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Health Claims Specialist resume examples

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Skills

  • Team building
  • Communications
  • Claims process improvement strategies
  • Business operations
  • Complex Case Analysis
  • Operational improvement
  • Regulatory compliance
  • Effective Communication with Stakeholders
  • Compliance with insurance regulations
  • Process improvement

Work Experiences

  • Reviewed open requests and redirected workloads to ensure that projects were completed on time.
  • Contributed to the development of training materials.
  • Achieved a 54% improvement in claim resolution turnaround time.
  • Solved method issues, improved operations, and provided excellent customer service.
  • Avoided litigation.
  • Analyzed rejected claims and provided comprehensive feedback to providers, enabling a 83% improvement in re-submission success.
  • Collaborated with the quality assurance team.
  • Contributed to fiscal planning for the 2015 fiscal year.
  • Achieved results within 6 months.
  • Achieved an error rate of less than 72%.

Summaries

  • Achieved improvements through education and process enhancement.
  • Achieved a 74% certification pass rate.
  • Experienced framework Insurance Specialist with a track record of managing large caseloads in high-pressure situations.
  • Achieved a 36% boost in team performance.
  • Adept in conducting root cause analysis of denied claims.
  • Bringing 2 years of insurance experience to the table.
  • Adjudicated complex claims.
  • Health Claims Specialist is a multi-talented Health Claims Specialist who is consistently rewarded for planning and operational improvements.
  • Achieved a 33% reduction in errored claims.
  • Achieved turnaround times 79% faster than team average.

Accomplishments

  • Assessed over 13 medical claims per day, ensuring accurate coding and compliance with payer requirements, resulting in 25% decrease in claim rejections.
  • Supported customer service initiatives by addressing patient inquiries and resolving disputes related to claim status, ensuring timely reimbursements.
  • Resolved product issue through consumer testing.
  • Developed specialized reporting tools to track claims status, reducing overdue claims by 17% within two years.
  • Established audit protocols for medical documentation, leading to a 61% improvement in claim accuracy and reducing rejected claims by 42%.
  • Initiated training programs to educate claims processors on latest insurance guidelines, boosting overall team productivity by 32%.
  • Monitored claim adjustment activity, identifying opportunities for process improvements that reduced manual intervention by 43%.
  • Collaborated with team of 2 in the development of program.
  • Documented and resolved metric which led to framework.
  • Boosted cross-departmental collaboration, improving communications between Claims and Customer Service divisions, which reduced escalated complaints by 17%.

Affiliations

  • American Society of Safety Professionals
  • International Council of Nurses
  • National Association of Social Workers
  • Partnership for Health IT Patient Safety (PHIT)
  • International Association of Claims Professionals (IACP)
  • Delta Epsilon Sigma Honor Society 2019
  • Insurance Professionals of America (IPA)
  • Association for Supply Chain Management (APICS)
  • Society of Human Resource Management
  • U.S. Healthcare Leadership Association (USHCLA)

Certifications

  • Certified Compliance and Ethics Professional (CCEP) - procedure
  • Project Management Professional (PMP)
  • Medical Billing and Coding Certification - standard
  • Healthcare Claims Professional Certification (HCPC) - Meridian
  • Advanced Managed Care Professional (AMCP) - Cedar Works
  • Project Management Professional (PMP) – PMI Institute
  • Certified Appeals Expert (CAE) - initiative
  • First Aid/CPR Certified
  • Certified Business Analysis Professional (CBAP)
  • CompTIA A+ Technician

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