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Senior claims processor skills for your resume and career

Updated January 8, 2025

4 min read

Below we've compiled a list of the most critical senior claims processor skills. We ranked the top skills for senior claims processors based on the percentage of resumes they appeared on. For example, 16.3% of senior claims processor resumes contained customer service as a skill. Continue reading to find out what skills a senior claims processor needs to be successful in the workplace.

15 senior claims processor skills for your resume and career

1. 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 senior claims processors use customer service:

Provided customer service, contacted providers for claim discrepancies and reviewed medical terminology daily.
Recognized for outstanding achievement for claims accuracy, speed and overall customer service.

2. 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 senior claims processors use process claims:

Applied claims settlement procedures to process claims within approved limits, initiated claim payment process and closed files assigned to management.
Pay and process claims with a high degree of accuracy and affiance within the compliance of all fund rules.

3. SR

Here's how senior claims processors use sr:

Started off as a claim processor and quickly became promoted to Sr.
Backed up department Sr. Secretary.

4. Medical Terminology

Here's how senior claims processors use medical terminology:

Interpreted coding and understood medical terminology in relation to diagnoses and procedures.
Entered claims into the computer utilizing knowledge of CPT, ICD, HCPCS, DR and medical terminology.

5. Appeals

Here's how senior claims processors use appeals:

Reviewed hospital and physicians' written appeals for additional payments and other administrative activities.
Processed and filed appeals and/or resubmit claims with required information and adjustments.

6. 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 senior claims processors use cms:

Research, process and Adjust Medicare Part A claims using CMS Website and CWF, also FISS, Facets and HIMR
Reviewed documents and medical information used to determine payment or denial of services based on CMS regulations and medical policy.

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7. Medical Claims

Here's how senior claims processors use medical claims:

Created and maintained claim reimbursement by providing and processing medical claims to ensure accurate and timely billing with completeness and eligibility.
Collaborate with provider billing associates to rectify and investigate questionable issues with medical claims and member benefits.

8. ICD-9

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

Utilized HCFA CPT and ICD-9 standards and coding guidelines.
General knowledge of CPT, HCPC, REV and ICD-9 Coding.

9. CPT-4

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

Used CPT-4 code for medical procedures and service, also coding and collections.
Use ICD-9, CPT-4 and other medical manuals to adjudicate claims.

10. COB

Here's how senior claims processors use cob:

Helped Quality Assurance team to provide testing for Nov. 2006 COB system upgrade for PMHS.
Determine possibility of coordination of benefits (COB) and calculate benefits accordingly.

11. HIPAA

Here's how senior claims processors use hipaa:

Adjusted Medical And Dental Claims Using A Variety Of Systems While Verifying Prior Authorizations Abide By HIPAA Regulations
Coordinated luncheons with Pharmaceutical Representatives.Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.

12. Medicaid

Here's how senior claims processors use medicaid:

Coordinated benefits with government, Medicaid, Medicare and individual insurance.
Structured the procedure to respond to Medicare and Medicaid demand letters by researching history of claims and sending correspondence for review.

13. HCPCS

Here's how senior claims processors use hcpcs:

Verify all member and provider information is correct and also make sure all HCPCS codes are correct
Check HCPCS codes to make sure that the correct code is billed for the correct service.

14. Electronic Claims

Here's how senior claims processors use electronic claims:

Examined and data entered/processed paper claims and/or electronic claims.
Screen, review, evaluates online entries, error correction and/or quality control review and final adjudication of paper/electronic claims.

15. Claims Issues

Here's how senior claims processors use claims issues:

Handled telephone calls from providers and members that had been elevated due to complexity of claims issues and/or appeal issues.
Operated memos and corporate policies to resolve claims and claims issues.

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List of senior claims processor skills to add to your resume

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

Customer Service
Process Claims
SR
Medical Terminology
Appeals
CMS
Medical Claims
ICD-9
CPT-4
COB
HIPAA
Medicaid
HCPCS
Electronic Claims
Claims Issues
HMO

Departmental Policies
Health Insurance Claims
Quality Standards
Dental Claims
Computer System
PPO
Hospital Claims
Insurance Policy
Facets
Police Reports
Hippa
Production Standards
Outbound Calls
Telephone Calls
Insurance Carriers
Medical Bills

DME
Auto Claims
Diagnosis Codes
EDI
Policy Provisions
EOB
Disability Claims
State Laws
Customer Inquiries
SME
BCBS
Payment Issues
Ub92
Provider Contracts

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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