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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

Medical Claims Coordinator Resume Sample

This resume is a sample for the post of Medical Claims Coordinator. A Medical Claim Coordinator is a person who supervises and manages all the approved accidental and casual cases of the clients. The Medical Claim requires case solutions on urgent basis. A Coordinator sees to it. He makes sure that all the cases are carried on smoothly and to the satisfaction of the customer. The insurance company is more interested in hiring a resourceful person with references and contacts for his claims with additional knowledge of medical field and great judgment skill. A person who has the quality, experience and capability of solving all cases to customer’s satisfaction Resume is your first interface with the employer. The resume sample given below should guide in building an impressive resume. Finally adding references to your resume will stand your resume out among others.

Name: XYZ

International city, Dubai

Cell No. 0000

Email xxxxxx

Professional Profile

Aim to secure a responsible position in the field of Insurance where able to utilize my knowledge and technical skills by maintaining a positive environment in the working place.

Professional Experience

Medical Claims Coordinator:

  • Managing all Reimbursement/Direct Billing claims for NLGI
  • Managing Approvals received from TPA and Hospitals
  • Replying to queries from TPA/Broker and Client Via Phone calls(Approx 35 calls per day/includes calls during office hours and out of office)
  • Replying to queries from TPA/Broker and Client Via Email(Approx 75 – 100 emails per day)
  • Maintaining claims tracker for Reimbursement claims/ Direct Billing approvals/ and medical death claims
  • Evaluating and Issuing approvals to the TPA for all direct billing approvals above 20,000 AED(Approx 50- 60 approvals per month)
  • Attending meetings held by Broker/Client and TPA.
  • Visit to the hospital for high cost claims.
  • Assist Cheque dispatch.
  • Coordinating with HO for approvals and all other issues via email and via Phone.
  • Coordinating and Arranging for Direct billing with TPA(Paramount Health Services)
  • Extracting Utilization report and beneficiary list as and when requested by Sales/Operations.
  • TPA payments and float fund management.

Duty Medical Officer

  • Provides medical patient care by interviewing, examining and treating of clinical patient in order to meet their medical needs
  • Educates patients on wellness, prevention and early detection by providing materials and resources to the patients and families, Diet and regimen advice
  • Determines which referrals are required based on examination and patient needs
  • Insurance Claim form filling and processes
  • Determines which referrals are required based on examination and patient needs
  • Exercises final medical judgment in all issues of health care
  • Prescribes medical treatment patients
  • Documents all services in patient medical record Reviews on a regular basis long term cases that require ongoing medical attention
  • Consults with Medical Director and other professionals on staff as needed regarding patient care, assessment, and education issues
  • Participates in quality improvement, management, continuing education, and other patient care programs established by the hospital or clinic requirements
  • Assists in the resolution of complaints, requests and inquiries from patients
  • Maintains confidentiality of all patient information according to federal guidelines and regulations.

Medical Registration

 Medical Council

Homoeo Medical Registration Certificate-A

Registration Number: 000

 Homeopathic medical council

Homoeo medical Registration Certificate-A

Registration Number: 000

Professional Education | Certifications

  1. RVS HOMOEOPATHIC COLLEGE & HOSPITAL.
  2. BHMS (Bachelor of Homoeopathic medical science and Surgery)
  • ICRM (Institute of Clinical research management).

Certificate in Clinical research management.

Internship/ Training

  • Training for Basics of infertility treatment, Infertility counseling, Pelvic scan, IUI and IVF laboratory techniques.
  • Industry internship at Clinical trial site from IQRAA international hospital ,Calicut, Kerala
  • Compulsory rotatory residential internship program from RVS Homoeopathic Medical College & Hospital.                                                          Certifications Presentation/Thesis

Dissertation submitted to the Tamilnadu Dr.MGR Medical University, Chennai as “A CLINICAL STUDY ON IRRITABLE BOWEL SYNDROME (IBS) AND ITS HOMOEOPATHIC MANAGEMENT” as partial fulfillment of the rules and regulation for the degree of Bachelor of Homoeopathic Medicine and Surgery (BHMS) under the guidance of Dr. Vinay Kumar MD (HOM), Head of the department of Forensic Medicine and Toxicology, RVS HMC, Coimbatore, Tamilnadu.                                               

