Claims Consultant Resume

[First Name] [Last Name]

Contact Address: [street]

[Country] [City] [State/Province] [Zip Code]

Contact Number: (012)-345-6789

Email Address: [[email protected]]

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Career Objective:

To work as a claims consultant for a health insurance company and perform thorough investigation for filed claims and resolved financial issues in an amicable manner.

Summary of Skills:

  • Experience in solving medical claims dispute in a professional manner
  • Knowledge of the medical industry, medical terminology, diagnosis and treatment procedures
  • Thorough knowledge of claims verification, investigation process, fraud detection, and payment processing
  • Strong numerical, computer, interpersonal and communication skills
  • Matured, professional, good listener, and decent negotiator
  • Skilled in holding meeting, presenting facts, and soothing clients

Work Experience:

Claims Consultant
ABC Insurance Company, Houston, TX

October 2013 – Present

  • Verify claims submitted for completeness and authenticity
  • Visit hospitals, clinics, and other medical service providers and collect information on treatment provided
  • Ensure details filed are as per established medical insurance policies
  • Negotiate with insured, service provider, and settle financial issues
  • Approve and reject claims by conducting detailed investigation
  • Maintain medical bills, medical reports, and other documents for reference
  • Ensure no escalation for claims filed and try not to get involved in litigation process

Claims Consultant
Phantom Insurance Company, Houston, TX

May 2012 – September 2013

  • Interviewed insureds, claimants, and witnesses and collected information
  • Created physical and digital file with complete investigation report
  • Evaluated filed claims and negotiated between the two parties
  • Processed, adjusted, and issued checks for settling payment
  • Negotiated settlement between insureds and claimants in a peaceful manner
  • Provided support to insureds in completing forms for filing claims
  • Verified authenticity and identify of the filed claims and insureds and processed claims

Education:

  • Bachelor’s Degree in Accounting
    Houston University, Houston, TX
    2011

Reference:

On request.