Yyyyyy x. yyyyyy

5565 Canoga Ave. #0000 xxxxxx xxxx , xxxx , xxxxx 00000 xxx-xxx-xxxx ▪ abc@xyz.com

Claims Examiner

 

Offering progressive experience in claims examination, with consistent results in achieving organizational objectives. Proven value and dedication as a team member, as demonstrated by longevity and progression throughout career. Dynamic communication, presentation, relationship building and problem-solving abilities. Highly versatile; quickly master new roles, responsibilities, technologies, and environments. Demonstrate outstanding problem solving and active listening skills; diffuse difficult customer situations with tact and ease.

Claims Processing Strategic Planning Process Improvement Project Management

Cost Containment Investigation Risk Management Regulatory Compliance

Negotiations Research & Planning Resource Allocation/Administration

 

Anthem Blue Cross, Woodland Hills, CA                                                                                     2007-2009

Claims Examiner III

  Contributed industry expertise toward processing entered claims to ensure compliance with Plan Designs, Commercial and Medicaid.

  Exhibited organizational skills and strong attention to detail in coding and processing claims forms for payment, ensuring accuracy and completion of all information before allowing eligible payments.

  Conducted comprehensive research and analysis of claims issues to resolve errors.

  Applied cost containment and other systems of review according to established policies and procedures.

 

Screen Actors Guild Pension and Health Plans, Burbank, CA                                                       2007-2008

Claims Auditor

  Thoroughly evaluated processed claims by Claims Adjusters to deliver high standards of quality assurance.

  Reviewed, audited and approved or disapproved all claims for payment submitted.

  Demonstrated strong knowledge of auditing processes and procedures in reviewing and auditing claims for payment for accuracy and appropriateness.

 

Health Net, Woodland Hills, CA                                                                                                  2002-2007

Claims Examiner II

  Successfully applied dynamic communication skills and industry expertise toward contacting subscribers, providers, brokers and/or policyholders to clarify and gather additional information.

  Closely reviewed and analyzed claims and calculated benefits determination, illustrating exceptional multitasking and prioritizing abilities in achieving goals and timelines.

  Determined appropriate course of action by referring to policy coverage and benefit limit information to ensure critical compliance with medical guidelines, corporate policy, contract provisions, and other coverage.

 

Health Net, Woodland Hills, CA                                                                                                  2001-2002

Eligibility Representative

  Contributed solid communication and customer service skills toward responding to incoming calls and initiating outgoing calls for missing information.

  Effectively maintained and updated records; verified enrollment status, changed records, resolved enrollment system rejections, and resolved various questions or concerns.

 

Blue Cross of California, Woodland Hills, CA                                                                              1998-2001

Customer Service Rep II

  Successfully promoted superior service and exceptional customer satisfaction by promptly responding to telephone, verbal, and/or written inquiries regarding claims, plans, policies and/or procedures.

  Proactively established key relationships and liaised effectively with senior management, staff and customers.

 

Yyyyyy x. yyyyyy

5565 Canoga Ave. #0000 xxxxxx xxxx , xxxx , xxxxx 00000 xxx-xxx-xxxx ▪ abc@xyz.com

 

 

 

Date

 

 

 

Contact Name, Title

Company Name

Address

City/State/Zip Code

 

Dear__________________:

 

I am currently exploring new career opportunities and to acquaint you with my qualifications, I am submitting my resume for review.  In advance, thank you for your time and consideration.

 

As illustrated by my career background, I have continually advanced as a Claims Examiner, assuming increasing levels of responsibility.  From supporting high performance teams and facilitating superior client servicing to streamlining operations and executing proactive organizational processes/procedures, I have continually excelled in maximizing performance as a dynamic team member.  I excel in identifying and resolving inefficiencies, introducing solutions instrumental to boosting performance and strategically utilizing resources to generate optimal results. 

 

As a member of your team, I will consistently exhibit a strong commitment to quality and a dedication to playing a large role in achieving and surpassing goals.  I am eager to meet with you to discuss how my qualifications support your current and prospective needs, and welcome the opportunity to interview at your earliest convenience.

 

Professionally,

 

 

 

 

Yyyyyy x. yyyyyy