Claims Adjudicator Resume

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Here is the Claims Adjudicator Resume example:

James Thompson

978 Elk Avenue

Lansing, MI 48933

(555)-555-5555

[email]

Job Objective Claims Adjudicator with excellent skills and the ability seeking to work for your company.

Highlights of Qualifications:

Excellent experience in processing claims for general accounts
Sound knowledge of insurance procedures and accounting processes
Profound knowledge of management utilization techniques
Ability to multitask and maintain accuracy in high pressure environment
Ability to coordinate with team members for various activities
Familiarity with claims processing, accounts payable, general accounting

Professional Experience:

Claims Adjudicator

Northwest Community Hospital, Lansing, MI

August 2012 – Present

Responsibilities:

Monitored various inputs from physicians such as x-ray and dental records.
Evaluated referrals and provided authorization for claims.
Managed claim system and provided information to new providers.
Coordinated with IT team for upload and obtained required DDE rates.
Generated remittance notice when required and obtain authorization from management.
Coordinated with departments and assisted in transmission of claim files.

Claims Adjudicator

Valence Health, Lansing, MI

May 2009 – July 2012

Responsibilities:

Adjudicated various medical and non-medical provider claims and updated on CMS.
Procured rate tables for Medicare processes and monitored expenses.
Maintained and generated accruals for accounting processes.
Evaluated plans and maintained notes of patient records.
Coordinated with providers and carrier contracts for authorization.
Performed research and facilitated processing of claim payments.

Education

Bachelor’s Degree in Finance

Edward Waters College, Jacksonville, FL