Resume Templates: Medical Claims Examiner


Resume Templates: Medical Claims Examiner

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Conrad Hylton 100 Broadway Lane New Parkland, CA, 91010 Cell: (555) 987-1234


Detail-oriented Medical Claims Examiner, well versed in health insurance statutes, regulations and practices. Excellent communication skills that serve to lessen claimant confusion about process and status. Adept at multi-tasking and completing assignments within any and all policy and statutory prescribed deadlines.


  • Command of medical insurance claims laws
  • Proactive solution finder
  • Detailed oriented
  • Effective communicator
  • Diligent documenter
  • Effective team member

Work Experience

July 2010 to October 2012 Happy Valley Insurance–New Cityland, CA Medical Claims Examiner
  • Provided front line claims settlement services for second largest health insurance carrier operating in California.
  • Increased claims processing efficiency by over 20% during time with insurer.
  • Resolved consumer initiated claims disputes with a 65% overall success rate, eliminating the need for expensive claims appeals.
  • Developed and presented monthly reports on claims processing and settlement activity.
October 2012 to January 2014 Big-O Health Insurance–New Cityland, CA Medical Claims Examiner
  • Implemented company-wide claims processing efficiency protocols in the aftermath of the implementation of the Affordable Care Act.
  • Coordinated team of 12 claims examiners attached to the Affordable Care Act.
  • Oversaw preparation of materials for claims appeals lodged by insureds.
  • Trained new claims examiners hired by company.
January 2014 to Present Gigantic Insurance Company–New Cityland, CA Senior Claims Adjuster
  • Liaison between claims adjustment team and senior management regarding all claims related issues associated with the Affordable Care Act.
  • Responsible for training new claims examiners and for implementing ongoing training and continuing education programming associated with the Affordable Care Act.
  • Presented at industry conferences on claims settlement and the Affordable Care Act.
  • Developed unified company-wide claims reporting system associated with the ACA Marketplace related claims.


2010 University of Florida, Hot Beach, FL Bachelor of Arts, Business Administration