Seminar/Conferences

  • Attended one day workshop on “SOURCE DOCUMENTATION” by Harish V Shankarankutty, Senior Clinical research associate & quality reviewer, GSK Pharmaceutical Ltd held at Institute of Clinical research Management, Calicut on 26th of August 2010
  • Attended one day workshop on “QUALITY MANAGEMENT IN CLINICAL TRIALS” by Harish V Shankarankutty, Senior Clinical research associate & quality reviewer, GSK Pharmaceutical Ltd held at Institute of Clinical research Management, Calicut on 23RD of September 2010
  • Attended the seminar on Food weapon conducted by IHMA (Indian Homoeopathic Medical Association)
  • Attended the continuing medical education program (CME) on Arthritis and its management conducted by IHMA (Indian Homoeopathic Medical Association)
  • Kerala state conference 2011 ‘FORSCHENE’ by IHMA (Indian Homoeopathic medical association) facilitated by Dr.Jayesh Bellare (Phd FNASc FNAE), IIT, Bombay (Scientific evidence for the presence of medicines in higher potencies).

 Personal Profile

AGE & DATE OF BIRTH                                    : 00

SEX                                                                         : Female

MARITAL STATUS                                             : Single

PASSPORT No                                                      : 00000

VISA STATUS                                                       : 0000

NATIONALITY                                                     : Indian

Medical Claims Secretary Resume Sample

This is a sample resume for the post of Medical Claims Secretary. A Secretary’s job, be it from any department, requires full-time commitment and low level of risks or mistakes. A Claim Secretary is a person who handles all the accidental and casual cases of the clients. The Medical Claim requires case solutions on urgent basis. The insurance company is more interested in hiring a resourceful person with references and contacts for his claims with additional knowledge of medical field and great judgment skill. A person who has the quality, experience and capability of solving all cases to customer’s satisfaction Resume is your first interface with the employer. The resume sample given below should guide in building an impressive resume. Finally adding references to your resume will stand your resume out among others.

NAME:XYZ

United Arab Emirates
Mobile No.: 0000

E-Mail Address: xxxx

CAREER OBJECTIVE:

To work with your company for any position I can utilize my medical profession, skills and work experience.

PROFESSIONAL QUALIFICATIONS:

  • Provides quality service  to  clients  and  effectively  assess  and  process  claims  and approval according to set standards.
  • Communication and leadership skills; excellent customer service relation.
  • Knowledge in MS Office software – Word, Excel, PowerPoint.
  • Recognized record of reliability and responsibility.
  • Resourceful problem solver capable of implementing solutions to complex problems; Flexible, can work under pressure and overtime as needed.
  • Remain calm and professional throughout critical incidents, with enthusiasm.
  • Ability to create a positive working environment.
  • Commitment to excellence and high standards.
  • Strong analytically skills, capable of assessing conditions and implementing appropriate intervention.

PROFESSIONAL EXPERIENCE:

Medical Claims Secretary

Arab Gulf Health Services- Nextcare

Sheikh Zayed Road, Dubai, UAE

September 22, 2014 – Present

  • Responsible on all claims update on the system and effectively adhere documentation /filing to the set standards.
  • Facilitate urgent follow-ups from call-center and channel it to respective departments.
  • Organize files, claims documents received and medical reports according to set standards and retrieved files as necessary.
  • Take charge of the high-cost claims sheet.
  • Accurately enter data on the system both Inpatient and Outpatient claims.
  • Determine all incoming faxes and channel documents to respective department accordingly.
  • Record all incoming and outgoing claims in the system and thru excel sheet.
  • Entertain all inquiries from phone calls, faxes and email communication.
  • Follow-up all status of claims, until a final judgment is made by medical claims officer.
  • Offers assistance to other team members.

Medical Claims Assessor

Arab Gulf Health Services.

