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Title Quality Assurance Customer Service
Target Location US-CT-Hartford
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Candidate's Name
EMAIL AVAILABLEhttps://LINKEDIN LINK AVAILABLEQUALITY ASSURANCE AUDITORA dedicated self-starter with 25 years of experience in healthcare. Looking to move to a leadership role that will utilize my organizational, technical, and customer service skills. Acted as an SME and resource for team members. Manages multiple priorities to meet deliverable dates. Key strengths include:Internal and External Customer Support Root Cause Analysis Project Management CollaborationQuality Coaching Continuous ImprovementEXPERIENCECigna Healthcare, Virtual WAH, East Hartford, CT 4/2016  4/2022Quality Review and Audit Analyst,Audit Dental BIDS/Dentacom client benefits info to ensure accuracy in benefit selections, product guidelines, and state/federal guidelines.Report on audit results to Analysts, Management, Technical coaches.Provide feedback regarding error trends and root causes.Partner with Ops Management, Service partners, and technical coaches to improve Dental and Dentacom quality and effectiveness.Sr. Quality Assurance Auditor, 6/2005  04/2016Audited BIDS (ePros and Profiles) for accuracy of client installation activities for Benefit Access Medical/Dental and Dentacom and raised questions\issues promptly to AnalystsResponded to questions from internal and external clients.Worked with the production team to meet standard turnaround times to ensure customer timing commitments.Worked with internal matrix partners compiling trending information and supports the process. improvements to ensure continued quality achievement of quality standards.Mentored coworker through job shadowing.Contact Senior Associate, 3/2001-06/2005Analyzed, verified, and processed Small Case, Middle Market, National, Transformed and Migrating (ePro) accounts for HMO, Non-HMO, and Managed Care business. Effectively represented Benefit Integrity in Expert Team meetings. Negotiated commitment dates with Matrix partners.Loaded Benefit plans into Benefit Information System (BIDS).Reviewed Special Processing Notes (SPNs), and Benefit Package Codes (BPCS) to ensure structure information is complete before generation.Analyzed, researched, and completed inquiries and problem referrals.Maintained accurate up-dated cases in LCMT, CTT, VISTA, and other applicable tracking applications.Managed multiple projects.Complied with HIPPA guidelines.EDUCATIONBusiness Administration Specializing in Project Management, Ashford University 2017

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