Home » Archive by category "Claim Officer Resume"

TPA (Third Party Admin.) Claim Resume Sample

This resume is a sample for the post of TPA (Third Party Admin) Claim Officer. This is a highly responsible job as buying the cases is not the only requisite but your employer would want to see your capabilities in managing and running things smoothly for the company’s reputation and goodwill. Companies mostly prefer intelligent, comprehensive and skillful person for this post (Claim Operation Officer Resume). For wining this job in full stream of competition firstly and foremostly you should build your (TPA (Third Party Admin) Claim Resume like Medical Claim Secretary Resume for more ideas. It should be developed in such a manner that your employer considers your the most suitable person for the job. We have given below a sample resume TPA (Third Party Admin) Claim for this purpose which should guide you in constructing a job wining resume. Finally adding references (verified) to your resume will add to the value of it.

Related: Business Flyers

Name xyz                                                        Paste Your Pics Here

E-mail: xxxx

Cell #: 000

Skype: abc

PROFESSIONAL EXPERIENCE: (Tpa Claim)

Professional experience and outstanding skills in Healthcare Insurance, Process management and risk management with 8 years of experience in ABC International, Dubai(International Health Insurance) backed by Master in Business Administration from European University Barcelona, Spain to working in a fast paced environment with the ability to think quickly and excellent interpersonal skills and solid decision making, hard-working and results-driven attitude.

CORE COMPETENCIES:

  • Profound Knowledge of Healthcare Insurance, Medical Coding, Process Management and Risk Management.
  • Able work in a pressurized environment with continuous deadline and capable of making quick decisions in time constraint situations.(Tpa Claim)
  • Energetic personality consistently praised for my passion for work and upbeat, positive attitude.
  • Proficiency in Microsoft Office programs (Word, Excel, PowerPoint, and Outlook).
  • Ability to work with several operating systems, including Windows, Mac OSX and Linux.
  • Experience with Actisure, OPERA, GDS, Travel Studio.

ORGANIZATIONAL EXPERIENCE:                                                              

xyz International, Dubai.

T.P.A Claims Officer:

Responsibilities:

  • Validate the information on all medical claims received and follow on lapsed claims.
  • Assisting members with account issues, and providing knowledge about the accounts.
  • Coordinating with Hospitals, AP companies, Medical and claims team.Re-confirming & assuring smooth flow of documents for all
    transactions processed and registered.Resolving the queries of the clients related to payable.
  • Handling all incoming & outgoing Emails Re-confirming & assuring smooth flow of documents for all transactions processed and registered.
  • Resolving the queries of the clients related to payable.
  • Re-confirming & assuring smooth flow of documents for all transactions processed and registered.
  • Provide Pre-Authorization, G.O.P, Approvals according to the Insurance policy.
  • Resolving the queries of the clients related to payable.
  • Handling all incoming & outgoing Emails Re-confirming & assuring smooth flow of documents for all
    transactions processed and registered.
  • Translation of claims and medical reports (Arabic, French, Spanish).
  • Contact customers in order to respond to inquiries or to notify them of claim investigation results and any planned adjustments.
  • Review insurance policy terms in order to determine whether a particular loss is covered.

XYZ & CO.

Claim Manager:                                                                

Responsibilities:

  • Overall review and total familiarity of the account/agent that is assigned to each Tour Operator. This includes a full understanding of the market, the nature of the client movement, the pricing strategy and the expectations of the agent/clients.
  • Planning itineraries and products to meet with the agent/clients’ requirements within the allocated time frame, budget and seasonality.
  • Coordinating with Quality Control and Representatives to ensure that everything is running as planned for each operating guest file.
  • Interaction with the suppliers, and arranging meetings with new partners.
  • Conducting market research on hotels and new products.
  • Ensure competitiveness of the products contracted by conducting price & product bench marking on daily basis.

Qualification & Award:

  • Chartered Insurance Institute – CII (Certificate In Insurance)
  • Insurance and Risk Certification –  (AAPM USA).
  • Master in Business Administration-  European University Barcelona, Spain.
  • Bachelor Degree in Economics –  University Proserpina, France
  • Selectivity (Spanish High School Degree)
  • High School Degree – Casablanca Morocco.

