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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical case management, utilization review, and claims processing, with strong analytical and organizational skills. Proficient in ICD 9 and CPT coding systems, and capable of providing exceptional customer service in a medical environment.
Highest-signal resume keywords
Medical Case ManagementUtilization ReviewICD 9 CodingCPT CodingCustomer Service Experience
About the role
Key responsibilities & impact- Access and assign cases for medical case management, utilization review and clinical consultation
- Provide accurate information to callers based on customer requests
- Triage telephone calls between utilization review, clinical consultation and telephonic case managers
- Enter new claims data accurately into the claims management system
- Maintain data integrity
- Support clinical staff through components of case management and utilization review
- Schedule diagnostic tests and physician appointments
- Provide channeling services for injured workers, employers and claims examiners by directing them into the PPO network
- Gather statistics and provide reports
- Confirm receipt of fax forms and regulatory filings
- Distribute, fax, mail and copy correspondence
Requirements
What you’ll need- Associate's degree or two (2) years of college preferred
- One (1) year of administrative experience required
- Customer service experience in a medical field preferred
- Worker's compensation, disability and/or liability claims processing experience preferred
- Knowledge of medical and insurance terms
- Knowledge of ICD 9 and CPT coding systems
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills; detail-oriented
- Good interpersonal skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
Benefits
Comp & perks- Blended work environment
- On-going learning and professional growth opportunities
- Three medical plans to choose from
- Two dental plans to choose from
- Vision insurance
- Tuition reimbursement eligibility
- 401K plan matching 50% of contributions up to the first 6% saved
- 4 weeks PTO in the first full year
- Disability insurance
- Life insurance
- Employee assistance
- Flexible spending or health savings account
- Additional voluntary benefits
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 EntryStatistical ReportingRegulatory FilingsMedical Terminology
Soft Skills
Excellent CommunicationInterpersonal SkillsOrganizational SkillsTeam CollaborationDetail-Oriented
Tools & Technologies
Claims Management SystemMicrosoft Office
Industry Keywords
Worker's CompensationDisability ClaimsLiability Claims