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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