Medical Claims Specialist Resume Example & Writing Guide

Use this Medical Claims Specialist resume example and guide to improve your career and write a powerful resume that will separate you from the competition.

Medical claims specialists are responsible for processing insurance claims for health care providers, working with doctors, hospitals, labs, pharmacies, and other medical facilities to ensure that their patients receive the care they need. They’re also tasked with identifying errors or inconsistencies in claims, returning calls to patients or providers when there are questions about a claim, and following up with insurance companies when there are issues with payment.

If you’re looking for a career in healthcare that allows you to use your analytical skills and attention to detail while also helping people, then becoming a medical claims specialist could be the perfect fit for you. Follow these tips and resume example to write a great medical claims specialist resume that will land you interviews in no time.

Michael Garcia
Los Angeles, CA | (123) 456-7891 | [email protected]

Highly experienced medical claims specialist with over 10 years of experience in the insurance industry. Proven ability to handle high-volume claims and navigate the complex web of insurance benefits. Skilled at problem solving and working with patients to ensure they receive the best possible care.

California State University, East Bay Jun '10
B.S. in Business Administration
Company A, Medical Claims Specialist Jan '17 – Current
  • Processed medical claims for members and dependents, including but not limited to: eligibility determinations, claim submissions, benefit plan amendments, terminations of coverage, etc.
  • Provided customer service support by responding to inquiries regarding benefits and/or claims status via phone or email within established timeframes.
  • Assisted with the development of new products and services as well as enhancements to existing ones through research and analysis of market trends and competitor activity.
  • Participated in projects that enhance our ability to deliver quality member care while maintaining a high level of operational efficiency.
  • Maintained knowledge of all applicable state regulations pertaining to health insurance companies along with federal laws governing employee relations (e.g., FMLA).
Company B, Medical Claims Specialist Jan '12 – Dec '16
  • Created and edited medical billing documents, including Explanation of Benefits (EOBs) for submission to insurance companies
  • Answered patient inquiries via email or phone regarding coverage status, benefits eligibility and claim status
  • Managed a high volume of daily incoming claims from multiple carriers; processed 95% on time
  • Maintained current knowledge of Medicare regulations and best practices in the industry
  • Collaborated with other departments to resolve payment issues that could not be resolved internally
Company C, Medical Billing and Coding Specialist Jan '09 – Dec '11
  • Reviewed medical records to ensure accuracy and completeness of diagnosis and procedure codes for billing purposes.
  • Submitted insurance claims electronically and processed patient payments.
  • Resolved coding denials by reviewing medical records and collaborating with physicians.
  • Certified Professional in Healthcare Compliance (CPHC)
  • Certified Medical Reimbursement Specialist (CMRS)
  • Billing and Coding Certification

Industry Knowledge: Health Insurance, Medical Terminology, CPT/ICD-9, ICD-10, HIPAA, Medicare, Medicaid, EOBs
Technical Skills: Microsoft Office Suite, SAS, SPSS, Excel, Word, PowerPoint
Soft Skills: Communication, Problem-Solving, Attention to Detail, Time Management, Teamwork

How to Write a Medical Claims Specialist Resume

Here’s how to write a medical claims specialist resume of your own.

Write Compelling Bullet Points

The best way to make your resume stand out is to use specific examples and numbers. So rather than saying you “managed claims processing for large health care provider,” you could say that you “managed claims processing for large health care provider, reducing turnaround time from 10 days to 3 days while maintaining 99.9% accuracy rate.”

The second bullet point is much stronger because it provides specific details about what you did, how you did it, and the results of your work.

Identify and Include Relevant Keywords

When you submit your resume for a medical claims specialist role, it’s likely that it will be scanned by an applicant tracking system (ATS) for certain keywords. ATS programs look for certain terms related to the job, like “medical coding” or “insurance” in order to determine whether your skills are a match for the job. If your resume doesn’t have enough of the right keywords, the ATS might filter out your application.

To increase your chances of getting an interview, use this list of common medical claims specialist keywords as a starting point when writing your resume:

  • Medical Billing
  • Electronic Medical Record (EMR)
  • Medical Terminology
  • U.S. Health Insurance Portability and Accountability Act (HIPAA)
  • Healthcare
  • Healthcare Management
  • Healthcare Information Technology (HIT)
  • Medical Coding
  • Insurance
  • Data Entry
  • Claims Management
  • Account Reconciliation
  • Insurance Claims
  • Medical Records
  • Medicaid
  • Hospitals
  • Claim Appeals
  • Patient Safety
  • Reimbursement
  • Medicare
  • Life Insurance
  • Property & Casualty Insurance
  • Reinsurance
  • Customer Service
  • Medical Assisting
  • Electronic Billing
  • Government Programs
  • Commercial Insurance
  • Working with Physicians
  • Teamwork

Showcase Your Technical Skills

As a medical claims specialist, you will need to be proficient in the use of software programs like ICD-10, CPT, and HCPCS. You will also need to have a solid understanding of medical billing and coding. Additionally, it is important to be able to effectively communicate with doctors, nurses, and other members of the healthcare team.


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