Medical Claims Adjudicator Resume

Samantha Gray

North Highlands CA 95660

(916) 987-6543

[email protected]

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Job Objective

Seeking a Medical Claims Adjudicator position that offers an immediate challenge, career opportunity and advancement.

Highlights of Qualifications:

  • Highly experienced in handling, processing, and settling medical insurance claims
  • Sound knowledge of medical terminology, coding, and billing standards
  • Immense knowledge of various health insurance, HMO, and managed care principles
  • Familiarity with MS Office, Outlook calendar, and Internet Explorer
  • Ability to comply with HIPAA and other applicable regulatory guidelines
  • Ability to review and submit medical claims, in a timely manner

Professional Experience:

Medical Claims Adjudicator

Mercer, Franklin, MA

August 2012 – Present


  • Assessed, approved, and denied various medical claim requests received.
  • Computed all medical benefits due and assisted with payment initiations.
  • Prepared and dispatched claim related correspondence to claimants and third party agencies.
  • Interpreted and followed government regulations and company policies, as applicable.
  • Informed and explained clients about medical terms and concepts, clearly.
  • Operated computer and used Microsoft Office programs, efficiently.

Medical Claims Adjudicator

CareCentrix, Franklin, MA

May 2009 – July 2012


  • Researched, processed, and resolved various medical claims for clients.
  • Reviewed and maintained all medical records and claim appeal materials.
  • Wrote and submitted all work related reports, accurately and on time.
  • Interpreted and followed government-approved insurance regulations and Social Security Act.
  • Answered phone calls from clients and responded to email and letters, in a professional manner.
  • Developed and maintained positive relationship with claimants and insurance providers.


Bachelor’s Degree in Health Insurance

Porterville College, Porterville, CA