Resume Company – The Internet’s Very Best
The Following Text Is An Unformatted Professional Resume Sample
From The Writers At Resumes Guaranteed

Click HERE!

yyyyyy x. yyyyyy                                           0000 xxxxxx xxxx , xxxx , xxxxx 00000



healthcare insurance professional with expertise in non-clinical medical operations, medical billing, admissions, claims management and vendor operations, eager to contribute toward defining, integrating and launching innovative reliability/productivity solutions.


career profile

ø  over 20 years experience in all phases of healthcare administration, operations, business development and program management.

ø  expertise in managing outside claim vendors.

ø  knowledgeable in sarbanes oxley regulatory requirements.

ø  ensure claims processing in timely and accurate manner.

ø  coordinate with medical management to facilitate file accuracy and validity.

ø  develop and execute effective policies/procedures.

ø  record of progression to assignments of increasing authority and responsibility.

ø  exceptional communicator and third party administrator.

ø  outstanding team leadership and customer relations skill sets.

ø  capacity in full life cycle project management.

ø  skilled in marketing and program enrollment initiatives.

ø  contribute effectively to revenue growth and p&l.

ø  expert in research and analysis focusing on revenue expansion.

ø  notable communication and presentation abilities.

ø  adept in management, personnel mentoring and meeting professional standards.

ø  proficient in advanced business software applications.

ø  well-organized multi-tasker with exceptional interpersonal skills.

ø  university-level management training.


professional experience

healthnet insurance company, shelton, ct                                                                        1999 c present

vendor operations management (2005-2008)

       manage outside claim vendors hns (health network systems).

       perform daily review of sox (sarbanes oxley) reports for import/export files.

       conduct continuous testing of extracting files and validating that claims are extracted regularly.

       act as troubleshooter when files fail validation. 

       coordinate with medical management when contract files in hns (health network systems) are tested.

       product payment issue resolutions with hns.

       implement policies/procedures of hns and teamed with itg, project managers and directors on project.   

       facilitated weekly meetings with outside vendor and internal associates to manage hns issues.

       direct healthnet savings post payment performed through hns. 

       aided development of hns medical record reviews based on age gender diagnosis and procedures, to ensure hospitals are billing correctly/receiving proper payments.

       successfully reprocessed claims and authored provider letters on financial findings.

       report was tracked monthly, quarterly and annually, then presented to all claims supervisors, managers, directors and vps.    

       direct monthly meeting with quality department and hns quality department to review statistical results. 

       research errors to determine if resolution could occur at vendor or healthnet.

       originated multiple scenarios to correct frequent issues.

       orchestrate all policy/procedures for hns disputes from providers.

       department representative for all government/state mandates including communications to team. 



yyyyyy x. yyyyyy

page two



claims supervisor (2003-2005)

       advanced to supervisor of government claims and benefits coordinator.

       directed 32 employees and oversaw attendance, hiring and policy/procedures.

       administered daily claims inventory operation.

       managed staff to cover specific claims due to high claim inventory. 

       originated monthly reports covering claim inventory-beginning of month, claim inventory-end of month and increase/decrease of claim inventory.

       authored and developed charts to show increase/decrease in claims inventory.

       responsible for departmental production and quality.

       facilitated meetings with it, medical management and quality departments to improve claims processing.


claims department team lead (2002-2003)

       tasked to work directly for claims supervisor and manager.

       served in team liaison role aiding claims processors with difficult claims.

       interpreted contracts for payment of claims. 




earlier background

prior to 2002, served healthnet as research and adjustments processor and claims processor.  other career positions were as medical management coordinator, oxford health plans, trumbull, ct, admissions coordinator, bridgeport hospital, bridgeport, ct, and emergency room/admissions coordinator, middlesex hospital, middletown, ct.  in these assignments, built outstanding project management, claims processing, medical records, admissions and emergency room operations skill sets.





sacred heart university, bridgeport, ct

management and supervisory studies


yyyyyy x. yyyyyy                                           0000 xxxxxx xxxx , xxxx , xxxxx 00000





cover letter text






hiring agent name


company name


city, state   zip code


dear                   :


i am currently seeking a challenging career opportunity in a manager/supervisor, medical administration capacity and am submitting my resume for your review.  in advance, i thank you for your time and consideration.


as demonstrated in the accompanying resume, my professional qualifications include over 20 years of successful background in the healthcare insurance and hospital sectors.  to complement this background, i possess demonstrated expertise in medical billing, admissions, outside claim processing, file testing, troubleshooting, validation and payment coordination, as well as strong analytical, problem-solving and managerial capabilities.  as an employee, you will find me to be an enthusiastic and disciplined team player, committed to supporting you in achieving your objectives through superior performance. 


i am confident that i could be a valuable asset to your firm, and look forward to interviewing with you in the near future to further discuss my areas of experience and expertise that would be a contribution to your organization.








yyyyyy x. yyyyyy







<< Previous           Back to Sitemap           Next >>

Remember: Hire Us To Write YOUR New Resume
And We GUARANTEE That If You’re Not Working In 60 Days Or Less,
We’ll Revise Your Resume, Refund Your Money,
AND Give You $50 EXTRA!

Click HERE!