PERSONAL DETAILS:

Age & Marital Status            : 00 Years, Single.

Nationality                             : Canada.

Languages Known                : English, Arabic (native), French and Spanish.

Visa Status                            : International

Safety Analyst Resume Sample

A Safety Analyst measures and foretells the risks for a company. This resume is a sample for the post of Safety Analyst. He prepares and makes the back-ups for several risks as flood risks, energy risks, financial risks or any other forthcoming risk that the company may encounter in future. It is his duty to warn a company afore and make arrangements to minimize the percentage of loss, hence he plays important role for the ‘safe-sailing’ of the organization/company. He plays a vital role for the sustenance and progress of a company. Below we have given you an avid example. Enlist your initial information following by your education and then describe your key skills and experiences. Highlight that you are able to work in any type of situations and a strong candidate handling tumultuous situations.

Name:           XYZ

Country:       Dubai.

Contact no:   000

Email id:        xxx

 OBJECTIVE: (Safety Analyst)

To be able to impart my skills in molding the company’s image and be able to create goodwill for the company’s goal of having a long term profit.OBJECTIVE

EDUCATION: (Safety Analyst)

COLLEGE:  Saint Louis University

Bachelor of Science in Commerce

Major in Marketing

HIGH SCHOOL:  Don Mariano Marcos Memorial State University

ELEMENTARY:  Britannica Elementary School

WORK EXPERIENCE

Safety Analyst

  • Works with Debit Card Fraud Prevention.
  • Provide support to clients who calls to remove temporary block on acct.
  • Identify fraud through outbound calls and follow up on incoming calls for suspicious caller.
  • Maintain goals by quarter and year to date.
  • Provides early warning to prevent fraud.
  • Transferred to another LOB which is Customer Data Accuracy Program.
  • As a Retail Fraud Operations Analyst, I minimize risk and prevent losses by reviewing and analyzing new and existing Chase Checking/Savings accounts. I take appropriate actions on accounts in order to verify and ensure the accuracy of the customer’s information. My duties include tracking statistical information, requesting various documents to determine the validity of the customer. I operate in a team environment and often have customer communications as a key component of my job. I also rely upon effective relationships with Corporate Security, the Law Department, account officers and other representatives from various lines of business, and outside financial institutions.

EXPERIENCES GAINED:

  • Learn how to access and use multiple operating systems efficiently.
  •  Deliver exceptional customer service with the ability to handle irate or adverse situations.
  • Documenting the review and investigation process followed for each account reviewed and preparing various documents, reports and system entries as necessary for financial entry, certification, reporting and statistical purposes
  • Ensuring that regulatory, legal, bank and audit requirements are met
  • Demonstrate the ability to identify, analyze, and solve problems by providing viable solutions and executing excellent follow through and communication
  • Must possess a strong understanding of business transactions, knowledge of account flow, and financial documents
  • Work on shifting schedules, US and Philippine Holidays as needed

Customer Care Service 

RESPONSIBILITIES:

  • Worked as a Line Balancing Agent where I worked with two different line of business,two different verification process and fraud identification.
  • Identify fraud through outbound calls and follow up on incoming calls for suspicious caller
  • Maintain goals by quarter and year to date.
  • Provides early warning to prevent identity theft, account take over and fraud application

EXPERIENCES GAINED:

  • Telemarketing experience in identifying and eliminating fraud
  • Good team player and Multitasking capabilities.
  • Proven initiative and ability to work with minimal supervision.
  • Excellent organizational and motivational skills.
  • Knowledge of Internet and Electronic Commerce industries.