Sheikh Zayed Road, Dubai, UAE

  • Ensuring patients membership validity and insurance coverage.
  • Enter ICD codes for patient’s complaints and diagnosis.
  • Enter CPT codes for patient request of procedures and other requested items.
  • Provide Written approval  through  emails,  faxes,  and  computer  generated system .
  • Applying intended coinsurance and deductible as per insurance policy.
  • Application of  adjudication  procedures  to  make  sure  proper  payment  of claims.
  • Review pending and denied claims submitted by providers for re-evaluation
  • Provide actual decisions for approval and denial in due time.
  • Providing quality customer service to members, providers, and other insurance companies.

General Ward Nurse 

Saint Jude Clinic and Hospital

Sto. Niño, South Cotabato, Philippines

Nurse Volunteer

Saint Jude Clinic and Hospital

Sto.Niño, South Cotabato, Philippines

CERTIFICATE / LICENSE:

  • Professional Board Examination for Nurses,
    License No.: 0000
    • Registered IV Therapy Nurse
    Current Member
    License No.: 0000
    • Philippine Nurses Association
    Current Member

ADVANCED TRAINING’S AND SEMINARS:

April 18, 2009                                      Cardio-pulmonary Assessment and Emergency Management

October 21, 2008                                 Seminar on Hospital Waste Management Program

October 16, 2008                                 Nursing Alert! Look, Listen, and Feel: Sharpening Your Assessment Skills

August 2. 2008                                     Seminar on Safe Nursing Practice

July 5, 2008                                          IV Chemotherapy

June 14, 2008                                       Seminar on Nursing Management for Myocardial Infarction

May 27, 2008                                      Dosage and Solutions Competency Review

May 22-24, 2008                                                Basic IV Therapy Training for Nurses

May 15, 2008                                      Seminar on Care of Patients on

May 13, 2008                                      Seminar on Training During Emergencies

April 26, 2008                                      Seminar on Total Parental Nutrition

April 19, 2008                                      Selected Cardiovascular Drugs: a Refresher

EDUCATIONAL BACKGROUND:

DAVAO DOCTORS COLLEGE

General Malvar St. Davao City

  • Bachelor of Science in Nursing, 2007

NOTRE DAME OF NORALA

PoblacionNorala, South Cotabato

  • High School Graduate, 2003

NOTRE DAME OF NORALA

PoblacionNorala, South Cotabato

  • Elementary School Graduate, 1999

PERSONAL DATA

Age                                            : 30 years old

Date of Birth                           : January 16, 1988

Sex                                            : Female

Civil Status                              : Single

Citizenship                               : Filipino

Religion                                    : Roman Catholic

Language Spoken                   : English; Tagalog

References :

available upon request.

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

 

Claim Processor Resume Sample

This resume is a sample for the post of a Claim Processor. The nature of this job is very important and operational where you must perform with your full-time skill, devotion absolute confidence. A Claim Officer primarily handles all the cases after precise investigation of the clients. He tries to solve urgently and makes sure to pay all the claim benefits on time. The insurance company would want to hire a person for the claim processor who has prevalent and up-to-date knowledge of medical field and have great and quick judgment skill; a person with quick decision making. A multi-talented person is definitely going to nail his name. Resume is your first interface with the employer so pay attention to build an attractive resume. Below we have devised an easy but impressive sample for this post. Enlist your basic education and skills followed by past experiences. For your help down we have mentioned all experiences that are highly demanded by the employer.

Name:XYZ

Deira, Dubai U.A.E

Mobile #:  +0000

Email add: xxxxx

Career Objectives

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.

Professional Qualification/Skills

  • High level of computer literacy (MS Word, Excel, MS Powerpoint)
  • Flexible to work independently or with a team
  • Highly capable of multi –tasking on a limited time scale
  • Solution finding oriented
  • Possess problem solving techniques
  • Ability to work under pressure and meet deadlines
  • Excellent follow up and organizational skills.
  • Be client oriented : listening and understanding to clients’ requests / ability to establish good work relationships matching our clients’ needs
  • Positive attitude when confronted to change
  • Attention to details and an observant of protocol and internal standards

PROFESSIONAL EXPERIENCE

  1. Team Leader- Medical Claims Assessor/Processor

Job Description:

