Claims Clerk Resume Sample
Clement Hahn
89490 Miller Plaza,
Houston,
TX
+1 (555) 510 1616
Work Experience
Claims Clerk
02/2018
-
PRESENT
Philadelphia, PA
- Type 45 wpm, while still adhering to quality controls
- Handle high volume Inbound calls
- Meet daily productivity requirements
- Knowledge and experience with MS Windows, Word, and Excel
- Set up and maintain client’s kitchen areas and conference rooms, order food and make coffee
- Knowledge and experience with MS Windows, Word, and Excel Republic
- Employee able to work independently
- Nine months experience as a Claim Support Clerk, or the equivalent, demonstrating a basic knowledge of computer operations and of claim file systems and procedures
Outside Claims Clerk
07/2011
-
08/2017
Boston, MA
- Two years of experience as a Claim Clerk or the equivalent demonstrating a basic knowledge of computer entry and operations
- One year of experience as a Claims Clerk II, or the equivalent, demonstrating a basic knowledge of computer operations and of claim file systems and procedures
- Conduct data entry and re - work; analyzes and identifies trends and provides reports as necessary. Provide general claims support by reviewing, researching, investigating claims
- Months’ experience in an insurance claims department or related experience
- Receives and matches mail to the appropriate claim file through the Focus system
- Nine or more months experience as a Claim Clerk or the equivalent demonstrating a basic knowledge of computer entry and operations
- Knowledge, Skills & Abilities: Basic computer skills
- Sends and tracks first and second refund request letters to providers
Claims Clerk Entry Level
01/2007
-
01/2011
Boston, MA
- Attend all Company required OSHA and Compliance training, annual training, and all mandatory Company updates. Complete the training in the allotted time the Company sets
- Maintain knowledge of job and medical field
- Keep current on training for new equipment, procedures, and techniques
- Basic knowledge of claims procedures and policies, desired
- Basic understanding of business programs and systems
- Acts with a sense of urgency to advance priorities
- Maintain professionalism and respectfulness under pressure
Education
Indiana Wesleyan University - Kokomo Campus
2003 - 2007
School's Degree in Computer
Professional Skills
- Experience using a computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
- Good organizational skills and strong attention to detail required to meet accuracy and speed expectations
- Solid problem solving and communication skills
- 6 months’ experience in insurance claims department or related experience
- 6-months of experience in an insurance claims department, or related experience
- Experience in an insurance claims department, or related experience
- H.S. Diploma or equivalent No prior experience required
How to write Claims Clerk Resume
Claims Clerk role is responsible for computer, insurance, training, typing, credit, database, recruiting, printing, compensation, shipping.
To write great resume for claims clerk job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claims Clerk Resume
The section contact information is important in your claims clerk resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Claims Clerk Resume
The section work experience is an essential part of your claims clerk resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous claims clerk responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular claims clerk position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Claims Clerk resume experience can include:
- Identify and track movement of sale/trade trucks from dealer to final locations and gather, consolidate and verify information for report running
- Entry level. 0-1 year experience working in a mailroom or professional office environment
- Experience working in production-based environment
- Previous data entry experience required
- AS400, Window/PC, and Office 2007 or equivalent experience required
- Demonstrated ability to follow through and consistently meet deadlines
Education on a Claims Clerk Resume
Make sure to make education a priority on your claims clerk resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claims clerk experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Claims Clerk Resume
When listing skills on your claims clerk resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical claims clerk skills:
- Demonstrates good working knowledge of Claim processing and of Claim policies and procedures
- Mental qualifications include ability to follow directions and communicate appropriately and effectively with staff and customers
- Experience working in claims in a medical or vision setting
- Experience with data entry (10 key with decimals and alphanumeric typing)
- Experience as a Claim Clerk or the equivalent demonstrating a basic knowledge of computer entry and operations
- Experience using Microsoft Word (create, update, and format documents) and Microsoft Excel (create, update spreadsheets, pivot tables, and sort data)
List of Typical Experience For a Claims Clerk Resume
1
Experience For Provider Claims Clerk Resume
- Operates photocopy equipment
- Completing first reports of injury and forwarding to appropriate recipients
- Assist in contacting insureds or other involved persons to obtain missing or incomplete information
- Daily indexing by typing codes into Outlook email subject line for large volumes (300-400 per day) of electronic documents to be attached to claim files
- Research, information gathering regarding claims
2
Experience For Outside Claims Clerk Resume
