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Peyton Griffin
Clerical Adjudicator
Summary
Highly experienced Clerical Adjudicator with a proven track record of processing and adjudicating high volumes of claims and documents with accuracy and efficiency. Consistently exceeded performance targets, ensuring compliance with regulations and guidelines. Demonstrated expertise in independently reviewing and assessing claims, gathering and analyzing data to determine eligibility and entitlements. Effective communicator with strong interpersonal skills, able to resolve inquiries and provide guidance to claimants, providers, and other stakeholders. Proficient in utilizing specialized software and technology to process claims, manage caseloads, and generate reports. Maintained detailed records and documentation of all claims processed, ensuring compliance with audit requirements. Collaborated effectively with other members of the adjudication team to ensure consistent and efficient claim processing. Actively participated in training and development programs to stay abreast of industry best practices and regulatory changes.
Education
Associate’s Degree or High School Diploma
October 2016
Skills
- Data Entry
- Document Preparation
- Case Management
- Records Management
- Correspondence Review
- Communication
Work Experience
Clerical Adjudicator
- Utilized specialized software and technology to process claims, manage caseloads, and generate reports.
- Maintained detailed records and documentation of all claims processed, ensuring compliance with audit requirements.
- Collaborated with other members of the adjudication team to ensure consistent and efficient claim processing.
- Participated in training and development programs to stay abreast of industry best practices and regulatory changes.
Clerical Adjudicator
- Processed and adjudicated high volumes of claims and documents, ensuring compliance with regulations and guidelines.
- Consistently met and exceeded performance targets for claim processing speed and accuracy.
- Independently reviewed and assessed claims, gathering and analyzing data to determine eligibility and entitlements.
- Communicated effectively with claimants, providers, and other stakeholders to resolve inquiries and provide guidance.
Accomplishments
- Reduced claim processing time by 15% through developing and implementing a streamlined adjudication process
- Improved claim accuracy by 10% by conducting thorough investigations and applying consistent adjudication criteria
- Resolved over 1000 complex claims within a 3month period, demonstrating a strong ability to manage highvolume workloads
- Developed a comprehensive training program for new adjudicators, ensuring consistent application of adjudication standards
- Automated 25% of the adjudication process using custom software, resulting in increased efficiency and reduced processing time
Awards
- Received the ‘Exceptional Performance Award’ for consistently exceeding expectations in adjudicating claims
- Recognized with the ‘Teamwork Award’ for collaborating effectively with colleagues to resolve complex cases
- Awarded the ‘Accuracy Excellence Award’ for maintaining an exceptionally high level of accuracy in adjudicating claims
Certificates
- Certified Claims Representative (CCR)
- Certified Medical Claims Processor (CMCP)
- Certified Professional Claims Analyst (CPCA)
- Certified Insurance Services Representative (CISR)
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How To Write Resume For Clerical Adjudicator
- Highlight your experience in claims processing and adjudication, emphasizing your ability to meet and exceed performance targets.
- Demonstrate your strong analytical and problem-solving skills, showcasing your ability to independently review and assess claims.
- Emphasize your effective communication and interpersonal skills, highlighting your ability to resolve inquiries and provide guidance to various stakeholders.
- Showcase your proficiency in utilizing specialized software and technology for claim processing and caseload management.
Essential Experience Highlights for a Strong Clerical Adjudicator Resume
- Processed and adjudicated high volumes of claims and documents, ensuring compliance with regulations and guidelines.
- Consistently met and exceeded performance targets for claim processing speed and accuracy.
- Independently reviewed and assessed claims, gathering and analyzing data to determine eligibility and entitlements.
- Communicated effectively with claimants, providers, and other stakeholders to resolve inquiries and provide guidance.
- Utilized specialized software and technology to process claims, manage caseloads, and generate reports.
- Maintained detailed records and documentation of all claims processed, ensuring compliance with audit requirements.
- Collaborated with other members of the adjudication team to ensure consistent and efficient claim processing.
Frequently Asked Questions (FAQ’s) For Clerical Adjudicator
What are the key responsibilities of a Clerical Adjudicator?
Key responsibilities include processing and adjudicating claims, ensuring compliance with regulations, meeting performance targets, independently reviewing and assessing claims, communicating with stakeholders, utilizing specialized software, maintaining records, and collaborating with team members.
What skills are required to be a successful Clerical Adjudicator?
Essential skills include data entry, document preparation, case management, records management, correspondence review, and communication.
What is the career path for a Clerical Adjudicator?
With experience and additional qualifications, Clerical Adjudicators can advance to roles such as Senior Claims Adjuster, Claims Supervisor, or Management positions.
What is the job outlook for Clerical Adjudicators?
The job outlook is expected to grow due to the increasing need for claims processing in various industries, including insurance, healthcare, and government.
What are the educational requirements to become a Clerical Adjudicator?
While a high school diploma is often sufficient, an Associate’s Degree or additional certifications can enhance career prospects.
What are the salary expectations for Clerical Adjudicators?
Salary expectations vary depending on experience, location, and industry, but typically range from entry-level to mid-level salaries.
What are the benefits of working as a Clerical Adjudicator?
Benefits may include competitive salaries, health insurance, paid time off, and opportunities for professional development.
What are the challenges of working as a Clerical Adjudicator?
Challenges may include high workloads, tight deadlines, and the need to stay up-to-date with regulations and industry best practices.