Quality Audit Non Calls Representative Resume Example

Love this resume?

By clicking Build Your Own Now, you agree to our Terms of Use and Privacy Policy

Jessica Claire
, , 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - -

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.

  • 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
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:
- ,
Activities and Honors
Personal Information
WORD | PDF , The Clean template stays true to its name by neatly dividing individual sections of your resume. It’s a fresh and clean style. Everest Available in: WORD | PDF The Everest template is a bold choice. Ascend to the top of the application pile with this robust, powerful resume design. Premium Available in: WORD | PDF The Premium template brings a little something extra to the table. Use it to add swagger and confidence to your resume. Windsor Available in: WORD | PDF The Windsor template is our most elegant resume design, and makes it easy to emphasize your background and expertise. 2021 Available in: WORD | PDF The 2021 is a simple yet refined resume template. Let your experience do the talking with our most modern style to date. Corporate Available in: WORD | PDF Using the Corporate template is like putting on a suit and tie for an interview. It shows the hiring manager you mean business. Advanced Available in: WORD | PDF If you have a highly developed skill-set, the Advanced template is perfect for you. Use it to quickly show that you’re a pro. Majestic Available in: WORD | PDF The Majestic template embodies the industriousness of a modern city – built for anyone entering today’s fast-paced workforce. Minimalist Available in: WORD | PDF The Minimalist resume template is sleek, and conveys only the information needed to get you hired. Traditional and classy. Modern Available in: WORD | PDF The Modern template uses a red color to highlight key aspects of your work history and education. Chicago Available in: WORD | PDF, The Chicago template features black dividing lines and bolded section titles for clear readability. Milano Available in: WORD | PDF The Milano resume template has a sophisticated look using a distinctive orange color to highlight section titles. Classic Available in: WORD | PDF The name of this resume template says it all. Classic is the most popular template on the market. Taj Mahal Available in: WORD | PDF The Taj Mahal is great for anyone applying for an ultra-competitive position and needs an extra edge to help them stand out. Elegant Available in: WORD | PDF The Elegant template inspires a sense of elegance professionalism and attention to detail. Pantheon Available in: WORD | PDF The Pantheon template exudes confidence, and introduces job applicants to hiring managers with strength.

By clicking Build Your Own Now, you agree to our Terms of Use and Privacy Policy

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

How this resume score could be improved?

Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:


Resume Strength

  • Formatting
  • Measurable Results
  • Personalization
  • Target Job
  • Typos

Resume Overview

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