- Open claims tracking database and determine which claim type to work on first based on established claim turn-around-time protocols
- Prepares files in electronic form for state audits (payment history, file notes, and gathering medical reports)
- Schedules medical appointments and sends all appropriate correspondence relating to that appointment
- Performs new loss inquiry, research and resolve of claims mail documents for indexing
- Review State Adjuster license spreadsheet and assign claim to appropriate adjuster for processing and completion
- Print letters/forms received in the Affinity Outgoing inbox from adjusters/processors, inserts into envelope and send via US postal service
- Assist in training new team members on various claims (i.e. Medical, AD&D, Travel, Halo, and Credit Card)
- Prepares documents for imaging and final disposition by client staff
3
Experience For Warranty Claims Clerk Resume
- Written and verbal communication with medical, legal and governing agencies
- Sort incoming claims
- Processes and tracks provider refunds received
- Reviews Customer Service retracts payment requests and process the reversal
- Performs address verification on return mail
- Data enters paper claims
- Back up to Facilities to pick up and distribute mail
4
Experience For Resolutions Claims Clerk Resume
- Runs daily inventory reports and creates ticket to Software Development for discrepancies
- Reports end of the month claims count
- Identify more complicated issues and refer to Supervisor
- Sort and collate mail, place mail in proper order for distribution, open envelopes dispose of junk mail.Date stamp incoming mail sort mail such as returned letters, adjustments, bills, orders, and payments. Complete and return incorrect mail
- Open and sort daily mail
- Review and identify documents by type and distribute to internal departments via fax or mail
- Scan documents and create internal business forms
- Review and create work from Microsoft SharePoint sites
5
Experience For Claims Clerk, Area Resume
- Update and run Excel spreadsheet reports
- Matches proper file and/or claim number on unidentified correspondence by use of the various automated systems
- Performs control operator functions for various Service Center or Claim Office data systems
- Retrieves and/or re-files items from central storage facility and maintains accurate records of file activity
- Coordinate, maintain and dispatch the activities of shuttler drivers over a designated geographic area. Track shuttler driver hours and input time in the system as needed
- Track and report productivity of drivers. Coordinate with maintenance shop and Inventory Manager to efficiently move units
- Compile accident information of all unallocated accident packages utilizing customer service and investigative skills via phone, mail and email and forward to manager and appropriate center
6
Experience For Claims Clerk Area Resume
- Answer telephone inquiries from internal or external customers (dealers, vendors) utilizing established telephone techniques. Respond to customer questions and complaints. Resolve problems and refer unusual or more difficult problems to Maintenance Manager, Regional Maintenance Manager or Territory Manager for resolution
- Monitor a phone extension to accept phone calls from body shops or vehicle owners looking for a supplement of repairs on their vehicle
- Dispatch the individual supplement requests to the supplement center appraisal staff per the guidelines
- Any additional tasks deemed appropriate by management as the position evolves
- Update/maintain data bases and prepare reports as needed
- Intermediate knowledge of MS Office, MS Word and MS Excel
7
Experience For Claims Clerk Entry Level Resume
- Receives and matches mail to the appropriate claim file through the various Service Center or Claim Office data systems
- Creates claim file by inputting initial loss report information into the various data systems; completes and distributes paper file to the appropriate claim area
- Types a variety of material such as letters, reports, form letters, or memorandums from handwritten copy, typed copy or transcribing equipment by use of a typewriter, personal computer, word processor or an automated system
- Determines proper file and claim number on unidentified claim correspondence by use of the various Service Center or Claim Office data systems
- This involves using IDX software to match patient claims to the correct patient, determine the correct vendor number for the providers submitting the claims, and work any other claim edits
- At the end of the day, log production into the production database
8
Experience For Claims Clerk Resume
- Provide appropriate contact information from initial call
- Enter claim file documentation in reference to call activity
- Insures total customer satisfaction through understanding of customer expectations, proactive problem identification/resolution, and maximizing opportunities to build relationships
- Matches proper file and/or claim number on unidentified correspondence by use of the various automated systems for mail delivered by USPS/ACS/Unmatched mail queue in ODM
- Assists in updating jurisdictional notices and manuals used in the office
- Types a variety of material such as letters, benefit notices, or memorandums for medical appointment, attorneys, or external clients
- Pulls files from storage for in-house state audits
9
Experience For Provider Claims Clerk Resume
- Contacts agents and insured on routine claims to obtain coverage information or obtains through the various systems
- Issues payments, requests wage information for the adjusters, orders surveillance, and completes medical calls to obtain the current work status