  • Provide customer service for plan benefits, provider networks and available services.
  • Processes medical claims and assure proper payment in accordance with the benefit plan. Provide customer service for plan benefits, provider networks and available services.
  • Independent and timely processing of claims in accordance with client requirements, member plan benefits, and applicable network fee schedules with minimal assistance.
  • Enter claims data into system while interpreting coding and understanding medical terminology in relation to the diagnosis and procedures.
  • Process claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
  • Meets quotas in terms of quantity and quality of claims processing standards.
  • Maintain current knowledge of assigned plan (s) and effectively apply this knowledge in the processing of claims and providing customer service.
  • Research bill discrepancies.
  • Deliver high quality customer service and respect medical & work ethics at all times.
  • Interact with medical units to capture the needs for new or changes guidelines and training & evaluation.
  • Develop medical guidelines (and accompanying rules) in line with the end-to-end process view of the company.
  • Coordinating with medical providers for the verification of documents. Following up with insurers for settlement.
  • Obtaining claims data from insurer and preparing claims report
  1. Medical Claims Administrator/ Processor

       Medical Claims Department

        NEURON LLC Dubai- TPA

Job Description:

  • Processes medical claims and assure proper payment in accordance with the benefit plan. Provide customer service for plan benefits, provider networks and available services.
  • Independent and timely processing of claims in accordance with client requirements, member plan benefits, and applicable network fee schedules with minimal assistance.
  • Enter claims data into system while interpreting coding and understanding medical terminology in relation to the diagnosis and procedures.
  • Process claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
  • Meets quotas in terms of quantity and quality of claims processing standards.
  • Maintain current knowledge of assigned plan (s) and effectively apply this knowledge in the processing of claims and providing customer service.
  • Research bill discrepancies.
  • Coordinating with medical providers for the verification of documents. Following up with insurers for settlement.
  • Obtaining claims data from insurer and preparing claims report
  • Reconciliation of Outpatient and Inpatient claims.
  • Perform related duties as assigned
  • Provides nursing care to patients.

Staff Nurse

 Job Description:

  • Identifies nursing needs of patients.
  • Carries out physicians orders.
  • Prepares equipment and aids physicians during treatment and an examination.
  • Taking patient’s history, allergies and other manifestations in the family.
  • Monitoring vital signs and reporting of any untoward signs and symptoms.
  • Administering medicines conscientiously by observing the five rights.
  • Informing laboratory results to the physicians.
  • Imparts the importance of health teachings to patients and clients family.
  • Assisting the physician in bedside rounds and procedures.
  • Putting patients at ease and reassuring him whenever necessary in giving treatment for his comfort.
  • The patient is safe guarded psychologically by discerning observation of all signs and symptoms relating either to local area or to his general condition.
  • Administer steam inhalation as per doctor’s order.
  • Administer oxygen inhalation to patient with respiratory difficulties.
  • Prepare patient for minor operations.
  • Assist physician during minor operation.
  • Proper and adequate cleansing and treatment of wounds.
  1. Staff Nurse/Nurse Trainee

Gives direct patient care. 

Job Description:

  • Anticipate nursing needs and treatments.
  • Gives critically ill patients the special health care needed, physical, psychological and spiritual.
  • Carry – out physician’s orders such as IV insertion, IM, SC Injections, Blood
  • Assist physician and other members of the health team with tests, examinations and treatments.
  • Extraction, Oral Medications.
  • Cooperates and shares responsibilities with co-nurse, head nurse, supervisors,

Physicians and the member of the health team.

Date of birth               13 Jan 1986

Sex                                Female

Citizenship                  Filipino

Languages Spoken    English,

Visa Status                  Employment Visa Transferable

Medical Claim Specialist Resume Sample

This resume is a sample for the post of a Medical Claim Specialist. This is a very important and operational nature job that demands your full-time devotion, commitment and skill. A claim specialist is a person who handles all the accidental and casual cases of the clients. The Medical Claim requires case solutions on urgent basis. The insurance company is more interested in hiring a resourceful person with references and contacts for his claims with additional knowledge of medical field and great judgment skill. A person who has the quality, experience and capability of solving all cases to customer’s satisfaction Resume is your first interface with the employer. The resume sample given below should guide in building an impressive resume. Finally adding references to your resume will stand your resume out among others.

