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Claim approver skills for your resume and career

Updated January 8, 2025

2 min read

Below we've compiled a list of the most critical claim approver skills. We ranked the top skills for claim approvers based on the percentage of resumes they appeared on. For example, 24.0% of claim approver resumes contained process claims as a skill. Continue reading to find out what skills a claim approver needs to be successful in the workplace.

15 claim approver skills for your resume and career

1. Process Claims

Process claims refers to the procedure an insurance agent follows once receiving a claim from an insured individual. This often includes reviewing, investigating, and deciding on whether the claim will be accepted or denied depending on the results of the insurer's investigation. This is a common procedure for all kinds of insurance including medical, auto, and liability insurance.

Here's how claim approvers use process claims:

Process claims using CPT/ICD9 codes, data entry, calculating claim benefits.
Process claims according to the HCFA regulations.

2. Medical Terminology

Here's how claim approvers use medical terminology:

Analyzed and coded claims by using medical terminology.
Analyzed surgery claims utilizing prior health care knowledge such as medical terminology, surgery guidelines and overall claims processing procedures.

3. Disability Claims

Here's how claim approvers use disability claims:

Processed health insurance and disability claims while maintaining production goals ensuring timely and efficient claims payment.
Analyzed medical and disability claims in relation to legislation, contract provisions and appropriate evidence.

4. Dental Claims

Here's how claim approvers use dental claims:

Evaluated and processed short-term disability, medical and dental claims.
Audited claims trainees for accuracy on hospital and dental claims.

5. Data Entry

Data entry means entering data into a company's system with the help of a keyboard. A person responsible for entering data may also be asked to verify the authenticity of the data being entered. A person doing data entry must pay great attention to tiny details.

Here's how claim approvers use data entry:

Used Microsoft spreadsheets for organizing tracking charts, data entry, and folder updates.
Handled data entry work on computer databases and entered health claims on C.R.T.

6. Insurance Claims

Here's how claim approvers use insurance claims:

Expedited and processed medical insurance claims for several group national accounts.
Reviewed health insurance claims and determined coverage

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7. Death Claims

Here's how claim approvers use death claims:

Review and process death claims while maintaining service level agreements.
Reviewed pending death claims to determine if funds should be escheated to the state.

8. CPT-4

Here's how claim approvers use cpt-4:

Processed medical claims Supervised staff of 12 employees Assisted in Quality Service Department Input ICD-9 codes and CPT-4 codes
Use ICD-9, CPT-4 and other medical manuals to adjudicate claims.

9. Medicaid

Here's how claim approvers use medicaid:

Interpret Manage Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collections.
Called Center for Medicaid and Medicare and patients medical insurance company to verify low income coverage.

10. Funeral Homes

Here's how claim approvers use funeral homes:

Communicate with medical professionals, attorneys, funeral homes, and clients by telephone and through written correspondence.

11. Health Insurance

Here's how claim approvers use health insurance:

Reviewed and process medical bills for injury parties under their health insurance.
Determine primacy of coverage for beneficiary and the health insurance company.

12. Insurance Benefits

Here's how claim approvers use insurance benefits:

Process medical claims and respond to customer questions regarding insurance benefits and claims status.
Verified insurance benefits and eligibility.

13. Metlife

Here's how claim approvers use metlife:

Review all required systems and databases within MetLife to obtain all necessary information to pay claims
Traveled to various customer sights as a representative of MetLife for medical benefit meetings.

14. Quality Standards

Quality standards are a specific level of standards of products that are set by the companies for the customers that have to be met and maintained throughout the process until the time of delivery. Quality standards are information that includes the customer's requirements, guidelines, and characteristics for the needed final product or service.

Here's how claim approvers use quality standards:

Maintained productivity, accuracy, and quality standards in the coding of claims.
Processed and adjusted 70-80 claims daily, including coordination of benefits, to consistently meet established productivity and quality standards.

15. PPO

PPO which stands for "Preferred Provider Organization" is a managed healthcare insurance coverage consisting of a network of healthcare providers that policyholders can get access to for a reduced rate. The PPO is negotiated between a healthcare facility and the respective insurance company to agree on service schedules and fees.

Here's how claim approvers use ppo:

Processed claims and quoted benefits for POS, PPO, Medicare and Indemnity plans.
Processed Medicare PPO claims by verifying accuracy of information from, determining eligibility under current plan design and calculating benefits.

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List of claim approver skills to add to your resume

The most important skills for a claim approver resume and required skills for a claim approver to have include:

Process Claims
Medical Terminology
Disability Claims
Dental Claims
Data Entry

Insurance Claims
Death Claims
CPT-4
Medicaid
Funeral Homes

Health Insurance
Insurance Benefits
Metlife
Quality Standards
PPO

Updated January 8, 2025

Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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