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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Proficient in claims processing and adjudication, with a strong understanding of ICD-9/10 codes and CPT. Capable of maintaining accurate records and providing effective communication and feedback within a team environment.
Highest-signal resume keywords
Claims ProcessingICD-9/10 CodesCurrent Procedural Terminology (CPT)Analytical SkillsCommunication 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 AdjudicationClaims AdjustmentsManual PricingReference Material MaintenanceComputer Applications Navigation
Soft Skills
Basic Written CommunicationBasic Oral CommunicationReading Comprehension
Certifications & Qualifications
GEDHigh School Diploma
Industry Keywords
ClaimsQuality Team CollaborationClaims Edits ResolutionSuspended Claims Management
About the role
Key responsibilities & impact- Process all claims accurately and timely
- Adjudicate claims and adjustments as required
- Resolve claims edits and suspended claims
- Maintain and update reference materials for claims adjudication
- Provide backup support to team/group members
- Manually price claims using various tools and processes
- Review daily material updates and provide feedback or suggestions
- Partner with the Quality team on procedures and complex claims
- Receive coaching from leadership
Requirements
What you’ll need- Demonstrated ability to navigate computer applications
- Experience with ICD-9/10 codes and Current Procedural Terminology (CPT)
- Demonstrated basic analytical skills
- Basic written/oral communication skills
- Demonstrated reading comprehension and ability to follow provided directions
- Required work experience in Claims
- Required education: GED or High School
Benefits
Comp & perks- Short-term incentives may be available
- Comprehensive benefits package
- Health, life, voluntary, and other benefits
- Physical, mental, emotional, and financial wellbeing perks
- Tobacco-free workplace