional Experience:

Claims Adjudicator

Northwest Community Hospital, Lansing, MI

August 2012 – Present


  • Monitored various inputs from physicians such as x-ray and dental records.
  • Evaluated referrals and provided authorization for claims.
  • Managed claim system and provided information to new providers.
  • Coordinated with IT team for upload and obtained required DDE rates.
  • Generated remittance notice when required and obtain authorization from management.
  • Coordinated with departments and assisted in transmission of claim files.

Claims Adjudicator

Valence Health, Lansing, MI

May 2009 – July 2012


  • Adjudicated various medical and non-medical provider claims and updated on CMS.
  • Procured rate tables for Medicare processes and monitored expenses.
  • Maintained and generated accruals for accounting processes.
  • Evaluated plans and maintained notes of patient records.
  • Coordinated with providers and carrier contracts for authorization.
  • Performed research and facilitated processing of claim payments.


Bachelor’s Degree in Finance

Edward Waters College, Jacksonville, FL