Quality Assurance Manager
Resume:
Jennifer Lawrence
Uniontown, PA 15401
Phone 724-***-****
OBJECTIVE
• Obtain a position with the opportunity to utilize my knowledge and experience for the efficient
operation of a company.
• Earn advancement through on the job performance.
WORK EXPERIENCE
Health Plan of Nevada, Subsidiary of UnitedHealthcare September 2001 – August 2012
Served as a vital member of the Health Plan of Nevada team, representing the largest single health carrier in the
nation, and advanced over the course of an eleven year career with key positions and job duties presented
below:
Small Business Renewal Account Consultant March 2009 – August 2012
• Support of account executives, assist and conduct enrollment meetings.
• Process group migrations from one platform to another.
• Provide service to group and brokers as well as assist members with enrollment, billing, and
claims.
December 2006 – March 2009
Sales Account Consultant New Business
• Process small group quotes and re quotes in Siebel.
Assist and conduct employer benefit enrollment and educational meetings.
•
Educate brokers and members about plans, benefits and services offered by Health Plan of
•
Nevada and Sierra Health Services.
Resolve service and eligibility issues on existing accounts.
•
Deliver and pick up correspondence and supplies, as needed.
•
Process new groups and request any needed items from brokers and/or group contact.
•
Enter and track new groups in Siebel.
•
Manager – Quality Assurance Specialist August 2004 – December 2006
• Conduct monthly enrollment and reconciliation audits.
• Perform weekly audits for new and select staff.
• Coordinate and train new and existing employees according to job function and applicable policy
and procedures.
• Write and perform annual reviews of all applicable policy and procedures.
• Run queries for specific reports related to enrollment and eligibility.
June 2004 – August 2004
GSR III – Medium/Specialty Team
• Responsible for the entry of membership, group, billing and rate transactions in accordance with
company policies and procedures.
GSR II/Medium/Specialty Team March 2003 – June 2004
• Execute collection of and reconciliation of premium payments and membership reports to
identify discrepancies and follow through to ensure outstanding balances are collected or resolved.
GSR II IHMO October 2002 – March 2003
Perform eligibility and enrollment for IHMO members, billing and reconciling of monthly premium
•
payments for IHMO members and IHMO list bills.
Communicate directly with IHMO members via phone or in person to resolve various issues.
•
Assist cash team with daily posting of checks for group and IHMO policies.
•
September 2001 – October 2002
GSR I – Government Programs/Member Services
• Enter senior dimensions applications
Handle out of area issues in accordance with Medicare guidelines
•
Work out of area section of reply and be in compliance with CMS guidelines, eligibility issues
•
with Medicaid members.
EDUCATION
Diploma, El Modena High School, Orange, CA
Licenses
Health and Life, Resident Producer Pennsylvania
SKILLS
Proficient in Microsoft applications
UHC applications
Facets, Macess, Onyx, Siebel
Reliable worker with the ability to quickly learn new concepts and skills
Contact this candidate