Claims Examiner Resume Sample

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Raymond Johansson

100 Broadway Lane
New Parkland, CA, 91010
Cell: (555) 987-1234

Professional Summary

Detail oriented Medical Claims Examiner with the document review and policy skills to efficiently and accurately complete claims examinations. Skilled at reviewing policy to determine coverage, maintaining and retrieving patient records and information, and reviewing and applying claims policy. Specializes at verifying and validating data.

Core Qualifications

  • Claim processing
  • Document review
  • Data verification
  • Coverage analysis
  • Policy review
  • Record management
  • Claim negotiation
  • Organized
  • Experience

    Medical Claims Examiner, February 2009 to Present
    Central California Hospital – New Cityland, CA

    • Resolved medical claims by conducting document examinations and reviews
    • Organized, processed and authorized claims payments, negotiated coverage rates with claim filers
    • Maintained and organized claims documentation including financial, account and medical information

    Medical Claims Examiner, March 2004 to January 2009
    Aeros Medical – New Cityland, CA

    • Monitored, updated and implemented guidelines and procedures for the processing of claims and the applicable coverage
    • Reviewed financial documents, account statements, and claims payments to determine coverage
    • Negotiated with clients individually to settle claims

    Medical Claims Examiner, October 2000 to April 2004
    Cityland Medical – New Cityland, CA

    • Reviewed claims policies and procedures to determine applicable coverage for filed claims
    • Inputted claims information, payments and reserves, organized and retrieved patient information
    • Coordinated with clients, medical insurers and accountants to retrieve and process claims payments


    2000 Bachelor of Science, Accounting
    University of Southern California – Los Angeles, CA

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