Customer Service Quality Assurance
Resume:
Maureen Brown
**** * **** ***** **. Apt ****
Chicago, IL 60657
*******.********@*****.***
Summary of Qualifications
. Experienced self starter with the ability to work under pressure to meet
deadlines.
. Analytic and problem-solving skills including data analysis to generate
fraud referrals to investigators. Also, analyzed customer requirements to
create reports and software, including debugging and trouble-shooting
software issues.
. Focus on quality and customer service utilizing Continuous Quality
Improvement (CQI) methodologies and process reviews as Supervisor of
Quality Review Team and programmer for health-plan quality indicators
(HEDIS).
. Excellent communication skills. Clear, concise writing skills required
for fraud referrals. Verbal skills include the ability to convey
technical concepts to non-technical business users and management.
. Management experience including development of fledgling Quality Review
Team. Hired, coached and developed employees including quarterly and
annual performance reviews. Delegated work and resolved conflict within
team.
Technical Experience
SQL TSO/ISPF
Teradata Excel
FAMS I2 Analysts Notebook
FOCUS IBM mainframe/MVS
JCL MS Office
Professional Experience
LABAT- ANDERSON - Chicago, IL
Data Analyst, Contractor at United States Attorney's Office, Northern
District of Illinois, Department of Justice,10/2009 to 12/2010
. Medicare and Medicaid health-care fraud Analyst
. Support health-care investigations by analyzing detail claims data and
other subpoenaed documents (e.g. banking documents, video tapes)
Health Care Service Corporation (DBA Blue Cross Blue Shield of IL) -
Chicago, IL
Sr. Supervisor, Provider Data Management, 1/2007 to 10/2009
. Supervised Quality Review Team of six direct reports
. Compiled documentation, reviewed initial results and responded to
exceptions for SAS-70 audits of provider file
. Researched and appealed results of Blue Cross Blue Shield Association
audit of provider data
Sr. FAMS Reporting Analyst, Special Investigations Department, 9/2002 to
12/2006
. Analyzed data for proactive fraud detection and refer cases for
investigation
. Compiled claims data and protected health information (PHI) tracking data
for law enforcement subpoenas
. Define role-based security for department to meet Health Insurance
Portability and Accountability Act (HIPAA) privacy requirements;
department Local Security Administrator
Maureen Brown
3450 N Lake Shore Dr. Apt 2607
Chicago, IL 60657
*******.********@*****.***
Sr. Database Administrator, Fraud Control Center, 5/1998 to 8/2002
Supervisor
. Referred cases for investigation resulting from data mining using IBM
Fraud and Abuse Management System (FAMS) software and supported ongoing
fraud investigations via ad hoc reporting
. Represented business area during development of data warehouse
. Liaison between IT and vendors for multiple projects and training
Sr. Product Specialist, Health Care Administration (HCA) Database Support,
4/1994 to 4/1998
. Wrote programs computing National Committee for Quality Assurance (NCQA)
Health Plan Employer Data and Information Set (HEDIS) indicators from
NCQA specifications and supported Quality Improvement initiatives with ad
hoc reports
. Provided end-user technical support for department
. DBA of FOCUS database
Education
Purdue University
Bachelor of Science
. Information Systems and Computer Programming
. Worked full time while completing B.S. degree and raising a family
Joliet Junior College
Associate Arts and Sciences
. Liberal Arts and Sciences
Achievements
TWO-ONE-NINE TOASTMASTERS
Vice President Membership
References available on request
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