Diana Solano

Phone Number 201-***-****

Email ad1zz1@r.postjobfree.com

Address Paterson, NJ 07501

EXPERIENCE

Quality Assurance Specialist

Evolent Health Nov 2022 - Present

Dental Claims Processor

US Jan 2021 - May 2022

Quality Analyst Specialist

Broadpath Healthcare Solutions, US Jan 2019 - Jan 2021 Hardworking, highly motivated professional eager to lend combined knowledge and skills to enhance business performance. Operates well in both individual and team capacities, leveraging seasoned work ethic to quickly adapt to different processes and drive company objectives. Resourceful and results-driven with a passion for growth and efficiency to meet company needs and increase service value.Seeking to utilize excellent communication, interpersonal, and organizational skills to complete tasks. Reliable with a good work ethic and the ability to quickly adapt to new tasks and environments.

• Assisted in defining, refining, and implementing SOPs and internal audit programs.

• Trained and mentored new quality assurance specialists on quality assurance processes and procedures.

• Conducted tests on products to verifty compliance with quality standards and industry regulations. Used quality monitoring data management system to compile and track performance at team and individual level.

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• Maintained QA dashboard to drive integrity of data.

• Performed routine audits and quality assurance reviews to test operational processes. My duties were to ensure each claim was completed and the treatment received leet the criteria for the insurance company.

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Interpreted contracts with payers to verify proper payment, sending initial or secondary bills to insurance companies.

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• Requested information from internal or external sources to complete and validate claims.

• Coordinated benefits while applying applicable deductibles, co-insurance and out-of-pocket costs.

• Recorded and maintained insurance policy and claims information in database systems.

• Updated insurance policies for changes, reinstatements and cancellations.

• Reviewed medical bills and medical records to determine medical necessity and appropriate treatment.

• Quality assurance agent for BlueCross BlueShield sales Agents

• Provide assistance to providers and hospitals in regards to benefits, claims and precertification.

• Developed and maintained test automation scripts using scripting languages such as JavaScript.

• Analyzed quality and performance trends to provide recommendations and action plans for improvement. Interpreter

Language Line Solutions, US Jan 2015 - Oct 2019

Call Center Supervisor

Stream International, US Jan 2009 - Jan 2012

Collected data and developed and utilized appropriate metrics for facilitating case reviews and root cause analysis.

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• Educated agents, supervisors and managers on QA process and goals.

• Created exercises and quality assessments to reinforce learning. Acted as positive agent for change and progress by enthusiastically supporting department and company initiatives.

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• Designed and implemented performance tests using tools like JMeter and LoadRunner.

• Simultaneous interpretation over the phone and live video. Facilitated effective communication between non-English speaking participants within a variety of legal settings.

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• Exhibited strong problem solving skills when faced with complex linguistic challenges. Demonstrated excellent knowledge of applicable laws, regulations, and court procedures related to language interpretation.

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• Ensured compliance with state and federal laws regarding the rights of interpreters.

• Researched unfamiliar terminology quickly and accurately to support interpretive tasks. Performed quality control checks on translations prior to submission for review or presentation in court proceedings.

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Developed and implemented best practices for legal interpreting, ensuring accuracy in translation of court proceedings.

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• Managed multiple projects simultaneously while meeting tight deadlines. Utilized exceptional listening skills to capture nuances in meaning while conveying the same sentiment between two languages.

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• Answer calls from customers regarding their account

• Process payments and update general information

• I was then promoted to be quality assurance representative My job consisted of monitored the agents to make sure they were adhering to company policies and procedures.

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• Implemented quality assurance measures to ensure accuracy of data entry into the system. Assisted with escalated calls when needed, providing guidance to agents on best practices for handling difficult customers.

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• Identified opportunities for process improvement through analysis of customer survey results. Recognized outstanding performances among team members through reward programs such as bonuses or recognition awards.

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Developed and implemented processes to streamline service operations, resulting in improved customer experience scores.

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Resolved conflicts between employees or customers in a timely manner while maintaining professional composure.

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• Developed training modules that incorporated product updates into existing curriculum materials. Collaborated with other departments within the organization to provide comprehensive solutions to customers' needs.

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EDUCATION

Completed coursework towards BS In Clinical Psychology Liberty University, Lynchburg, VA

GPA 3.9

May 2023

SKILLS

LANGUAGES

Maintained up-to-date records related to call center operations such as agent availability and contact information.

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• Provided technical support during peak hours when necessary or assigned additional tasks as required.

• Handled customer inquiries in a courteous manner while demonstrating empathy for their situation. Performed regular coaching sessions with staff members to improve their knowledge base and communication skills.

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• Facilitated regular meetings with staff to discuss performance metrics, objectives and feedback.

• Monitored employee progress against established targets and key performance indicators. Provided leadership and direction to team of 20+ call center representatives, ensuring customer satisfaction goals were achieved.

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• Trained new hires on company policies, procedures, products and services. Analyzed call trends to identify areas for improvement and develop strategies for resolving customer issues efficiently.

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• Project Management • Problem-Solving Skills

• Quality Assurance • Customer Service

• Analytical Thinking • Verbal and Written Communication

• Understanding of Evaluation Methodologies • Standards Interpretation

• Team Leadership • Collaboration Skills

• Database Maintenance • Adept at Performing Analysis

• Performance Testing • Establishing and Enforcing Policy

• Post-Resolution Follow-Ups • Personnel Management

• File Management • Internal Audits

• Communication Proficiency • Quality Improvement

• Correction Action Planning

Spanish

Advanced (C1)

English

Advanced (C1)

German

Intermediate (B1)

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