Medical claims examiner resume examples from 2026
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How to write a medical claims examiner resume
Craft a resume summary statement
A resume summary is your opening statement that highlights your strongest skills and top accomplishments. It is your chance to quickly let recruiters know who you are professionally - and why they should hire you for the medical claims examiner role.
Step 1: Start with your professional title, or the one you aspire to.
Step 2: Detail your years of experience in medical claims examiner-related roles and your industry experience.
Step 3: What are your biggest professional wins? Here is your opportunity to highlight your strongest accomplishments by placing them at the start of your resume.
Step 4: Don't forget, your goal is to summarize your experience. Keep it short and sweet, so it's easy for recruiters to quickly understand why you're a great hire.
These tips will help you demonstrate why you are the perfect fit for the medical claims examiner position.Please upload your resume so Zippia’s job hunt AI can draft a summary statement for you.
List the right project manager skills
Your Skills section is an easy way to let recruiters know you have the skills to do the job. Just as importantly, it can help your resume not get filtered out by hiring software. Here is how to make the most of your skills section and make sure you have the right keywords:
- Look to the job listing. You often need to include the exact keywords from the job description. Take note of the skills listed for the job.
- Put all relevant hard and soft skills in your skills section.
- Be specific. If you are too broad, you may not be giving the best picture of your skills and leave the hiring manager uncertain of your abilities.
- Be up to date. Software names change and companies merge. Don't look out of touch by being careless.
- Be accurate. Spelling and even upper or lowercase can dramatically change meanings. Make sure you are correctly listing your skills.
Here are example skills to include in your “Area of Expertise” on a medical claims examiner resume:
- Medical Terminology
- Customer Service
- Data Entry
- Medical Treatment
- Computer System
- Provider Contracts
- Medicaid
- CPT-4
- Process Claims
- ICD-9
- CMS
- Denial Letters
- HIPAA
- HCPCS
- Fee Schedules
- Adjudicate Claims
- Medical Bills
- Medical Insurance Claims
- HMO
- DRG
- Dental Claims
- COB
- UB
- Legal Compliance
- Claims Examiners
- HCFA
- Insurance Coverage
- PPO
- Quality Standards
- Medical Documentation
Zippia’s AI can customize your resume for you.
How to structure your work experience
Your work experience should be structured:
- With your most recent roles first, followed by earlier roles in reverse chronological order.
- Job title, along with company name and location on the left.
- Put the corresponding dates of employment on the left side.
- Keep only relevant jobs on your work experience.
How to write medical claims examiner experience bullet points
Your resume is your chance to show your biggest accomplishments. Don't just list your job responsibilities, instead take the opportunity to show why you're really good at what you do. Here is how you do that:
- Start with strong action verbs like managed, spearheaded, created, etc. Your goal is to show what you did and verbs will help demonstrate your contributions.
- Use numbers to quantify your achievements. Did you save time with a new report? Increase revenue? How large was the team you managed?
- Keep it concise. You're highlighting your achievements. Consider if all details you are sharing are relevant, or can be written more efficiently.
Here are examples from great medical claims examiner resumes:
Work history example #1
Claims Assistant
State Farm
- Coordinated incoming claims and assigned them to appropriate adjusters.
- Initiated outgoing communications to customers as required by jurisdiction or State Farm processes.
- Demonstrated Competencies: Quality, Decision Making and Judgment, Communication
- Communicated with customers and associates via telephone and other communications channels.
- Assisted claim adjusters and management of allocated caseload by performing administrative functions in easing the workload.
Work history example #2
Medical Claims Examiner
Mount Sinai Health System
- Processed paper and electronic; Hospital, Medical, and Medicare claims.
- Provided accurate and timely coordination of Medicare claims.
- Applied ICD-9 and CPT codes for claims processing.
- Composed written communication necessary in the appeal of denied and ineffectively processed medical claims.
- Verified and adjudicated hospital/facility claims for medicaid.
Work history example #3
Benefits Analyst
American Income Life Insurance ...
- Educated customers on extensive line of insurance products- Responsible for completing customer applications- Maintained client accounts and ensured confidentiality- Ensured HIPAA compliance
- Educated clients about supplemental benefits provided through their labor union.
- Discussed confidential medical information within the laws and regulations of HIPPA
- Scheduled appointments with prospective clients to deliver and explain insurance benefits.
- Spearheaded the transition of 10,000 plus associates' HSA accounts to the new HSA/FSA vendor HealthEquity (HEQ).
Work history example #4
Claims Adjuster
Travelers
- Participated in catastrophe team during hurricane season.
- Developed three-month training curriculum for the department that included auto and general liability; supervised implementations of the program.
- Developed estimates including creation of accurate floor plans in Xactimate.
- Investigated and evaluated property damage to determine coverage and negotiate a monetary settlement for each claim using Xactimate.
- Negotiated estimate differences with contractors and homeowners to ensure resolution and customer satisfaction.
Zippia’s AI can customize your resume for you.
Add an education section to your resume
The education section should display your highest degree first.
Place your education section appropriately on your resume. If you graduated over 5 years ago, this section should be at the bottom of your resume. If you just graduated and lack relevant work experience, the education section should go to the top.
If you have a bachelor's or master's degree, do not list your high school education. If your graduation year is more than 15-20 years ago, it's better not to include dates in this section.
Here are some examples of good education entries from medical claims examiner resumes:
Bachelor's Degree in business
Ashford University, San Diego, CA
2011 - 2014
Bachelor's Degree in medical assisting services
Brown University, Providence, RI
2002 - 2005
Highlight your medical claims examiner certifications on your resume
If you have any additional certifications or education-like achievements, add them to the education section.
Include the full name of the certification, along with the name of the issuing organization and date of obtainment.
If you have any of these certifications, be sure to include them on your medical claims examiner resume:
- Certified Billing and Coding Specialist (CBCS)
- Medical Assistant
- Certified Coding Specialist (CCS)
- Certified Professional Coder (CPC)
- Dental Assistant (RDA)
- Emergency Medical Technician (EMT)
- Certified Medical Administrative Assistant (CMAA)