Insurance Claims Processor Resume

Posted in Processor Resume Examples

Dwayne Scales

2210 Riverwood Drive

Chico, CA 95928

(555)-555-5555

[email]

Job Objective Obtain work as Insurance Claims Processor.

Highlights of Qualifications:

  • Substantial experience in processing commercial insurance claims
  • Operational knowledge of establishing professional office for insurance claim processing
  • Deep knowledge of annuity and life systems namely Capsil, Alis, AS400, Vantage, ISA and Life 70
  • Solid understanding of terminology applicable in general and medical insurance
  • Familiarity about precise computer based applications
  • Ability to adjust and perform in inconsistent team environment
  • Ability to plan, organize and implement workflow during formulating goals
  • Ability to verify specific details on polices

Professional Experience:

Insurance Claims Processor

TMG Health, Inc., Chico, CA

August 2007 – Present

  • Evaluated benefit insurance claims and processed payments for applicable claims.
  • Responded and analyzed queries related to claim applications, payment procedure, denial reason and deductible amounts.
  • Ensured received information from all sources is complete and accurate.
  • Analyzed and verified data received for claim application and related documents.
  • Ensured company records were validated and claim approval.
  • Conversed with insurance agents and claimants to investigate questionable statements.
  • Inspected clarity and completeness of documents and processed medical insurance claims.
  • Assisted customer to update on their claim status.

Insurance Claims Processor

Olathe Health System, Chico, CA

May 2004 – July 2007

  • Gathered important information and updated claimants’ records accordingly.
  • Interacted with claimants, customers and shop owners as required.
  • Prepared, arranged and maintained reports for review and appraisals.
  • Secured important details about accidents and accessed liability.
  • Negotiated financial aspect, arrived at settlement and updated clients and claimants about final decisions.
  • Supported claims department with clerical tasks comprising work lists on routine basis.
  • Ensured backlog reports prepared on weekly basis was complete and cross-linked with related correspondence.

Education

Associate Degree in Business Administration

Honolulu Community College, Honolulu, HI


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