Customer Service Quality Assurance

*** ******* **** ***** 904-***-****

Jacksonville, Fl 32218 E-mail

********@*****.***

Paula S. Evers

Objective My Goal is to obtain a position in which acquired experience, creative talents and

commitment to excellence will have valuable application.

Professional experience 2003 – 2010 Amerihealth Administrators Jacksonville, Florida

Medical Claims Supervisor

• Provided support, guidance, leadership and motivation to promote maximum

performance. Administered company personnel policies regarding performance

management and time management. Established and implemented team and

individual performance development plans.

• Increased associate opinion results in people management from 67.00%

to 95.00%

• Increased and maintained team production level of 130.00% or greater

• Increased and maintained team overall accuracy score of 99.00% or

greater

• Quality Assurance Analyst – Responsible for accurately monitoring the

quality integrity of medical claims processing

• National Accounts Audit Reviewer – Responsible for the oversight of the

integrity of the national accounts claims auditors. Ensure compliance of national

accounts standards, create and administer action plans, and implement necessary

improvements.

• Increased the national accounts financial accuracy score from 78.00% to

99.00%

• Trainer – Facilitate medical claims processing training classes for new hire and

existing associates locally and nationally. Developed training material based on

company needs.

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1996 – 2003 Humana Insurance Company Jacksonville, Florida

Lead Benefit Analyst – Responsible for the daily oversight and distribution of

high volume claims inventory. Through the use of Six Sigma techniques I identified

and advised management of trends, problems, and issues as well as recommended

course of action. Created updated workflows and procedures based on analytical

review and results. Implemented process and quality indicators to observe process

functions and make the necessary changes when needed.

• Selected to represent the service center on the National Claims Process

Management Team

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• 1989 – 1996 Prudential Insurance Company Jacksonville, Florida

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• Medical Claims Examiner – Responsible for accurately processing medical claims.

Reviewed medical records and procedures for correct benefit determination.

Provided customer service for large national accounts group.

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Office Skills

• Proficient use of Microsoft Office

• ICD-9, CPT, and HCPCS coding

• Medical terminology

• Gold Level Career Readiness Certificate

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Honors and Awards

• Certificates in Re-engineering, Benchmarking, and Process Management from Practical

Quality Solutions

• Participated in the Governors Sterling Award program. The Sterling Award Program

highlights companies throughout Florida with substantial process improvements.

• Certificate in Project Management Fundamentals

Education

Florida State College at Jacksonville

Completed multiple human relations courses to enhance personal and professional relationships

Andrew Jackson High School

Diploma - 1989

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