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Claims reviewer skills for your resume and career

Updated January 8, 2025
2 min read
Below we've compiled a list of the most critical claims reviewer skills. We ranked the top skills for claims reviewers based on the percentage of resumes they appeared on. For example, 50.0% of claims reviewer resumes contained home health as a skill. Continue reading to find out what skills a claims reviewer needs to be successful in the workplace.

15 claims reviewer skills for your resume and career

1. Home Health

Here's how claims reviewers use home health:
  • Reviewed Home Health claims prior to payment from Medicare.
  • Work from home reviewing home health charts for Medicare

2. Insurance Claims

Here's how claims reviewers use insurance claims:
  • Reviewed Insurance claims received from providers for accuracy in spelling and assurance of all required Insurance company payment submission requirements.
  • Reviewed life insurance claims to determine eligible beneficiaries and benefit amount.

3. 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 claims reviewers use data entry:
  • Direct data entry of patient demographics and secondary insurance information to aid in the coordination of benefits process.
  • General office duties including filing, copying, faxing, data entry and financial balancing of tax deferred accounts.

4. Medical Terminology

Here's how claims reviewers use medical terminology:
  • Researched medical terminology, pharmaceuticals and prepared correspondence to communicate benefit determinations.
  • Research of financial documents, medical terminology and pharmaceuticals.

5. 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 reviewers use cpt:
  • Requested further explanations or revisions of CPT codes of treatment from physicians; requested necessary paperwork or alternative insurance of patients.
  • Analyze denials and partial payments and resubmit with appropriate ICD-9 and CPT codes to Insurance Carrier or Third Party Administrator.

6. Claims Submission

Here's how claims reviewers use claims submission:
  • Evaluated claims submissions and administered the completeness criteria to determine the expected outcome of required documentation.
  • Reviewed claims submissions and made eligibility determinations based on information provided at time of review.

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7. BP

Here's how claims reviewers use bp:
  • Review varies claims due to the BP oil incident submissions and applies completeness criteria to determine completeness of required documentation.
  • Support BP Oil Settlement Litigation Claims by providing claims and quality assurance reviews for Coastal Real Property Damage Claims.

8. Medical Claims

Here's how claims reviewers use medical claims:
  • Review medical claims billed by various providers including anesthesiologists, physical therapists, radiologists, physicians and hospital inpatient/outpatient.
  • Worked in a team environment to appropriately pay medical claims as related to automobile accident injuries.

9. Regular Quality Control

Here's how claims reviewers use regular quality control:
  • Perform regular quality control of client databases through secondary review of claims information which may include correspondence to communicate benefit determinations.
  • Perform regular quality control of client databases through secondary review of claims information.

10. CMS

A Content Management System or CMS is computer software that works as a framework where content can be assembled and managed by using a database. CMS is an important asset in web development. This platform enables users to create, edit, collaborate on, publish and store digital content. It helps users to manage their content and modify it from a single system.

Here's how claims reviewers use cms:
  • Maintain HIPAA Privacy and Security Rules and CMS security requirements.
  • Reviewed and edited CMS 1500 forms with appropriate modifiers.

11. Loss Statements

Here's how claims reviewers use loss statements:
  • Reviewed tax documents, profit and loss statements, state sales and use records, rental property statements, commission statements.
  • Reviewed financial documents such as Income Statement, Rental Statement, and Profit and loss statements to evaluate claims.

12. Oil Spill

Here's how claims reviewers use oil spill:
  • Analyze and enter financial documentation submitted in support of claims resulting from major environmental oil spill.
  • Review policies and procedures related to tracking generated notices and performing quality control measures on Deep Water Horizon Oil Spill.

13. Computer System

Here's how claims reviewers use computer system:
  • Enter claim payments, reserves and new claims with accompanying file documents into company computer system.
  • Use of multiple computer systems simultaneously while providing customer service via phone.

14. Medical Necessity

Here's how claims reviewers use medical necessity:
  • Review claims for medical necessity and ensure that they meet NCCI clinical editing requirements.
  • Used Milliman medical necessity criteria to validate medical necessity and appropriateness of charges.

15. Medicaid

Here's how claims reviewers use medicaid:
  • Prepared claims for coordination of benefits with Medicare and Medicaid secondary payers.
  • Reviewed incoming documentation for Medicaid reimbursement on a per batch basis.
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List of claims reviewer skills to add to your resume

Claims reviewer skills

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

  • Home Health
  • Insurance Claims
  • Data Entry
  • Medical Terminology
  • CPT
  • Claims Submission
  • BP
  • Medical Claims
  • Regular Quality Control
  • CMS
  • Loss Statements
  • Oil Spill
  • Computer System
  • Medical Necessity
  • Medicaid
  • Client Database
  • ICD-9
  • Secondary Review
  • Fee Schedules
  • Value Claims
  • Federal Laws
  • Horizon
  • Financial Data
  • Claims Data
  • Law Firm
  • Complete Review
  • Scra
  • Tax Returns
  • OCC
  • AS400
  • Medical Bills
  • HMO
  • Compensation Claims
  • Dental Claims
  • Financial Analysis
  • Procedure Codes
  • DRG
  • Federal Regulations
  • PPO
  • Loss Mitigation
  • Interrogatories
  • LPS

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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