PERSONAL DATA

Birth Date:                                                   000

Civil Status:                                                  Married

Father’s Name:                                            xyz

Mother’s Name:                                          abc

SPECIAL SKILLS

  • Excellent interpersonal and communication skills
  • Excellent customer service skills
  • Strong organizational skills and attention to details
  • Natural ability to work both alone or as a part of a team
  • Strong analytically and problem solving skills
  • Excellent sales and negotiation skills
  • Strong multi-tasking skill

Claims Processor & Administrator Officer Resume Sample

This resume is a sample for the post of Claim Processor and Administrator Officer. This is a highly responsible job as buying the cases is not the only requisite but your employer would want to see your capabilities in managing and running things smoothly, For the company reputation and goodwill companies mostly hire intelligent, comprehensive and skillful person for this post(Claim Operation Officer Resume). For wining this job in full stream of competition firstly am fore mostly you should build your resume like Medical Claim Secretary Resume. It should be developed in such a manner that your employer considers your the most suitable person for the job. We given below a sample resume for this purpose which should guide you in constructing a job wining resume. Finally adding references (verified) to your resume will add to the value of it.

Name xyz

UK.

E-mail: xxxxxx

MOB: 000000

PROFESSIONAL SYNOPSIS

Substantial experience and outstanding skills in Healthcare Insurance, Process management and risk management with 2 years of experience in Aetna International, Dubai(International Health Insurance) backed by Master in Business Administration from European University Barcelona, Spain; to working in a fast paced environment with the ability to think quickly and excellent interpersonal skills and solid decision making, hard-working and results-driven attitude.

CORE COMPETENCIES

  • Profound Knowledge of Healthcare Insurance, Medical Coding, Process Management and Risk Management.
  • Able work in a pressurized environment with continuous deadline and capable of making quick decisions in time constraint situations.
  • Energetic personality consistently praised for my passion for work and upbeat, positive attitude.
  • Proficiency in Microsoft Office programs (Word, Excel, PowerPoint, and Outlook).
  • Ability to work with several operating systems, including Windows, Mac OSX and Linux.
  • Experience with Actisure, OPERA, GDS, Travel Studio.

ORGANIZATIONAL EXPERIENCE                                                              

Claims processor & Administrator

xyz International, Dubai.

Claims processor &  Administrator

Responsibilities:

  • Validate the information on all medical claims received and follow on lapsed claims.
  • Assisting members with account issues, and providing knowledge about the accounts.
  • Coordinating with Hospitals, AP companies, Medical and claims team.Re-confirming & assuring smooth flow of documents for all
    transactions processed and registered.Resolving the queries of the clients related to payable.
  • Handling all incoming & outgoing Emails Re-confirming & assuring smooth flow of documents for all transactions processed and registered.
  • Resolving the queries of the clients related to payable.
  • Re-confirming & assuring smooth flow of documents for all transactions processed and registered.
  • Provide Pre-Authorization, G.O.P, Approvals according to the Insurance policy.
  • Resolving the queries of the clients related to payable.
  • Handling all incoming & outgoing Emails Re-confirming & assuring smooth flow of documents for all
    transactions processed and registered.
  • Translation of claims and medical reports (Arabic, French, Spanish).
  • Contact customers in order to respond to inquiries or to notify them of claim investigation results and any planned adjustments.
  • Review insurance policy terms in order to determine whether a particular loss is covered.

XYZ & CO.

Assistant Contracting Manager                                                                  

Responsibilities:

  • Overall review and total familiarity of the account/agent that is assigned to each Tour Operator. This includes a full understanding of the market, the nature of the client movement, the pricing strategy and the expectations of the agent/clients.
  • Planning itineraries and products to meet with the agent/clients’ requirements within the allocated time frame, budget and seasonality.
  • Coordinating with Quality Control and Representatives to ensure that everything is running as planned for each operating guest file.
  • Interaction with the suppliers, and arranging meetings with new partners.
  • Conducting market research on hotels and new products.
  • Ensure competitiveness of the products contracted by conducting price & product bench marking on daily basis.

EDUCATION

  • Chartered Insurance Institute – CII (Certificate In Insurance)
  • Insurance and Risk Certification – 2013 – 2014 – American Academy of Project Management (AAPM USA).
  • Master in Business Administration- 2010 – 2012 European University Barcelona, Spain.
  • Bachelor Degree in Economics – 2006 – 2009 University Proserpina, France
  • Selectivity (Spanish High School Degree) – 2005 – 2006
  • High School Degree – Casablanca Morocco – 2004 – 2005.

