Claims Case Manager Resume

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A claims case manager is a health care service professional who develops and implements plans and procedures of health care services. This professional is accountable for coordinating and planning patient care and patient discharge.

Some of the responsibilities of a claims case manager include handling case management functions, assessing the requirements of the patient, planning patient care and discharge planning, conducting psychological assessment of the patients, supervising clinical staff activities, reviewing medical records, checking and monitoring the progress of the patient's health, coordinating with physicians and health care staff in developing health care plans, evaluating claims data, preparing budget, providing guidelines to patients in health care, supporting physicians in maintaining appropriate cost of patient care, and monitoring the utilization of health care services.

A bachelor's degree in health care is mandatory to obtain the profile. Claims case manager should be well versed in hospital case management procedures, claims practices, health care management principles, and health care standards.

Sample Claims Case Manager Resume

John Christopher
56th Sremac Dr., Orange, CA
Cell: 566-587-0895
Email: j.c@example.com

Career Objective:

Hands on experience in handling day to day operations of claims management with extensive knowledge of medical claim benefit and practices. Seeking a position as a claims case manager in a renowned organization

Educational Qualifications:

Achieved Bachelor's degree in Health Science
University of California in the year 2008

Summary of Qualifications:

• Comprehensive knowledge of health care services, claims practices, and procedures
• Extensive knowledge of insurance products, claims audit process, and life claims
• Possess excellent knowledge of management principles, process improvement methodologies, and account management techniques
• Demonstrated leadership skills and has the ability to develop good relationship with customers
• Familiar with health insurance claims with diverse knowledge of medical insurance processing systems
• Excellent risk management, communication, presentation, and organizational skills

Summary of Professional Experience:

Organization: Samlon Group (June 2010 till date)
Designation: Claims Case Manager

• Handle the tasks of developing and implementing claims processing techniques and best practices that meet standard health guidelines
• Assigned the responsibilities of supervising and overseeing the activities of staff and performed analysis of claims data
• Perform the tasks of reviewing and analyzing claims data to ensure that the work flow complies with claims guidelines
• Responsible for coordinating with the health care department head in preparing the budget and in developing guidelines
• Handle the responsibilities of conducting investigations on claims that exceed the limits
• Perform the tasks of gathering the necessary documents and provide training to the new staff

Organization: Nation Wide Health Systems (October 2009 to May 2010)
Duration: Assistant Claims Case Manager

• Responsible for supervising the administrative activities of the claims staff in the absence of the claims case manager
• Assigned responsibilities of supporting the claims case manager in the investigation of claims related issues
• Performed the tasks of preparing and maintaining claims related data in the database system for future reference
• Handled the responsibilities of updating case strategy and risk status to the risk management staff
• Assigned the tasks of attending the meeting with external insurance organizations to update on claims policies and process
• Performed other administrative tasks like preparing performance appraisal of the staff

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