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Claims collector skills for your resume and career

Updated January 8, 2025
3 min read
Below we've compiled a list of the most critical claims collector skills. We ranked the top skills for claims collectors based on the percentage of resumes they appeared on. For example, 26.6% of claims collector resumes contained patients as a skill. Continue reading to find out what skills a claims collector needs to be successful in the workplace.

15 claims collector skills for your resume and career

1. Patients

Here's how claims collectors use patients:
  • Contacted patients on accounts in collections, Filed claims, Received payments for private insurance Medicare and Medicaid.
  • Answered phones and interacted with patients, doctors, hospitals and insurance companies.

2. Appeals

Here's how claims collectors use appeals:
  • Perform telephone appeals wherever necessary for payment consideration of claims denied past timely filing.
  • Resolved discrepancies by providing accurate medical documentation in the claim appeals process.

3. Medicaid

Here's how claims collectors use medicaid:
  • Determined presumptive Medicare and/or Medicaid eligibility.
  • Processed orders in compliance with Medicare, Medicaid and private insurance verification guidelines; confirming customer's eligibility and insurance coverage.

4. Medical Insurance Claims

Here's how claims collectors use medical insurance claims:
  • Research for the recovery of medical insurance claims which were not paid in full or correctly.

5. EOB

EOB stands for explanation of benefits. This is a common outline provided as part of many health insurance plans to explain what services were completed, the co-pay required for each appointment, and how much of your payment is covered by health insurance. EOB is an indication that your insurance claim has already been processed.

Here's how claims collectors use eob:
  • Verified eligibility when secondary insurance carriers have been identified, gathered primary EOB's to forward with claim for correct reimbursement.
  • Research and resolve incorrect payments, EOB rejections, Send secondary claims upon processing of primary insurance.

6. 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 collectors use outbound calls:
  • Receive inbound calls and make outbound calls concerning account inquiries or pay offs on debt.
  • Provided assistance to customers to solve outstanding bills Made outbound calls to assist in unpaid debts

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7. 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 collectors use hippa:
  • Speak to debtors without breaking- Fair Debt Collections Practices & HIPPA acts.
  • Operated under HIPPA guidelines for all collection activities.

8. Unpaid Claims

Here's how claims collectors use unpaid claims:
  • Review medical claims for accuracy and submit to insurance companies-Work with insurance companies and follow-up on unpaid claims
  • Provided follow-up information for medical insurance denials and unpaid claims with Medicare.

9. 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 collectors use cpt:
  • Use of ICD-9 and CPT codes for HCFA-1500 Form.
  • Evaluated CPT and other coding to maximize reimbursement and increase business profitability.

10. Payment Arrangements

Here's how claims collectors use payment arrangements:
  • Established and coordinated payment arrangements.
  • Negotiate payment arrangements with debtors in order to expunge the balance owed.

11. Account Management

The process of strengthening the relationship between a company and client is called account management. Effective account management has two key objectives, one is to retain loyal customers and the second one is to help the company grow by creating connections with new customers.

Here's how claims collectors use account management:
  • Performed timely follow-up and account management to guarantee timely claims processing.
  • Maintained key account analysis, produced major account proposals, participated in pro-active account management, call planning and goal/objective setting.

12. HIPAA

Here's how claims collectors use hipaa:
  • Updated project database that consisted of extremely sensitive and confidential information; maintained patient data in accordance with HIPAA regulations.
  • Prepared and distributed patient and insurance company invoices, ensuring compliance with all HIPAA laws and federal regulatory requirements.

13. Inbound Calls

Here's how claims collectors use inbound calls:
  • Receive inbound calls, politely assisting patients and clients ensuring superior customer service skills by addressing concerns and demonstrating empathy.
  • Exceed customer expectations through professional telephone interactions on inbound calls and additionally offer existing and new customers products and service.

14. 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 collectors use telephone calls:
  • Performed collections activity based on collection queue/production goals by making outbound and receiving inbound telephone calls from clients.
  • Received incoming telephone calls and gave professional customer service help to customers about question on delinquent accounts.

15. Epic

Epic is a private healthcare company which developed and continues to provide a software intended for healthcare professionals and the organization and management of medical records. It is by far one of the largest in its field, with over 50% of patients having a medical record present in their system. Patients, as well as clinics and various medical professionals and facilities are all able to use this system to keep medical history and information safe and easy to reach, alter, and share with the necessary people.

Here's how claims collectors use epic:
  • Performed well, using State of the art claims Billing software, such as EPIC.
  • Use resources such as EPIC, Chartmax to access medical records to assist in getting claims processed.
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List of claims collector skills to add to your resume

Claims collector skills

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

  • Patients
  • Appeals
  • Medicaid
  • Medical Insurance Claims
  • EOB
  • Outbound Calls
  • Hippa
  • Unpaid Claims
  • CPT
  • Payment Arrangements
  • Account Management
  • HIPAA
  • Inbound Calls
  • Telephone Calls
  • Epic
  • Computer System
  • Insurance Payments
  • Account Balances
  • ICD-9
  • Refund Request
  • DME

Updated January 8, 2025

Zippia Research Team
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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