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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in processing health insurance claims while adhering to regulations and internal standards. Proficient in data analysis and claims resolution, with strong communication skills to support team operations and ensure prompt reimbursement.
Highest-signal resume keywords
Claims ProcessingHealth Insurance OperationsData AnalysisCommunication SkillsClaims Resolution Systems
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 ProcessingData AnalyticsHealth Insurance OperationsClaims ResolutionData EntryProblem SolvingReviewing ClaimsAnalyzing DataNavigating SystemsHandling PHI
Soft Skills
Verbal CommunicationWritten CommunicationAbility to Take DirectionBalancing Competing PrioritiesExecuting Projects with Excellence
Tools & Technologies
Google SuiteMicrosoft Office
Industry Keywords
Claims ProductionProcessing GuidelinesEligibility ReviewPayment GuidelinesComplianceAuditsDiscrepancy IdentificationReimbursement
About the role
Key responsibilities & impact- Accurately and timely process health insurance claims
- Research and process claims according to business regulations, internal standards, and processing guidelines
- Resolve system edits, audits, and claims errors using approved references and investigative sources
- Reduce daily inventory through claims processing
- Contribute to team-wide goals supporting Claims Production daily operations
- Comply with all applicable laws and regulations
- Review eligibility, benefits, supporting documentation, coding, and payment guidelines
- Identify discrepancies or potential issues for follow-up
- Resolve claim inquiries and clarify claim status
- Support prompt reimbursement
- Perform other duties as assigned
- Report to the Claims Lead
Requirements
What you’ll need- High School Diploma, GED or equivalent years of experience in data analytics, provider data and/or claims processing
- Strong verbal and written communication skills
- Ability to take direction and navigate through multiple systems simultaneously
- Ability to solve problems within pre-defined methods and guidelines
- Ability to review claims and analyze critical data
- Experience with navigating claims resolution systems
- Advanced Google Suite or Microsoft Office capabilities or willingness to learn
- In-depth knowledge of Health Insurance operations processing protocols and payment schemes
- Experience manipulating and entering accurate data in a production driven environment
- Experience handling Personal Health Information (PHI) in a professional manner
- Demonstrated capacity to balance competing priorities and continue to execute projects with excellence
Benefits
Comp & perks- Monthly vacation accrual at a rate of 15 days per year
- Medical, dental, and vision benefits
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life and disability insurance
- Paid wellness time and reimbursements
- Remote work from a home office
- Occasional travel for team meetings and company events