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Claims Analyst Resume Samples
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0-5 years of experience
- Manage risk while achieving customer and shareholder objectives by minimizing quality errors
- Investigate and decision daily incoming claims using multiple systems and tools; resolve differences; answer service requests and inquiries received from various channels
- Increase process efficiency by making sure associates get the knowledge and education to choose correct situations descriptors and regulatory
- Resolves customer ATM, ACH, and Debit Card claims within the bank’s
- Active member as ASSET champion to boost team morale and performance to be better connected
0-5 years of experience
Under the supervision of the Patient Financial Services (PFS) manager and senior director my responsibilities include various aspects of receivable management for the PFS department. Working in a stratified process environment I collect, analyze, and report on data within the patient accounting system. Review specific cases, re-bill and follow-up with third party payers for accounts receivable.
- Handle all Medicaid, Medicaid HMO, Medicare, Medicare HMO, Blue Cross, and Commercial High Cost Outlier claims from billing to payment/resolution, ensuring effectiveness and accuracy of claim submission and processing for timely payment.
- Report, analyze, and resolve all High Cost Outlier claim denials for Medicaid, Medicaid HMO, Medicare, Medicare HMO, Blue Cross, and Commercial Insurance Carriers.
- Review ageing reports to ensure all accounts are being worked to payment/resolution.
- Communicate and work with inter/intra departments.
- Review/analyze weekly Medicaid payment report against projected cash, to find discrepancies and take steps to correction.
- Prepare, review and maintain HMO’s payer grid for inpatient and outpatient claims.
- Prepare weekly High Cost Outlier spreadsheets
- Update credential for Medicaid providers on the NYS Department of Health website and ensure that accounts with updated information are rebilled for correct process and payment.
- Responsible for special project as assigned by Manager, Director a/o Vice President.
0-5 years of experience
- Manage property preservation vendors per FHA, FHLMC, FNMA, VA, USDA national guidelines from the initial secure upon first time vacancy through sale, conveyance back to the investor or transfer to REO in order to ensure maximum equity is preserved in the asset.
- Oversee the filing of hazard insurance claims on all FHA, FNMA, FHLMC, VA, USDA and bank-owned default mortgage loan accounts to identify and determine any insurable damage present for a possible hazard insurance claim to be filed.
- Manage all insurance claim funds received in relation to all FHA, concluded hazard insurance claims.
- Maintain constant communication with valuations, foreclosure, bankruptcy, loss mitigation departments as well as external legal counsel to ensure customer is receiving best-in-class service.
- Consistently score at the highest level (4.0 out of 4.0) on quarterly performance reviews.
0-5 years of experience
- Assisted colleagues completing daily tasks which included completing balance transfers, creating and sending liability letters, and ensuring accounts were backdated correctly
- Took claims status calls to help Check Fraud Claims office
- Opened new accounts for customers affected by fraud and mimicking services
- Accurately submitted valid items to be paid for clients
- Met monthly handle time and quality goals
0-5 years of experience
- Review critical errors from EDI submissions, research and correct data in system.
- Review various system settings in new system.
- Analyzed claims for data corrections.
- Maintaining recommendations to the team for final decision. Trainer and Staff Assistant.
0-5 years of experience
Customer service/ Claims Initiation experience
- Receive incoming calls and assist customers with questions or issues regarding claim related activities.
- Experience working with multiple transaction types and products-such as: checking and savings accounts, ATM debit cards, ACH transactions, Virtual teller Machines and On-line Banking.
- Take ownership to ensure that Customer’s requests are processed timely and efficiently while maintaining compliance with industry regulations and Bank policies and procedures.
- Initiate and process claims using multiple systems (Internal) and tools – such as Synergy, Lean BOSS, Pix, Image View and the Refund tool.
- Ask the Customer probing and relevant questions to determine how to appropriately file the claim.
- Assist the Customer with identifying and resolving disputes directly with Merchants.
- Research and explain debits and/or credits on customer accounts.
- Meet and exceed production goals set by management.
6-10 years of experience
- Responsible for managing and ensuring on a weekly basis (450) – manual medical claims submitted are payable, with a $20,000 U.S. dollar payment authority.
- Manage company’s largest client accounts, various queues reviewing independent claims to determine if claim requests are payable.
- Convert currency rates in order to process international medical claims for foreign providers.
- Communicate via phone and email maintaining professional relationships with domestic and foreign doctors.
- Analyze, confirm and streamline policy information to remain in accordance with industry regulations.
- Execute and release weekly check-runs allocated to insurers and doctors.
- Train staff on documented procedures and protocols, and resources related to equipment processes.
- Convey account information providing feedback as a customer service representative to clients, and medical providers.
- Process paper and electronic documentation related to coverage information.
0-5 years of experience
- Responsible for analyzing, auditing, and investigating assigned clients A/R process.
- Managing all reimbursement/direct billing claims for client.
- Analyzing data and recognizing trends to implement processes that increase client’s monthly revenue.
- Managing approvals received from client and insurance carriers.
- Replying to queries from insurance carriers and clients via email and weekly conference calls.
- Developing bi-weekly and monthly reports reflecting clients A/R from raw data and delivering to clients/management.
- Identifying projects to be worked on, developing action plans, and delivering projects by target date to management.
- Conducted research to identify the authencity of claims.
0-5 years of experience
- Responsible for analyzing, auditing, and investigating assigned clients A/R process.
- Managing all reimbursement/direct billing claims for client.
- Analyzing data and recognizing trends to implement processes that increase client’s monthly revenue.
- Managing approvals received from client and insurance carriers.
- Replying to queries from insurance carriers and clients via email and weekly conference calls.
- Developing bi-weekly and monthly reports reflecting clients A/R from raw data and delivering to clients/management.
- Identifying projects to be worked on, developing action plans, and delivering projects by target date to management.
- Conducted research to identify the authencity of claims.
0-5 years of experience
- Servers as liaison between claimants and state office
- Extracts information from KAPS database for claimants property
- Reviews and documents claimants request
- Processes claims in compliance with state standards
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Claims Analyst
Last edited by: Gabriela Barcenas, CONTENT STRATEGIST -
Gabriela Barcenas
CONTENT STRATEGISTGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