PERSONAL DETAILS

Age & Marital Status            : 28 Years, Single.

Nationality                             : Moroccan.

Languages Known                : English, Arabic (native), French and Spanish.

Visa Status                            : UAE.

Claim Operation Officer Resume Sample

This resume is a sample for the post of Claim Operation Officer. The Insurance Claim Operation Officer is a job of an analyst, he prepares the basic report after the Client’s application. He inquires after all the existing things, facts and all the requirements that he considers to be important for the further action. And forwards to his officer or senior officer at their satisfaction level. For the company reputation and goodwill companies mostly hire intelligent, comprehensive and skillful person for this post. For wining this job in full stream of competition firstly am foremostly you should build your resume. It should be developed in such a manner that your employer considers your the most suitable person for the job. We given below a sample resume for this purpose which should guide you in constructing a job wining resume. Finally adding references(verified) to your resume will add to the value of it.

Name:XYZ

E-Mail: xxx 

Mobile: 000000

Career Objective (Claim Operation Officer)

Seeking full time career with an organization, which will permit to use my abilities and also to put my skills and practice efficiently in the best interest of the company.

Career Summary (Claim Operation Officer)

Over 5 years of extensive, executive operations management role in organizations; contributed to firm growth by executing business strategies using strong decision making abilities.

  • Strong background in back end operations.
  • Knowledge of Quality assurance, audits, bugs fixing and production management.

Core Competencies:

  • Excellent people manager – Persuader, influence, leader, negotiator and delegate.
  • Team work – Effectively communicates to delegate responsibilities using interpersonal skills.
  • Accuracy and punctuality – Precise with details and facts.

EDUCATION QUALIFICATION:

  • Master of Computer Applications from Osmania University.
  • Bachelors of Sciences (computers) from Kakatiya University.

EXPERIENCE:

Company: United Health Group, Hyderabad

Worked as a Sr Claims Associate in United Health Group, Hyderabad

  Responsibilities:

  • Coordinate with customers and staff and provide support to all data analysis.
  • Perform data analysis on all results and prepare presentations for clients.
  • Perform audit on data and resolve business related issues for customer base.
  • Coordinate with engineering and product management team and ensure accuracy on all deliverable and prepare summaries.
  • Perform data analysis and facilitate in delivery to all end users.
  • Supervise all client issues and coordinate with managers and supervisors and facilitate in deliverable.
  • Monitor and organize all client invoices and perform all timely assessment for all payment issues.
  • Administer all data for customer invoices and provide company metrics.
  • Monitor and resolve all customer invoice data issues and coordinate with various vendors and manage all previous balance.
  • Organize all consumption anomalies and determine defects for data and prepare appropriate resolutions.
  • Supervise process management tools and ensure compliance to all cycle guidelines.
  • Maintain and document library of invoices and resolve all issues in same.
  • Perform internal audit and prepare all invoices and determine quality improvement processes.
  • Maintain and escalate issues to lead analyst if required.

 Company: Sutherland Healthcare Solutions, Hyderabad.

Worked as a Process Associate in Sutherland Global Services, Hyderabad.

  • Assists in implementing production procedures to optimize new and existing manufacturing processes.
  • Gathers research on new and existing technologies and procedures
  • Monitor all transactions and ensure compliance to quality regulations and maintain effective relationships with clients.
  • Manage everyday work activities and informed supervisor appropriately
  • Administer and collect all metrics on processes and identify data points to improve all processes.
  • Documents all transactions on an everyday basis and collate metrics from various associates and prepare appropriate reports.
  • Monitor all data entry operations and ensure compliance to time frame.
  • Ensure and maintain effective professional relationships with staff.
  • Perform quality check assessment on all processes of various associates.
  • Coordinate with team members and ensure achievement of all team objectives and goals.
  • Analyze all issues of internal and external clients and provide effective resolutions for same.