- Proficient in the Microsoft suite of products and like systems
- Performs data entry functions (claim checks, claim file updates, forms, form letters, electronic interfaces, etc.) as directed by Superviosr - Claims Operations
- Receives and/or returns telephone calls as directed by Supervisor - Claims Operations
- Processes new claims received daily in Appian and sends out system generated letters to claimants
- Review RCCM and Diaries daily to ensure claims are processed within SLA
- Proofreads work for accuracy; distributes all letters and memorandums for proper approval
- Contacts agents and insured on routine claims to obtain or to clarify information supplied on a loss report
10
Experience For Outside Claims Clerk Resume
- Return calls to claimants on status inquiries and routine claim questions within 24 hours
- Receives documents via US postal mail, courier and fax, matches claim number on document to claim in CMS. Scans and redacts credit card info from documents and uploads to the claim file in CMS
- Retains documents for 2 weeks and after dispose in recycle bin
- Determines proper file and claim number on unidentified claim correspondence and process accordingly
- Tracks all documents received via the Document Center (i.e. outgoing mail, incoming mail, faxes and return mail) by updating the spreadsheets stored in the A&H shared drive
- Operates equipment such as desktop PC, copiers; scanners, fax obtains and distributes copies as requested
- Performs new loss claim entry
List of Typical Skills For a Claims Clerk Resume
1
Skills For Provider Claims Clerk Resume
- Data entry experience
- Experience with Microsoft Excel - create / update spreadsheets and Microsoft Word - create / update / format documents
- Data entry experience (both numeric and alphanumeric)
- Experience in a data entry production driven environment
- Clerical/office experience
- Some light computer experience
- Copier/Fax machine N/A Posses an automobile and valid drivers license
- Experience with Microsoft Excel (create and update spreadsheets) and Microsoft Word (create, update, and format documents)
- At least 6 months customer service experience
2
Skills For Outside Claims Clerk Resume
- Basic of entry level knowledge, skill, and ability with Microsoft Office programs
- Bending, reaching, and standing
- Understanding of Healthcare Claims including ICD-9 and CPT Codes
- Understanding of Healthcare Claims including ICD-10 and CPT codes
- Working with Others - Works with other Claims Clerks to realize the highest level of data entry accuracy and speed
- Embracing Change - Accepting and mastering new claims processing technology and disposition policies
- Prepare outgoing mail including sorting, creating and printing labels, preparing mail envelopes and shipping documents
- Performs Mail Room tasks of opening, sorting, batching, counting, and scanning incoming paper claims
3
Skills For Warranty Claims Clerk Resume
- Provide general claims support by reviewing, researching, investigating, and correcting insurance registration errors
- Work in a client site interfacing with insurance adjuster assisting to data enter information and scan documents related to the processing of claims
- Contacts involve obtaining or providing information requiring little explanation
- Provide clerical support, including, but not limited to, sorting, filing, distribution of work, copy and other clerical functions to support business needs
- Ensure resources are available during normal working hours to assure quick resolution of printing, mail distribution, or technical problems and maximize uptime
4
Skills For Resolutions Claims Clerk Resume
- Decision Making and Problem Solving – Follow claims disposition policies and comprehends the basis and application of these policies
- Understanding of healthcare claims including ICD-9 and CPT codes
- Basic understanding of healthcare claims, including ICD-10 and CPT codes
- Updates and maintains claims tracking database and tasking database
- Memorialize any incoming supplement request as a note in GWCC, indicating which appraiser the request was sent to
- Return denied claims and issue accompanying correspondences to merchants
5
Skills For Claims Clerk, Area Resume
- Successfully complete training as required
- Attention to Detail – Maintain the highest claims entry speed while strictly adhering to current claims disposition policies
- Area Expertise and Technical Knowledge – Utilizes current claim processing technology in the most efficient and accurate manner possible
- Document preparation of all claims for scanning
- Competitive earning and overtime potential
- Basic understanding of Microsoft Word, Microsoft Excel, Microsoft Outlook, and Microsoft PowerPoint
- Basic understanding of healthcare claims and forms
- Working in production based environment
6
Skills For Claims Clerk Area Resume
- Working in production-based environment
- Forwards claims to the health plan for processing
- Interfaces with Provider Relations to research and update mailing address in Eye Manager
- Processes pending lab invoice claims
- Reviews lab invoice claims with errors and clears for processing
- Update/maintain data bases and prepare reports as needed. Scan all incoming claims for distribution
- Performs Mail Room claim inventory control and prepares imaged claims for shredding in accordance with company policy
- Recognize claims by determining claim type – Professional, HCFA and Hospital, UB
- Works on tasks using established procedures
7
Skills For Claims Clerk Entry Level Resume
- Keep up to date DIMS and spreadsheets concerning out of service and in service units.
