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Quality Assurance Specialist Resume Example

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QUALITY ASSURANCE SPECIALIST
Summary
Dedicated, customer focused, results oriented, and energetic with Customer Service and Customer implementation teams. Excellent leadership and management skills with the ability to manage and lead a successful customer service team. Excellent internal/external written and verbal communication, presentation, interpersonal and analytical skills. Ability to multi-task and prioritize issues in a complex environment. Excellent customer service, management, organizational and computer skills, Extensive background in developing teams, training material, leading teams in process improvements, developing and enhancing team processes and procedures.
Highlights
  • Team management
  • Meticulous attention to detail
  • Skilled multi-tasker
  • Training and development
  • Deadline-oriented
  • Claims analysis and review specialist
  • Proven patience and self-discipline
  • Relationship and team building
  • Sound decision making
  • In-depth claims knowledge
  • Standard operating procedures
  • Personal and professional integrity
Experience
January 2014
to
Current
XeroxRichmond, VA.Quality Assurance Specialist
  • Process and determine initial eligibility for Medicaid.
  • Determine initial and continued eligibility for state medical assistance programs.
  • Completing full investigations on cases that have been appealed and working directly with DMAS (The Department of Medical Assistance Services) to ensure the appropriate decisions are made on each case.
  • Present the appeals summary during the appeal hearings.
  • Gather information, collects data, and evaluate information for accuracy and consistency.
  • Process applications and determine eligibility and benefit levels using VaCMS (Virginia Case Management System) and MMIS (Medicaid Management Information System).


    October 2008
    to
    May 2014
    General Dynamics ITChester, VA.Quality Specialist
    • Lead implementation team to improve the efficiency and effectiveness of the projects we support with focus driving revenue.
    • Focus on driving a knowledge of the material for Medicare Responsible for development of training material Lead training classes for new hires to expand the knowledge of Medicare and claims and existing members on current and new best practices.
    • Assist in job interviews and hiring process.
    January 2008
    to
    October 2008
    General Dynamics ITChester, VATraining Specialist
    • Responsible for developing, training, and implementation of the Customer Service Representatives.
    • Review recorded calls through systems such as Avoke, Mattersight, Behavior Analytics, and Verint to ensure quality and accuracy.
    • Develop plan of action on reoccurring issues Provide direction to the training team for the ongoing maintenance and prioritization of training programs and tools.
    • Worked with Supervisors to improve the efficiency and effectiveness of the request of providing excellent customer service.
    • Travel to different sites across the U.S.
    • to assist with the startup of the MarketPlace contract.
    December 2006
    to
    January 2008
    General Dynamics ITChester, VASupervisor
    • Manage internal and external teams.
    • Utilizes reporting tools to measure and communicate progress, quality, and compliance to the program.
    • Responsible for annual performance reviews for Customer Service Representatives.
    Education
    John Tyler Community CollegeNursing
    Skills

    Account Management, Active Learning,Client Relations, Computer Proficiency, Coordination, Creative Problem Solving, Critical Thinking, Customer Needs Assessment, Customer Service, Data Collection, Data Entry, Documentation, Email, Executive Management Support, Filing, Grammar, Internet Research, Report Transcription, Research, Scheduling, Service Orientation, Speaking, Spreadsheets, Telephone Skills, Time Management, Travel Arrangements, Travel Booking, Travel Planning, Type 40 WPM, Typing, Writing, Letters and Memos, Microsoft Excel, Microsoft Office Suite, Microsoft Outlook, Microsoft PowerPoint, Microsoft Word, Multi-Task Management, Organizational Skills, Prioritization, Proofreading, Reading Comprehension

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    Resume Overview

    Companies Worked For:

    • Xerox
    • General Dynamics IT

    School Attended

    • John Tyler Community College

    Job Titles Held:

    • Quality Assurance Specialist
    • Quality Specialist
    • Training Specialist
    • Supervisor

    Degrees

    • Nursing

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