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Medical claims processor skills for your resume and career

Updated January 8, 2025
4 min read
Medical claims processor example skills
Below we've compiled a list of the most critical medical claims processor skills. We ranked the top skills for medical claims processors based on the percentage of resumes they appeared on. For example, 13.0% of medical claims processor resumes contained patients as a skill. Continue reading to find out what skills a medical claims processor needs to be successful in the workplace.

15 medical claims processor skills for your resume and career

1. Patients

Here's how medical claims processors use patients:
  • Demonstrated extensive, amicable telephone communication with patients and medical facilities to obtain and supply necessary information.
  • Responded to calls from patients and other facilities requesting medical record information.

2. Healthcare

Healthcare is the maintenance or improvement of a person's health by the diagnosis and treatment of a person's injury, illness, or any other disease. Healthcare is a basic necessity of human life and is the responsibility of the country's government to ensure that each person gets healthcare. Providing healthcare is the job of certified health professionals that includes doctors, surgeons, nurses, and other physicians. Pharmaceutical companies, hospitals, dentistry, therapy, and health training all come under healthcare. Healthcare plays a vital role in the country's economy and its development.

Here's how medical claims processors use healthcare:
  • Prepare Medical Claims to be processed and pay Healthcare Claims for Veterans on behalf of the VA health facilities.
  • Processed Medical claims for Gold Coast Healthcare Group * Complete claims by specified deadlines to avoid account closure

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 medical claims processors use data entry:
  • Performed accurate coding and data entry of medical and dental information provided by medical facilities.
  • Perform data entry into all applicable applications and databases.

4. Medical Insurance Claims

Here's how medical claims processors use medical insurance claims:
  • Processed secondary medical insurance claims in accordance to coordination of benefit rules of Medicaid and Medicare.
  • Processed medical insurance claims per policy provisions.

5. Medical Terminology

Here's how medical claims processors use medical terminology:
  • Position requires in depth knowledge of medical terminology which is useful in reading medical reports and determining coverage.
  • Hold an expansive knowledge of medical terminology and medical documents.

6. 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 medical claims processors use customer service:
  • Resolve policyholder's questions regarding policy benefits and payment and consistently provide excellent customer service on all inquiries received.
  • Provide high quality customer service to a diverse customer population regarding routine eligibility, benefits, and claim status.

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7. ICD-9

Here's how medical claims processors use icd-9:
  • Review bills for correct ICD-9 and CPT-4 coding, timely filing, enrollment and utilization review issues.
  • Utilized ICD-9 and CPT coding to process HMO medical claims on Windows 95 based software.

8. CPT-4

Here's how medical 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.
  • Analyzed patient records to verify benefits and apply appropriate codes (ICD-9 and CPT-4).

9. Medicaid

Here's how medical claims processors use medicaid:
  • Coordinated benefits with other medical insurance plans, Medicaid and Medicare.
  • Process medical charts electronically for Medicare Advantage and Medicaid providers.

10. 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 medical claims processors use eob:
  • Worked many positions in the company starting in Accounting- Verified Information on Checks and EOB for check writer typists.
  • Produced and reviewed the finalized EOB s before issuing to the appropriate insured/claimant, provider, and/or insurance carrier.

11. Process Claims

Process claims refers to the procedure an insurance agent follows once receiving a claim from an insured individual. This often includes reviewing, investigating, and deciding on whether the claim will be accepted or denied depending on the results of the insurer's investigation. This is a common procedure for all kinds of insurance including medical, auto, and liability insurance.

Here's how medical claims processors use process claims:
  • Identified provider information and other documentation to process claims.
  • Process claims electronically and manually.

12. Medical Charts

Here's how medical claims processors use medical charts:
  • Retrieve medical charts remotely keeping private health information secure.
  • Completed administrative duties, scheduled appointments, created medical charts, and transmitted medical records and correspondence.

13. HCPCS

Here's how medical claims processors use hcpcs:
  • Researched the scanned documents to ensure correct I-CD9, HCPCS, and CPT codes were used.
  • Entered and looked up claims information in the database HCPCS.

14. Medical Bills

Here's how medical claims processors use medical bills:
  • Processed medical bills for payment to providers Precisely completed appropriate claims paperwork, documentation and system entry.
  • Processed electronic medical claims and processed medical bills.

15. 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 medical claims processors use hippa:
  • Trained in fraudulent claims, patient privacy and confidentiality in accordance with HIPPA regulations.
  • Insure following all HIPPA, state, federal and HRI regulations.
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List of medical claims processor skills to add to your resume

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

  • Patients
  • Healthcare
  • Data Entry
  • Medical Insurance Claims
  • Medical Terminology
  • Customer Service
  • ICD-9
  • CPT-4
  • Medicaid
  • EOB
  • Process Claims
  • Medical Charts
  • HCPCS
  • Medical Bills
  • Hippa
  • HIPAA
  • Insurance Policies
  • CMS
  • ICD-10
  • DME
  • EMR
  • HCFA
  • Computer System
  • Electronic Claims
  • Diagnosis Codes
  • COB
  • Patient Accounts
  • PPO
  • Dental Claims
  • Outbound Calls
  • Production Standards
  • Insurance Verification
  • Claims Data
  • Facets
  • HMO
  • Paper Claims
  • Insurance Coverage
  • Inbound Calls
  • Hospital Claims
  • Insurance Carriers
  • Patient Charts
  • Procedure Codes
  • Telephone Calls
  • Quality Standards
  • Medical Necessity
  • Ub04
  • Patient Demographics
  • Ub92
  • Ub-04

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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