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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in processing and adjudicating complex claims while ensuring compliance with organizational policies and regulations. Strong analytical and communication skills are essential for resolving claim issues and training new staff.
Highest-signal resume keywords
Claims AdjudicationClaims ProcessingAnalytical SkillsMicrosoft Office ProficiencyOrganizational Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ReviewProcedure CodingDiagnosis CodingClaims VerificationClaims ResearchClaims AdjustmentClaims RecoupmentBusiness MathQuality Standards ComplianceSpreadsheet Management
Soft Skills
Strong Communication SkillsJudgment SkillsDiscretion Handling
Certifications & Qualifications
High School Diploma or Equivalent
Industry Keywords
Claims ManagementInternal StandardsBusiness RegulationsConfidential Information HandlingClaims Edits
About the role
Key responsibilities & impact- Review and adjudicate complex or specialty claims
- Determine whether to return, deny or pay claims according to organizational policies and procedures
- Assist in training or mentoring new staff members
- Examine and process claims according to business/contract regulations, internal standards and examining guidelines
- Enter claims into the claim system after verifying procedure and diagnosis coding
- Verify claims have been keyed correctly
- Ensure claims meet quality and production standards
- Correct processing errors by reprocessing, adjusting, and/or recouping claims
- Research and resolve claims edits and deferrals
- Research claim problems using policies, procedures, reference materials and forms
- Coordinate with internal support areas
- Respond to routine correspondence and complete spreadsheets when applicable
Requirements
What you’ll need- High School Diploma or equivalent
- 2 years of experience processing, researching and adjudicating claims
- Strong organizational, analytical and judgment skills
- Strong oral and written communication skills
- Proficient in spelling, punctuation and grammar
- Proficient in basic business math
- Ability to handle confidential or sensitive information with discretion
- Microsoft Office proficiency
- No sponsorship eligibility now or in the future
Benefits
Comp & perks- Subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
- Supplemental pay until enrolled in health benefits 28 days after the hire date