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Insurance claims processor skills for your resume and career

Updated January 8, 2025

4 min read

Quoted expert

Li Zhang Ph.D.

Below we've compiled a list of the most critical insurance claims processor skills. We ranked the top skills for insurance claims processors based on the percentage of resumes they appeared on. For example, 17.9% of insurance claims processor resumes contained data entry as a skill. Continue reading to find out what skills an insurance claims processor needs to be successful in the workplace.

15 insurance claims processor skills for your resume and career

1. 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 insurance claims processors use data entry:

Filled out any necessary patient information for data entry.
Performed data entry and processed medical insurance claims

2. 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 insurance claims processors use customer service:

Provided general information for complaint calls Completed detailed reports on all complaint calls Provided General Customer Service
Conducted quality assurance monitoring on incoming and outgoing phone calls by customer service representatives.

3. Medicaid

Here's how insurance claims processors use medicaid:

Processed a number of different Medicaid insurance claims
Submitted Medical claims for Medicaid, Medicare and, Private Insurances.

4. Medical Terminology

Here's how insurance claims processors use medical terminology:

Required knowledge of ICD 9 codes, CPT codes, Procedure codes and Medical Terminology.
Processed health insurance claims utilizing ICD-9, CPT, HCPCS, medical terminology.

5. Insurance Coverage

Here's how insurance claims processors use insurance coverage:

Ensured homeowners maintained proper insurance coverage and monitored accounts.
Modified existing health insurance coverage.

6. ICD-9

Here's how insurance claims processors use icd-9:

Processed health insurance claims based on ICD-9 indentified procedures.
Managed invoices and transaction receipts*Expertly reviewed charts and processed billing and payments*Processed medical claims using ICD-9 coding

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7. Inbound Calls

Here's how insurance claims processors use inbound calls:

Maintained quality and professionalism in a fast-paced environment while taking inbound calls.
Received inbound calls requesting information on specific claims or general information.

8. CPT-4

Here's how insurance claims processors use cpt-4:

Applied accurate CPT-4 and ICD-9CM coding to all claims and enter claims into the CRIS system within 5 days of receipt.
Applied knowledge of ICD-9CM, ICD-10CM and CPT-4 coding in order to determine services rendered.

9. Insurance Verification

Here's how insurance claims processors use insurance verification:

Maintain appropriate information relating to the medical chart such as maintaining current laboratory stickers and insurance verification forms.
Maintained distribution of incoming mail throughout the Insurance Verification Department from various insurance companies and/or patients.

10. Insurance Policies

Here's how insurance claims processors use insurance policies:

Processed commercial insurance policies for businesses.
Process new insurance policies and modify existing policies to reflect either company coverage protocols or clients requested changes.

11. Policy Holders

Here's how insurance claims processors use policy holders:

Examined claims for validity of coverage for business policy holders.
Assisted policy holders with a limited amount any questions or concerns they may have had when the adjuster was unavailable.

12. HMO

Here's how insurance claims processors use hmo:

Displayed good understanding of multiple products (HMO, PPO, COB).
Process State Specific Dental claims Experience with specific insurance products such as HMO, PPO, Medicare and Medi-Cal.

13. Electronic Claims

Here's how insurance claims processors use electronic claims:

Possess extensive knowledge of electronic claims editing and submission capabilities, including on-line claims processing and query systems.
Transmitted electronic claims for designated commercial medical insurance.

14. Computer System

Here's how insurance claims processors use computer system:

Trained new employees on our computer system so that they would be efficient in their position as well.
Take any payments and post them into computer system.

15. Health Insurance Claims

Here's how insurance claims processors use health insurance claims:

Examined health insurance claims to verify payments as determined by ICD-10, and CPT codes.
Research Health Insurance claims and process for Blue Cross Blue Shield of Michigan.

5 Insurance Claims Processor resume examples

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What skills help Insurance Claims Processors find jobs?

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

What hard/technical skills are most important for insurance claims processors?

Li Zhang Ph.D.

Professor, St. Cloud State University

It would be analytical skills and numerical skills, no matter if it's in underwriting, claims, actuarial, investment, sales, or other positions. For example, a successful salesperson should be able to efficiently analyze the client's information, assess the client's need, recommend the appropriate products, and convey product advantages and disadvantages clearly. Also, competent employees should be comfortable with working with numbers/graphs to communicate with clients or coworkers.

Do you want to know more?

List of insurance claims processor skills to add to your resume

The most important skills for an insurance claims processor resume and required skills for an insurance claims processor to have include:

Data Entry
Customer Service
Medicaid
Medical Terminology
Insurance Coverage
ICD-9
Inbound Calls
CPT-4
Insurance Verification
Insurance Policies
Policy Holders
HMO
Electronic Claims
Computer System
Health Insurance Claims

Claims Data
EOB
Claims Issues
Police Reports
Patient Accounts
Telephone Calls
Diagnosis Codes
Property Damage
Insurance Carriers
Medical Insurance Claims
Claims Forms
Hippa
Policy Provisions
HIPAA
Medical Bills

EDI
Dental Claims
Computer Programs
Outbound Calls
PPO
Paper Claims
Insurance Payments
Insurance Applications
Procedure Codes
NextGen
Reflect Changes
Billing System
BCBS
Bank Deposits

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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