Name:XYZ

Dubai U.A.E

Mobile #:  0000

Email add: xxxxx

Career Objectives

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.

Professional Qualification/Skills

  • High level of computer literacy (MS Word, Excel, MS PowerPoint)
  • Flexible to work independently or with a team
  • Highly capable of multi –tasking on a limited time scale
  • Solution finding oriented
  • Possess problem solving techniques
  • Ability to work under pressure and meet deadlines
  • Excellent follow up and organizational skills.
  • Be client oriented : listening and understanding to clients’ requests / ability to establish good work relationships matching our clients’ needs
  • Positive attitude when confronted to change
  • Attention to details and an observant of protocol and internal standards

PROFESSIONAL EXPERIENCE

Team Leader- Medical Claims Assessor/Processor

Job Description:

  • Independent and timely processing of claims in accordance with client requirements, member plan benefits, and applicable network fee schedules with minimal assistance.
  • Enter claims data into system while interpreting coding and understanding medical terminology in relation to the diagnosis and procedures.
  • Process claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
  • Meets quotas in terms of quantity and quality of claims processing standards.
  • Maintain current knowledge of assigned plan (s) and effectively apply this knowledge in the processing of claims and providing customer service.
  • Research bill discrepancies.
  • Deliver high quality customer service and respect medical & work ethics at all times.
  • Interact with medical units to capture the needs for new or changes guidelines and training & evaluation.
  • Develop medical guidelines (and accompanying rules) in line with the end-to-end process view of the company.
  • Coordinating with medical providers for the verification of documents. Following up with insurers for settlement.
  • Obtaining claims data from insurer and preparing claims report

Medical Claims Administrator/ Processor

Job Description:

  • Processes medical claims and assure proper payment in accordance with the benefit plan. Provide customer service for plan benefits, provider networks and available services.
  • Independent and timely processing of claims in accordance with client requirements, member plan benefits, and applicable network fee schedules with minimal assistance.
  • Enter claims data into system while interpreting coding and understanding medical terminology in relation to the diagnosis and procedures.
  • Process claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
  • Meets quotas in terms of quantity and quality of claims processing standards.
  • Maintain current knowledge of assigned plan (s) and effectively apply this knowledge in the processing of claims and providing customer service.
  • Research bill discrepancies.
  • Deliver high quality customer service and respect medical & work ethics at all times.
  • Interact with medical units to capture the needs for new or changes guidelines and training & evaluation.
  • Develop medical guidelines (and accompanying rules) in line with the end-to-end process view of the company.
  • Coordinating with medical providers for the verification of documents. Following up with insurers for settlement.
  • Obtaining claims data from insurer and preparing claims report
  • Reconciliation of Outpatient and Inpatient claims.
  • Perform related duties as assigned

Staff Nurse
Job Description:
 

  • Provides nursing care to patients.
  • Identifies nursing needs of patients.
  • Carries out physicians orders.
  • Prepares equipment and aids physicians during treatment and an examination.
  • Taking patient’s history, allergies and other manifestations in the family.
  • Monitoring vital signs and reporting of any untoward signs and symptoms.
  • Administering medicines conscientiously by observing the five rights.
  • Informing laboratory results to the physicians.
  • Imparts the importance of health teachings to patients and clients family.
  • Assisting the physician in bedside rounds and procedures.
  • Putting patients at ease and reassuring him whenever necessary in giving treatment for his comfort.
  • The patient is safe guarded psychologically by discerning observation of all signs and symptoms relating either to local area or to his general condition.
  • Administer steam inhalation as per doctor’s order.
  • Administer oxygen inhalation to patient with respiratory difficulties.
  • Prepare patient for minor operations.
  • Assist physician during minor operation.
  • Proper and adequate cleansing and treatment of wounds.
  1. Staff Nurse/Nurse Trainee

 Job Description:

  • Anticipate nursing needs and treatments.
  • Gives critically ill patients the special health care needed, physical, psychological and spiritual.
  • Carry – out physician’s orders such as IV insertion, IM, SC Injections, Blood
  • Assist physician and other members of the health team with tests, examinations and treatments.
  • Extraction, Oral Medications.
  • Cooperates and shares responsibilities with co-nurse, head nurse, supervisors,

Physicians and the member of the health team.

