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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