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Claims account specialist skills for your resume and career

Updated January 8, 2025

2 min read

Quoted experts

Francisco Depusoir,

Francisco Depusoir

Below we've compiled a list of the most critical claims account specialist skills. We ranked the top skills for claims account specialists based on the percentage of resumes they appeared on. For example, 28.1% of claims account specialist resumes contained customer service as a skill. Continue reading to find out what skills a claims account specialist needs to be successful in the workplace.

13 claims account specialist skills for your resume and career

1. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how claims account specialists use customer service:

Provide customer service, such as limited instruction on proceedings with accounts.
Worked with large national accounts with commitment to customer service.

2. Medical Terminology

Here's how claims account specialists use medical terminology:

Entered claims data into system while interpreting and understanding coding and medical terminology for diagnoses and procedures.
Required review of medical terminology/records to determine the medical necessity / relationship of treatment.

3. Patient Accounts

Patient accounts are a part of a hospital information system that is used for storing financial data, keeping a record of healthcare costs, and providing information regarding patient billing. It deals with the financial aspects of the healthcare setting.

Here's how claims account specialists use patient accounts:

Maintain patient accounts Follow up with insurance companies Work outstanding accounts
Provided training and assistance to the patient account representatives in researching variances in reimbursement received and the system generated contractual posted.

4. Medical Treatment

Here's how claims account specialists use medical treatment:

Monitor and review medical treatment, coordinate resolution of lost time claims issues, and develop return to work plans.
Received approximately 30 claims per day, assigning claim numbers, authorizing medical treatment, and paying medical bills.

5. Process Payments

Here's how claims account specialists use process payments:

Process payments, closely monitor accounts and inform clients of any modifications needed.
Process payments over the phone and answer general questions regarding mortgage loan accounts.

6. Medicaid

Here's how claims account specialists use medicaid:

Resolve and adjust Medical, Dental, Medicare, Medicaid, and Workmen Compensation claims based on error and edits.
Determined presumptive Medicare and/or Medicaid eligibility.

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7. Outbound Calls

An outbound call is made by the call center representative to the customers on behalf of the company. Such calls help increase sales and generate revenue for the organization.

Here's how claims account specialists use outbound calls:

Researched, resolved, and documented patient inbound and outbound calls involving a wide range of issues utilizing multiple information systems.
Performed Customer Service through inbound and outbound calls and answered customer questions as well as educated customers regarding their mortgage obligations.

8. CPT

CPT is a medical term that stands for Current Procedural Terminology. Whenever a procedure like surgery or diagnosis occurs or some other medical service is rendered to a patient, it is reported to the concerned physician, insurance company, or organization. The aforementioned practice is widely referred to as CPT.

Here's how claims account specialists use cpt:

Evaluated CPT and other coding to maximize reimbursement and increase business profitability.
Recruited and interviewed internal/external CPT Account Specialists resulting a successful division launch.

9. Compensation Claims

Here's how claims account specialists use compensation claims:

Investigated, reserved, and negotiated workers' compensation claims in Connecticut, Massachusetts, and Rhode Island jurisdictions.
Attend meetings with insured to develop strategies and action plans on how to manage Worker's Compensation claims.

10. HIPAA

Here's how claims account specialists use hipaa:

Maintained strictest confidentiality and all HIPAA guidelines/regulations while communicating with diverse backgrounds of clients on a day-to-day basis.
Updated project database that consisted of extremely sensitive and confidential information; maintained patient data in accordance with HIPAA regulations.

11. Hippa

HIPAA, which stands for Health Insurance Portability and Accountability Act, is a United States federal statue created, enacted, and turned to law in 1996, which whose primary purposes were to modernise the healthcare systems in the United States, secure and generally enhance the management of that personal information of patients that was in the hands of healthcare facilities, such as hospitals and insurance companies, and to enable the providing of healthcare and insurance to more people.

Here's how claims account specialists use hippa:

Demonstrated knowledge of HIPPA Privacy and Security Regulations by appropriately handling patient information.
Integrated working knowledge of behavioral health, psychology and HIPPA guidelines in providing excellent patient interaction and assistance.

12. Insurance Verification

Here's how claims account specialists use insurance verification:

Performed insurance verification and benefits eligibility.
Specialized in insurance verification and benefits coordination for referrals received for pediatric heart transplants and pediatric bone marrow transplants.

13. Telephone Calls

Telephone calls are a communication means through which a caller is connected to the called party. The call is done through a telecommunications device called a telephone. The caller can use a landline, mobile phone, or satellite phone to make the call.

Here's how claims account specialists use telephone calls:

Handle all telephone calls regarding adjustments, billing questions, check refunds, check voids, stop payment and overpayments.
Performed collections activity based on collection queue/production goals by making outbound and receiving inbound telephone calls from clients.

What skills help Claims Account Specialists find jobs?

Tell us what job you are looking for, we’ll show you what skills employers want.

What soft skills should all claims account specialists possess?

Francisco Depusoir

Associate Professor of Accounting, University of the Virgin Islands

-Analytical and problem-solving skills
-Strong written and oral communication
-Critical thinking
-Time Management
-Active learning
-Organization and attention to detail

What hard/technical skills are most important for claims account specialists?

Francisco Depusoir

Associate Professor of Accounting, University of the Virgin Islands

-Basic knowledge of Generally Accepted Accounting Principles (GAAP)
-Experience with business intelligence software.
-Independent research skills.
-Data management abilities.
-Preparation and understanding of financial statements.

What skills stand out on claims account specialist resumes?

Francisco Depusoir

Associate Professor of Accounting, University of the Virgin Islands

The following skills could open the door to various opportunities for an accounting graduate on their resume.
-Excellent analytical skills
-Knowledge of Microsoft Excel
-Knowledge of Quickbooks

What type of skills will young claims account specialists need?

Elisha Blankson

Program Director NCCU, Assistant Professor, North Carolina Central University

Graduates will need a skill set about the field in which they received training and additional skills useful to the job market. For example, with the changing demographics in the United States, extra skills in information technology and foreign languages will be a plus when entering the job market.

Do you want to know more?

List of claims account specialist skills to add to your resume

The most important skills for a claims account specialist resume and required skills for a claims account specialist to have include:

Customer Service
Medical Terminology
Patient Accounts
Medical Treatment
Process Payments

Medicaid
Outbound Calls
CPT
Compensation Claims
HIPAA

Hippa
Insurance Verification
Telephone Calls

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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