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Quality Audit Non Calls Representative Resume Example

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Jessica Claire
, , 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Summary

Hard-working professional with 13 years of experience in healthcare with proven knowledge of data collection and analysis, electronic claims processing, and provider relations. Aiming to leverage my skills to successfully fill Quality, Billing and Claims Specialist roles at your company.

Skills
  • Seasoned professional in healthcare, telecom and retail industries
  • HIPAA knowledgeable
  • Auditor
  • Management Proficient with vendor relationships
  • Benefits
  • Computer Literacy
  • Data entry
  • Leadership
  • Notes
  • Medical terminology
  • Exchange
  • OSF
  • Processes
  • Quality
  • Retail
  • Telecom
  • Phone
Experience
05/2018 to Current
Quality Audit (Non-Calls) Representative Markel Corporation Lakewood, MN,
  • Reviewed and inspected processes of the company's products or services.
  • Analyzed errors to determine the cause and outcomes of several RSO departments.
  • Audited (25) each associate and non-associated based audits on a monthly bases.
  • Participated on and lead ANOC/EOC project.
  • Created process templates and made available to the team.
  • Lead as a Subject Matter Expert (SME) on KY/FL/LA MCD training in January 2020.
  • Trained new associates to team on our processes.
  • Audited The Auditor on HGS Refunds process every month.
  • Achieved 99% quality while maintaining 99% of production.
  • Winner of Star Awards 2018 and 2019 for growth and leadership.
04/2017 to 05/2018
Claims Specialist-Transplant Humana Inc City, STATE,
  • Adjusted, processed and checked eligibility status for transplant claims.
  • Utilized Clinical Guidance exchange and investigated and made phone calls.
08/2010 to 01/2016
Claims Specialist-COB COMM-FI Humana Inc City, STATE,
  • Investigated, processed and coordinated members benefits.
  • Achieved quality goals while maintaining production.
  • Bailout of transplant as needed.
  • Trained team members on our claims and bailout process.
  • Winner of Star Award for growth and leadership.
02/2008 to 07/2010
Claims Specialist Humana Inc, Core MTV Fully Insured Claims City, STATE,
  • Reviewed, processed and investigated coverage of claims.
  • Trained on Humana systems and mastered data entry and medical terminology.
  • Reviewed notes and processed claims for denial or approval.
  • Maintained proactive communication with Medical Providers and Nurses.
  • Maintained team expectations in quality and production.
  • Cross-trained in ASO, OSF MTV claims.
Education and Training
Expected in 1980
Jeffersonville Technical School louisville, KY Certificate Computer Literacy:
- ,
GPA:
Activities and Honors
Personal Information
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Resume Overview

School Attended
Job Titles Held:
  • Quality Audit (Non-Calls) Representative
  • Claims Specialist-Transplant
  • Claims Specialist-COB COMM-FI
  • Claims Specialist
Degrees
  • Jeffersonville Technical School louisville, KY Certificate Computer Literacy