Resume For Claims Examiner

Rajan Sharma
956/6, Gandhi Nagar,
Delhi – 110011
(+91-11) 456 789

OBJECTIVE
A challenging and responsible position where my experience as a Claims Examiner for Medical Assistance recipients and provider liaison can be utilized in support of company goals.

SUMMARY
Over eight years experience in positions of increasing responsibility with rapidly growing Health Maintenance organization includes the following:

Organizing and establishing policies for Medical Assistance Organization.

Extensive customer service and provider communication.

Staff supervision and coordination.

Auditing and quality control.

Utilizing Com Tec and Disc Corp computer system.



EXPERIENCE
1986-Present IDAHO HMO, Boise, ID
Quality Control Coordinator (1991 -Present)
Maintain daily, weekly and monthly statistics on 25 claims examiners, reporting claim error through paper tracking and daily audit report. Interact with State Health auditors yearly. Make adjustments to claims and maintain relationships with providers.

Senior Claims Examiner/Unit Leader (1989-90)
Trained and supervised three claims examiners, processing claims for 15.000 Medical Assistance recipients. Responsibilities included coordination of benefits, determination of eligibility, extensive provider relations and customer service communication.

Claims Examiner (1987-88)
Created new position, organizing and establishing policies for a Medical Assistance Organization which grew from 250 members in 1987 to its present 15,000. Processed medical and dental claims, referrals, encounters, eye and prescription claims. Maintained heavy telephone contact with customers. Negotiated rates with providers and Health Partners administration.

1985-1986 NEW LOOKS, Caldwell, ID

Assistant Manager
Trained and supervised staff of 20 employees for women’s clothing store. Responsible for sales, customer service, inventory, payroll, merchandising, management reporting, and problem solving.