Claims Auditor Resume

Posted in Auditor Resume Examples

Benjamin Malone

210 Hall Place

Texarkana, TX 75507



Job Objective Searching for work as a Claims Auditor with company seeking a hard working dependable employee.

Highlights of Qualifications:

  • Remarkable claims examining experience in a managed care environment
  • Good knowledge of DMAP, Medicare, and Medicare Advantage benefits and protocols
  • Comprehensive knowledge of ICD-9, CPT, HCPCS and Family Care’s claims policies and procedures
  • Remarkable experience in interpreting Health Plan Division of Financial Responsibilities (DOFR)
  • Ability to create reports using data gathered from audits
  • Ability to build and improve the claims processes
  • Excellent organizational skills
  • Proficient with MS office tools and claims software applications
  • Ability to work in an environment with diverse individuals and groups
  • Excellent written and verbal communication skills

Professional Experience:

Claims Auditor, August 2005 – Present

Nautilus Healthcare Management Group, Texarkana, TX

  • Identified underpayments/overpayments and generated periodic reports.
  • Performed to resolve errors by communicating with the Production Manager or Supervisor.
  • Audited member liability denials to assure quality of claim.
  • Managed to generate accurate claim payments and reimbursement calculation of applicable fee schedules.
  • Provided tools and recommendations to avoid overpayments.
  • Ensured compliance with health plan requirements.

Claims Auditor, May 2000 – July 2005

XL Health, Texarkana, TX

  • Identified problems, troubleshoot, and provided guidance to claim analyst.
  • Conducted daily review of pending claims and prepared weekly audits for each claim.
  • Contributed to the development of claims analysis reports.
  • Reviewed claims to ensure that claims are appropriately processed.
  • Ensured that denied and underpaid claims are timely reprocessed.
  • Computed and corrected claim errors in the Facets system.


Bachelor’s Degree in Business Administration, Thomas Jefferson University, Philadelphia, PA

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