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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.

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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