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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical claims adjudication and processing, with a strong focus on attention to detail and effective communication. Capable of working independently and collaboratively to meet deadlines while improving claims processes.
Highest-signal resume keywords
Claims AdjudicationClaims Processing ExperienceAttention To DetailWritten And Verbal CommunicationKnowledge Of Insurance Principles
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 ProcessingClaims AdjudicationResearch And Resolution Of Claim IssuesProcessing Appeals And DisputesMeeting Processing Targets
Soft Skills
Excellent Communication SkillsAbility To Work IndependentlyTeam CollaborationFast LearnerSelf-Directed
Certifications & Qualifications
Two-Year Degree
Industry Keywords
Health Plan PoliciesClaims ManagementCustomer SupportOperational IssuesTimely Payment
About the role
Key responsibilities & impact- Ensure timely and accurate adjudication and payment of medical claims according to health plan policies and procedures
- Consult with team members, care partners, and advisors as necessary
- Maintain accurate and up-to-date notes of all claims processed
- Process appeals and disputes by gathering and verifying claim information
- Research and resolve claim issues and communicate outcomes to appropriate parties
- Provide claims-related answers and support to Customer Success and Customer Support teams
- Identify operational issues and escalate them to the appropriate internal team
- Contribute to teamwide goals to improve claims processes and integrate additional functions into daily operations
- Work independently and as part of a team to meet deadlines and daily processing quotas
- Complete daily and weekly processing targets
Requirements
What you’ll need- Two-year degree and/or two years of claims adjudication and processing experience
- Unparalleled attention to detail
- Excellent written and verbal communication skills
- Ability to work independently and as part of a team
- Fast learner, entrepreneurial, and self-directed
- Ability to meet deadlines and work under pressure
- Experience in claims processing and knowledge of insurance principles and procedures is a plus
Benefits
Comp & perks- Base salary of $43,000–$59,000 per year
- Equity