Date of birth             000

Sex                              Female

Citizenship                Filipino

Languages Spoken  English,

Visa Status                Employment Visa Transferable

Insurance Claim Investigator Resume Sample

This resume is a sample for the post of Insurance Cum Claim Investigator. The insurance claim processor post requires rich experience and multiple skills. Because a claim officer investigator’s major responsibility is to study all the claim cases, finding all hidden truth and assessing the customer loss along with real reason. The insurance company hires a person for this post who has previous experience, versatile and quick judgement skill. Because every company wants to find out actual reason of the loss and to satisfy the customer also with his investigator report. For this purpose we have constructed a sample resume that should give you better guidance in building a better resume. Finally adding references to your resume is going to stand your resume out among other appliactors.

Namr:XYZ

Dubai.UAE

Mobile: 00000

Email: xxxxxx

OBJECTIVE:-

Seeking a position as a Claims Processor or Customer Service – Medical Call Centre with a reputed organization /Insurance Company / TPA where my professional and personal skills can be utilized to achieve their goals which in turn enhance my career growth as well.

PROFILE:-

  • Understanding of medical terminology in relation to diagnoses and procedures.
  • Knowledge of verifying unrecognized characters and flags quality issues as they arise
  • Demonstrated ability of communicating to customers in a timely, polite manner
  • Independent self-motivated, able to take responsibilities and work well under pressure, quick learn and flexible team player
  • Resourceful with an ability to organize and prioritize multiple tasks
  • Provide high level customer service, excellent communication skills, able to interact with customers of different nationality and culture
  • Excellent MS Office skills.

PROFESSIONAL EXPERIENCE:-

  • Daman national insurance Abudhabi .claims processor in international patient care and E claims May 12-2013 -till now.
  • Clouds Stationery Trading – Customer Service and Sales Assistant (May 15th, 2009 July 31st, 2012)
  • School Nurse Al Sadique School, Al Qusais, Dubai – (May 2008 to October 2008)
  • Staff Nurse – Philip Memorial Hospital, Kerala, India (January 2003 to July 2005)
  • Staff Nurse – Vijay Hospital, Chennai, India (November 2000 to May 2002

RESPONSIBILITIES:-

Nursing related Skills

  • Management of multiple trauma patients, neurological patient care including use & interpretation of GCS, care of adult incubated and ventilated patient
  • Knowledge of paediatric and neonatal intensive care concepts
  • Initiate and maintain Basic Cardiac Life Support, working knowledge of other specialized equipment’s.
  • Basic knowledge of tropical diseases and their management
  • Care of pregnant women, monitoring patients during labor, conducting delivery (with and without episiotomy), post-natal care etc.

RESPONSIBILITIES:- Others – Call Centre – Sales

  • Handle general administration tasks for the organization.
  • Provide administrative support to the Management for Operations including scheduling of business meetings and appointments and arrangement of department functions
  • Maintain office facilities including procurement processing of necessary office supplies and equipment requirements, petty cash management, prepare & maintain expenses
  • Prepare office supplies and equipment purchase requisitions, coordinate and monitor maintenance services and serve as liaison between departments, management and staff.
  • Assists the Manager during the employment processing of job applicants by collecting the initial document requirements and scheduling of interview appointments.
  • Interdepartmental coordination; responsible for annual maintenance contracts.
  • Review, organize and distribution of incoming/outgoing mail.
  • Input data and compile report information into a database.
  • Maintain and update accounts status of clients on computer software program.
  • Communicate & prepare necessary office correspondence.
  • Handling Conference calls / discussing process specific changes, process improvements
  • Appraising team members jointly with the manager on the basis of the quality parameters, job knowledge, communication skills and production targets achieved attendance and an overall performance evaluation.
  • Marketing over the phone and at times, meeting clients.

Academic Qualification:

  • Registered Nurse (G N M) from the University of Karnataka, Bangalore in the year 2000

Personal Details.

Date of Birth               :           2nd June, 1977

Religion                       :           Christian

Marital status              :           Married

Driving License           :           UAE Driving License

Language known         :           Fluent in English, Hindi, Tamil and Malayalam