Claims Auditor Resume

When writing a Claims Auditor Resume remember to include your relevant work history and skills according to the job you are applying for. Whether you're seeking an entry-level position or have been in your career for a few years, exposing your relevant achievements in your resume can allow you to stand out and get that job interview.

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Here is the Claims Auditor Resume example:

Benjamin Malone

210 Hall Place

Texarkana, TX 75507

(555)-555-5555

[email]

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.

Education

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