Claims Analyst Resume

Samantha Gray

North Highlands CA 95660

(916) 987-6543

[email protected]

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Job Objective

A Position as Claims Analyst.

Highlights of Qualifications:

  • Basic knowledge of government agency and insurance company programs, NAIC coordination of benefits guidelines
  • A great deal of experience in claims and financial concepts
  • Extensive knowledge of CPT, ICD-9, HCPCS and UB04
  • Familiar with Health care insurance and medical coding
  • Strong oral and written communication skills
  • Familiar with billing and payment guidelines
  • Strong interpersonal skills, reading comprehension and analytical ability
  • Proficient in Microsoft Office (Excel, Word, Outlook) and relational databases
  • Ability to build good relationship with customer

Excellent analytical and critical thinking skills

Professional Experience:

Claims Analyst, August 2005 – Present

Molina Healthcare, San Diego, CA

  • Proficiently reviewed claims for completeness and approves and denied payment using established guidelines.
  • Documented clearly and concisely claims adjudication decisions in Claim Notes.
  • Identified potential system problems and claims training issues.
  • Attended departmental training when required.

Claims Analyst, May 2000 – July 2005

Phoenix Health Plan, San Diego, CA

  • Performed and conducted research on claims inquiries and reprocess claims.
  • Recovered and retrieved funds from providers due to overpayment and adjusted provider claims for overpayment and underpayments.
  • Performed effective research on larger projects and major reconciliations.
  • Developed and maintained an efficient and accurate system to advancing newborn claim payments when eligibility information from the State is delayed.
  • Monitored and determined claims accuracy using available claims editing tools.
  • Assisted supervisor in the review of various claims reports.


High School Diploma, Waverly High School, Waverly, IL