Claims Analyst Resume
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795 Hammond Dr NE, Apt 209
San Diego, CA 92101
(123)-000-1234
a.wagele@emailaddress.com
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.
Education:
High School Diploma, Waverly High School, Waverly, IL