- Monitor the same phone extension for any voicemails left from body shops or vehicle owners looking for a supplement of repairs on their vehicle
- Monitor an e-mail box for any e-mails sent to us from a body shop or vehicle owner requesting a supplement of repairs on their vehicle
- Monitor a fax line for any faxes from a body shop or vehicle owner requesting a supplement of repairs on their vehicle
- Once a batch is completed, the batch is logged out of the claims tracking database
- Research, respond, and resolve issues in a timely manner from inbound calls as well as returning outbound calls
- Assist callers by providing highest level of customer service
- Operation of automated equipment: mail, reprographic, and finishing equipment
8
Skills For Claims Clerk Resume
- Use print, mail and peripheral equipment during production process
- Perform quality checks on print and mail during respective processes
- Recognize claims by determining claim type - Professional, HCFA and Hospital, UB
- Data entry of claims received on a daily basis
- Process claims in strict compliance with current disposition policies
9
Skills For Provider Claims Clerk Resume
- Exhibit professional appearance and behavior at all times
- Denotes ADA essential function of the job
- Delighting Customers – Processing claims in the most accurate and efficient manner in order to provide merchants an immediate disposition of items submitted for reimbursement
- Dependable, self-starter with attention to detail
- Familiarity with basic office equipment (copier, scanner, postage machine, etc.)
10
Skills For Outside Claims Clerk Resume
- Batches claims by Payer and and entity for our scan vendor
- Some data entry on PC required, i.e., Microsoft Excel and Word. As well as inquires and data entry into our GE claims system
- Retrieves day files upon request
- Photo copies checks and related material and correspondence
- Prepares Misdirected claims to send back to the Payer.
- Perform data entry at the rate of 10000 key strokes recommended
- Work in team driven environment, yet be able to work independently to complete daily expectations and to ensure a positive, delightful customer experience
- Reviews insurance claims forms and documents for accuracy and completion and obtains missing information as necessary
- Make accurate decisions based on departmental guidelines
List of Typical Responsibilities For a Claims Clerk Resume
1
Responsibilities For Provider Claims Clerk Resume
- Knowledgeable of CPT, HCPCS and ICD-10 coding
- Performs data entry functions, as directed by management
- Receives and/or returns telephone calls as directed by management
- Interfaces with Adjuster, Agent and insured to obtain information to assure completeness of information and update client systems
- Prepares reports and insurance claim forms for damage or loss
- Monitors email boxes inboxes and other client systems to fulfill requested services
2
Responsibilities For Outside Claims Clerk Resume
- Records routine claims and acts as intermediary between company and insured
- Multi-task. Ability to take and follow directions
- Collect, sort, code, and route department mail
- Scan large volumes of claims department mail (300-400 per day) and process into workflow for several regional offices
- Process large volumes of emails and documents across multiple regions
- Copy claim files to be forwarded at claim managers request
3
Responsibilities For Warranty Claims Clerk Resume
- New claim file intake and set up
- Document claim files with various notifications and claim notes
- Complete Department of Labor forms timely as requested
- Administrative support and help desk for in house claims document management system
- Maintain electronic claim files
4
Responsibilities For Resolutions Claims Clerk Resume
- Support of medical bill payment process and input of payments to claims system
- Responds to telephone and other inquiries
- Work directly with claims manager remotely to handle all aspects of claims support through completion of claim file
- Career growth opportunities with management potential
- Medical and dental coverage available 2 month period
- Recent experience analyzing complex medical claim information (i.e. forms, determining claim types, codes) and a high level understanding of how to identify the claims. Recognize claims by determining claim type - HCFA, Hospital, UB, and / or RX
5
Responsibilities For Claims Clerk, Area Resume
- Proficient with computer and Windows PC applications, which includes previous experience working with dual computer screens and multiple applications at a time. The ability to navigate new applications is key
- The ability to create, modify, and manipulate word documents and spreadsheets within MS Word and Excel
- Proficient with 10-key numeric pad data entry
- AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off
- Basic proficiency with computer, Windows PC applications, and numeric 10 key, which includes the ability to learn new and complex computer system applications
6
Responsibilities For Claims Clerk Area Resume
- Create, copy, edit, send, and save within Word, Excel, and Outlook
- Frequent use of hand and foot controls
- Basic proficiency with computer, Windows PC applications, and numeric 10-key, which includes the ability to learn new and complex computer system applications
- Create, copy, edit, send, and save within Microsoft Word, Microsoft Excel, and Microsoft Outlook
- In a customer service related position
- Multiple concurrent tasks
- Faxes, mail, printouts
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