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Emmett Butler
Claim Processing Specialist
Summary
Highly experienced Claim Processing Specialist with a proven track record of evaluating and processing over 1000 claims per month, ensuring accuracy and adherence to company policies. Utilized advanced claims management software to track, monitor, and document claims throughout the processing cycle. Negotiated and settled claims with claimants and healthcare providers, resulting in cost savings of $150,000 annually. Identified and investigated fraudulent claims, preventing over $200,000 in potential losses. Developed and implemented training programs for new claim processing specialists, improving team efficiency by 20%. Managed a team of 5 claim processing representatives, providing guidance and support. Collaborated with departments across the organization to ensure seamless claims processing. Established and maintained positive relationships with key stakeholders, including policyholders and brokers.
Education
Bachelor’s Degree in Business Administration, Finance
August 2015
Skills
- Claims Investigation
- Policy Interpretation
- Settlement Negotiation
- Subrogation
- Medical Terminology
- Fraud Detection
Work Experience
Claim Processing Specialist
- Developed and implemented training programs for new claim processing specialists, improving team efficiency by 20%.
- Managed a team of 5 claim processing representatives, providing guidance and support.
- Collaborated with departments across the organization to ensure seamless claims processing.
- Established and maintained positive relationships with key stakeholders, including policyholders and brokers.
Claim Processing Specialist
- Evaluated and processed over 1000 claims per month, ensuring accuracy and adherence to company policies.
- Utilized advanced claims management software to track, monitor, and document claims throughout the processing cycle.
- Negotiated and settled claims with claimants and healthcare providers, resulting in cost savings of $150,000 annually.
- Identified and investigated fraudulent claims, preventing over $200,000 in potential losses.
Accomplishments
- Implemented a new claim processing software that streamlined the process and reduced turnaround time by 20%.
- Developed and implemented training materials for new claim processing specialists, resulting in a 15% reduction in errors.
- Collaborated with the legal department to develop new claim handling guidelines that improved compliance and reduced litigation risks.
- Successfully processed over 5,000 claims per month, maintaining a high level of accuracy and customer satisfaction.
- Established a peer review system to ensure the accuracy and consistency of claim processing across the team.
Awards
- Received the Employee of the Month award for outstanding performance in claim processing accuracy and efficiency.
- Recognized with the Top Performer Award for consistently exceeding claim processing targets and customer satisfaction benchmarks.
- Awarded the Quality Excellence Award for maintaining a high level of accuracy and attention to detail in claim processing.
Certificates
- Certified Claim Processor (CCP)
- Associate in Claims (AIC)
- Certified Professional in Insurance Adjusting (CPIA)
- Certified Insurance Claims Specialist (CICS)
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How To Write Resume For Claim Processing Specialist
- Highlight your experience in evaluating and processing claims.
- Demonstrate your knowledge of insurance policies and procedures.
- Showcase your negotiation and settlement skills.
- Emphasize your ability to identify and investigate fraudulent claims.
Essential Experience Highlights for a Strong Claim Processing Specialist Resume
- Evaluate and process claims according to company policies and procedures
- Investigate and resolve discrepancies in claims
- Negotiate and settle claims with claimants and healthcare providers
- Identify and investigate fraudulent claims
- Train and mentor new claim processing specialists
- Manage a team of claim processing representatives
- Collaborate with departments across the organization to ensure seamless claims processing
Frequently Asked Questions (FAQ’s) For Claim Processing Specialist
What is the role of a Claim Processing Specialist?
A Claim Processing Specialist is responsible for evaluating, processing, and settling insurance claims. They investigate claims, negotiate with claimants and healthcare providers, and identify and investigate fraudulent claims.
What are the qualifications for a Claim Processing Specialist?
To become a Claim Processing Specialist, you typically need a bachelor’s degree in business administration, finance, or a related field. You also need experience in claims processing and insurance.
What are the key skills for a Claim Processing Specialist?
Key skills for a Claim Processing Specialist include: claims investigation, policy interpretation, settlement negotiation, subrogation, medical terminology, and fraud detection.
What is the job outlook for Claim Processing Specialists?
The job outlook for Claim Processing Specialists is expected to grow faster than average in the coming years.
What is the average salary for a Claim Processing Specialist?
The average salary for a Claim Processing Specialist is around $50,000 per year.