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Medical Claims Examiner Resume

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Here is the Medical Claims Examiner Resume example:

James Burden

840 Woodbridge Lane

Detroit, MI 48219



Job Objective Seeking work as a Medical Claims Examiner where my expertise can be utilized to their fullest potential to help company meet short and long-term goals.

Highlights of Qualifications:

  • Remarkable experience in processing medical claims
  • Good understanding of medical terminology, HCPCS, PDR , CPT and ICD-9 codes
  • Extensive knowledge of appropriate health insurance principles
  • Thorough knowledge of subrogation, reinsurance, workman compensation, third party liability and coordination of benefits claims
  • Ability to analyze claims, set reserves, determine compensability and settle claims
  • Ability to resolve difficulties quickly
  • Ability to make decisions and institute change when appropriate

Professional Experience:

Medical Claims Examiner, August 2005 – Present

Apollo Health Street, Detroit, MI

  • Adjudicated medical and dental claims.
  • Processed all types of pended claims.
  • Handled customer service calls for both medical and dental claims status and coverage questions.
  • Handled provider demographic up-dates to claims system.

Medical Claims Examiner, May 2000 – July 2005

Aerotek, Detroit, MI

  • Examined, data enter, calculated and adjudicated insurance claims complying with federal, state and county laws, plan policy and company procedures.
  • Entered codes and verified data for computer processing.
  • Maintained individual production count.
  • Updated and maintained policy manual timely.


Bachelor’s Degree in Business Administration, Northern Michigan University, Marquette, MI

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  • March 1, 2024Create Date
  • March 1, 2024Last Updated

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