PERSONAL PROFILE:

Name                                       :           XYZ

Father’s Name                           :         XYZ

Marital Status                            :          Married

Nationality                                 :            Indian

Passport No                               :            00000

Visa Type                                  :           Visit Visa

Hobbies                                     :            Playing cricket.

Date of Birth                              :          000

 

Claims Analyst Resume Sample

This resume is sample for the post of Claim Analyst. The Insurance claim analyst a person who prepare the basic report after the Clint application. He analyst all existing things and inquires which he consider is important for the further action of officer or senior officer asking about them. For the company reputation and goodwill companies mostly hired intelligent and skillful person for this post. For wining job in competition first of all your should build your resume perfectly which attract the reader or employer . We given below a sample resume for this purpose which giving you a idea for constructed job wining resume.

Name: XYZ

E-Mail:0000

Mobile: 000000

Applied For:Claims Analyst Officer/Assistant Claims Analyst Officer/ Business Claims Analyst

Career Summary

Over 3 years of extensive, executive operations management role in organizations; contributed to firm growth by executing business strategies using strong decision making abilities.

  • Strong background in back end operations.
  • Knowledge of Quality assurance, audits, bugs fixing and production management.

Core Competencies:

  • Excellent people manager – Persuader, influence, leader, negotiator and delegate.
  • Team work – Effectively communicates to delegate responsibilities using interpersonal skills.
  • Accuracy and punctuality – Precise with details and facts.

EDUCATION QUALIFICATION:

  • Master of Computer Applications from Osmania University.
  • Bachelors of Sciences (computers) from Kakatiya University.

EXPERIENCE:

1)     Company: United Health Group, Hyderabad

Worked as a Sr Claims Associate in United Health Group, Hyderabad

  Responsibilities:

  • Coordinate with customers and staff and provide support to all data analysis.
  • Perform data analysis on all results and prepare presentations for clients.
  • Perform audit on data and resolve business related issues for customer base.
  • Coordinate with engineering and product management team and ensure accuracy on all deliverables and prepare summaries.(Claims Analyst)
  • Perform data analysis and facilitate in delivery to all end users.
  • Supervise all client issues and coordinate with managers and supervisors and facilitate in deliverables.
  • Monitor and organize all client invoices and perform all timely assessment for all payment issues.
  • Administer all data for customer invoices and provide company metrics.(Claims Analyst)
  • Monitor and resolve all customer invoice data issues and coordinate with various vendors and manage all previous balance.
  • Organize all consumption anomalies and determine defects for data and prepare appropriate resolutions.
  • Supervise process management tools and ensure compliance to all cycle guidelines.
  • Maintain and document library of invoices and resolve all issues in same.
  • Perform internal audit and prepare all invoices and determine quality improvement processes.
  • Maintain and escalate issues to lead analyst if required.

2)     Company: Sutherland Healthcare Solutions, Hyderabad.

Worked as a Process Associate in Sutherland Global Services, Hyderabad.

  • Assists in implementing production procedures to optimize new and existing manufacturing processes.
  • Gathers research on new and existing technologies and procedures
  • Monitor all transactions and ensure compliance to quality regulations and maintain effective relationships with clients.
  • Manage everyday work activities and informed supervisor appropriately
  • Administer and collect all metrics on processes and identify data points to improve all processes.
  • Documents all transactions on an everyday basis and collate metrics from various associates and prepare appropriate reports.(Claims Analyst)
  • Monitor all data entry operations and ensure compliance to timeframe.
  • Ensure and maintain effective professional relationships with staff.
  • Perform quality check assessment on all processes of various associates.
  • Coordinate with team members and ensure achievement of all team objectives and goals.(Claims Analyst)
  • Analyze all issues of internal and external clients and provide effective resolutions for same.

PERSONAL PROFILE:

Name                                       :           XYZ

Father’s Name                           :         XYZ

Marital Status                            :          Married

Nationality                                 :            Indian

Passport No                               :            00000

Visa Type                                  :           Visit Visa

Hobbies                                     :            Playing cricket.

Date of Birth                             :          31,MaY, 1986