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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.