Claims Processor Resume

Samantha Gray

North Highlands CA 95660

(916) 987-6543

[email protected]

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Job Objective

In search of work as a Claims Processor.

Highlights of Qualifications:

  • Substantial experience in medical billing, data processing and claims submission
  • Profound knowledge of medical terminology, codes applicable in CPT, ICD-9 and HCPCS systems
  • Deep knowledge of benefit plans and processing of medical claims
  • Familiarity about universal billing forms and billing processes in electronic system
  • Solid understanding of claim processing for healthcare industry
  • Proficient with Health Solutions Plus suite of applications and Microsoft Office products
  • Ability to respond to customers’ requirements in adherence with company policies
  • Ability to complete assigned multiple tasks effectually in changing environment

Professional Experience:

Claims Processor

Centene Corporation, Kingston, PA

August 2007 – Present

  • Investigated, verified and processed billing invoice forms provided by transportation provider on time.
  • Interacted with transportation providers effectively and efficiently as needed.
  • Identified and solved issues related with billing invoice forms from transportation provider.
  • Conversed and performed tasks in collaboration with Abuse and Fraud department.
  • Identified protocols of claim processing and provided accurate claim policies.
  • Adjudicated claims accurately on basis of insurance, benefits included and provider contracts.
  • Interacted with clients over phone, email and in person effectively and efficiently.
  • Maintained and preserved confidential aspect of claim information effectually.

Claims Processor

Retreat Capital Management, Inc., Kingston, PA

May 2004 – July 2007

  • Revised process claims to complete estimates resolution.
  • Ensured to make payments on estimated completed as prompt as possible.
  • Provided assistance to appraisers with details as provided in claims system.
  • Complied with customers’ requirement as needed to assure repairs satisfaction.
  • Identified and took decision to accept, return, deny or approve claims as per established rules.
  • Inspected and processed claims made on paper or electronically.
  • Identified steps and stages as required for claim adjudication.
  • Complied with set departmental standards, corporate policies and operating memo to solve claims and related issues.


Associate Degree in Business

Gateway Community College, New Haven, CT