Customer Service Quality Assurance
Resume:
Dawn Hofmeister
Knapp, WI ****9
Cell: 651-***-****
Email: *******@*****.***
Profile
One year of experience at United Healthcare as a Medicare Claims Representative
Associate, providing expertise and general claims support by reviewing, researching,
investigating, processing and adjusting claims. Six months of crop insurance claims
processing experience. Seven years of experience were developed in the Long-Term
Care industry in information technology comprising all phases of the software
development cycle. Additional years of experience were developed in various areas of
the health insurance, auto and fire insurance, and long-term care insurance industry
including customer service, billing, and enrollment entry processing.
Objective
To obtain a challenging position, utilizing abilities developed through my professional
experiences and education, with the opportunity for professional growth based on
performance.
Education
Bachelor of Science (1981)
University of Wisconsin, River Falls
Business Administration / Economics
Employment Experience
United Healthcare, Eau Claire, WI, 4/22/2013 to 4/5/2014
Claims Representative Associate – Medicare claims processing.
• Provided expertise and general claims support by reviewing, researching,
investigating, processing and adjusting claims.
• Analyzed and identified trends and worked on special projects as necessary.
• Meeting established productivity, schedule adherence, and quality standards
were key elements of this position.
• Telephone and computer are the primary instruments to perform job duties.
• Required the ability to multi-task, including the ability to understand multiple
products and multiple levels of benefits within each product.
NAU country Insurance, Eau Claire, WI, 10/2012 to 4/2013
Claims Processor – Crop Insurance
• This was a temporary position through Adecco. This position provided claims
processing support for the Senior Claims Processor ensuring adjuster paperwork
is complete and correct.
Long Term Care Group (LTCG), Woodbury, MN, 01/2000 thru 10/2006
Principal IT Quality Assurance Analyst
• Provided guidance and leadership to the Quality Assurance department by
serving as the lead analyst on assigned projects. Developed, maintained, and
executed test plans, test cases, and test requirements aimed at finding and
resolving software product defects.
• Developed the Functional and Integration Test Plan in collaboration with the
external client for a large Billing and Collections project.
• Tested data feeds to ensure they contained the correct data and the data
displayed correctly in the various module windows.
• Trained new and existing team members on testing processes and procedures.
• Attended and participated in Project Planning meetings.
Quality Assurance Analyst
• Responsible for the team lead activities on a large document printing project for
an external client, using Document Sciences Software. Activities included the
development of an overall test plan, system and user acceptance test cases,
consulting with developers and users on product discrepancy issues, providing
progress reports to the QA Manager, and providing guidance to the QA testers on
the testing team.
• Successfully participated as a team member in the QA testing process, including
understanding the requirements of assigned projects, execution of the project
test strategy, updating the defect tracking system and interacting with the project
team in the overall success of the project.
Quality Assurance Tester
• Developed and executed all phases of the reporting project test plan including
the new functional testing as well as regression testing. Worked closely with the
external client.
Enrollment / Application Data Entry
• Data entry of the Long-Term Care enrollment applications.
Fortis, Woodbury, MN 1999-2000
Annuity Customer Service Call center processor.
• Telephones and computer processing.
State Farm Insurance, Woodbury, MN 2/1998 to 8/1999
Customer Response Center - Customer Service
• Providing auto and fire claims assistance to policyholders in a call center setting
using the telephone and computer as the primary instruments to perform job
duties.
Fortis Benefits Insurance Company, Woodbury, MN 5/1982-1/1996
Management Support Services - Business Project Specialist – 5 years
• Used SQL for building data views and extracting information from DB2 and
ORACLE relational databases providing information to the claims, customer
service and underwriting departments.
• Quality test plan creation including new functional testing as well as regression
testing.
• Defect reporting, documentation updates and user training.
Customer Service / Billing Representative – 8 years
• Coordinated all activity on large health insurance group accounts, such as group
terminations, setting up COBRA accounts, adding new hires to the system, salary
changes, and employee terminations.
• Maintained customer accounts by utilizing a variety of programs to make
payments or adjustments as needed.
• Assessing / auditing member accounts and reconciling billing statements by
identifying past due amounts, deductions, credits, etc.
• Answered inbound calls from customer and agents, assisting them with
questions related to billing and invoices.
• Running reports and documenting all activities in the internal system.
Policy / Contract Issue – 1 year
• Prepared policy contracts and issued new business cases.
• Made revisions to the policies per the policyholder’s request.
Skills
• Ability to learn new and complex computer system applications.
• Ability to independently manage processes to deadline.
• Ability to analyze processes and implement ideas to improve efficiencies.
• Strong analytical, organizational and documentation skills.
• Strong ability to interact with all levels of staff and develop relationships that
enhances the department.
• Knowledge of software quality assurance methodologies and procedures.
• Sold knowledge of all phases of the software development cycle including
requirements and use case evaluation, test management, test case design and
execution, unit testing, functional testing, integration testing, system testing
acceptance testing, regression testing and data testing, defect management and
process improvement.
• Experienced in working with third party vendors and remote development teams.
• Access based defect tracking database tool.
• Web based Track Studio defect management tool.
• Microsoft project management tool.
• Microsoft Office Suite ( word and excel)
• Microsoft Windows 7
• Microsoft Outlook
Contact this candidate