case management in line qa analyst resume example with 7+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK Home: (555) 432-1000 - Cell: - resumesample@example.com - : - -
Career Focus
Over 6 years of experience in non customer service facing roles and 1 solid year in a direct customer service role.
* Supervision & Office administration experience.
*1 year in a supervisor position.
Summary of Skills
Proficient in all Microsoft Office programs.
Professional Experience
09/2010 to 09/2016
Case Management in Line QA AnalystNovant Health – Thomasville, NC,
Provides
analytical and administrative support within an internal control environment.
Assists team in gathering, organizing, and processing data that
helps track, report and manage internal control gap issues and mitigation
plans.
Involves
substantial knowledge of operating policies and procedures, works with internal
customers to establish and perform quality control, and assists with analysis
and development of recommendations.
Works
independently on general assignments, with the direction of more senior staff,
on complex projects and analysis.
Provide
statistical reporting and undertaking audits to ensure compliance with control
procedures, as well as working with internal QC/QA partners and business
partners.
Manual modifications of DOJ, SFO and FNMA loans.
Review IIN Letters for Accuracy and Completion.
Fraud
prevention and detection.
Created internal and external user documentation
through complete life cycle.
Business Control Specialist/
Product Management
Performed regular statistical reporting and undertook audits to
ensure compliance with control procedures; as well as working with internal
QC/QA partners and business partners.
Researched and documented organizational review, workflow and
staff analysis.
Analyzed and assembled data to define problems.
Completed loan-level research in support of high-level program
initiatives.
Reduce/Mitigate risk by performing cost analysis on underwritten
expense reports.
Provided analytical and administrative support within an internal
control environment.
Provides guidance to associates within unit regarding procedural,
technical and/or operational changes.
SFO ILQA Production
Analyzed procedures, regulatory and investor requirements to
develop and enhance the Line of Business.
Performed audits and risk management on underwriters to identify
any issue that required remediation.
Evaluated credit decisions for accuracy based upon established
risk parameters.
Assisted in designing, documenting, implementing and monitoring of
new services.
Provided guidance to associates within unit regarding procedural,
technical and/or operational changes.
06/2010 to 09/2010
Insurance Verification Specialist Bridger Steel – Evansville, WY, I verified several Medicare and Medicaid insurance plans
with different insurance companies/carriers to make sure the effective and
termination dates are accurate and correct. I also verified the member’s
demographic information, and policy type to ensure that they as well are
correct; along with other insurance verification steps.
09/2009 to 06/2010
Customer Service RepresentativeHumana Insurance Company – City, STATE, I used a number of systems to assist customers through
inbound calling updating members demographic information as needed, I also
compared
Insurance plans and advised members about different Humana
plans. I made PCP changes
When necessary and assisted customers to find in network
physicians/specialist.
As well as, helped pharmacist to complete medication
overrides when a member needed medication. I also processed payments in the
Humana billing system, while explaining any information regarding several
different insurance plans.
06/2009 to 07/2009
Collector (Internship)Physicians Reimbursement Experts – City, STATE,
Verified insurance on patients claims.
Called Insurers to see whose responsibility payment was.
Posted payments and wrote off claims as needed.
Re-filed claims.
Mailed corrected claims with all needed
documents.
Worked through the system of AllMeds (Similar to
Medisoft)
Kept log on an Aged Receivables (EOB's needed,
paid accounts, patient responsibility and insurance responsibility)
Education
Expected in 2009 to to
: Medical Billing and Coding Sanford Brown Institute - Dallas, Texas GPA: This Certification was obtained in order to gain professional development in the medical field. I was in the Top 10% of Class.
Expected in 2006 to to
: High School Pegasus School of Liberal Arts & Science - Dallas, Texas GPA: I received my HS Diploma with honors also graduating in the Top 5% of my class as Valedictorian.
Expected in to to
Associate of Arts: Criminal Law El Centro Community College - Dallas, Texas GPA:
Languages
Fluent in speaking and writing English with a minimal understanding of how to comprehend and speak Spanish.
Skills
Proficient in all Microsoft office programs including Microsoft Excel. 10 key as well as AS400.
Strong Computer and Analytical skills.
Extensive overall knowledge of the Mortgage Loan Origination System, and an understanding of the Mortgage Loan Life Cycle.
Agile and Waterfall product development background.
Excellent verbal and written communication.
Long term experience in a paperless Loss Mitigation environment.
Ability to translate business requirements into technical specifications.
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