Quality Assurance Customer Service
Resume:
TOMIKA PEARSON
**** ***** *** *** **, Florence, *9501, SC (US)
*************@*****.***
PROFESSIONAL SUMMARY
Skilled in navigating complex healthcare systems
insurance policies
and financial assistance programs. Proficient at providing compassionate guidance resolving issues
and educating patients on coverage options. Adept at conducting thorough assessments to determine eligibility and securing necessary resources for veterans. Strong communicator and problem solver expert at collaborating with healthcare providers and insurance agencies to achieve favorable outcomes for patients. AREAS OF EXPERTISE Quality Assurance Multitasking Complex Problem Resolution Cross- Functional Collaboration Customer Service & Retention Strategic Planning & implementation Proficient in MS Office
Excel
and Windows Continuous Process Optimization Safeguarding confidential PHI(HIPAA) EXPERIENCE
Senior Quality Assurance Analyst, BlueCross BlueShield Of SC
• Performs quality control audits to evaluate accuracy and effectiveness of departmental operations functions including
• but not limited to
• claims
• membership
• customer service/call center
• workflow
• processing support systems
• procedures
• documentation
• etc. Identifies problems
2013 - Present
• analyzes cause and effect
• and makes recommendations for improvements.
• Conducts focused quality audits across various operations functions to ensure quality standards
• procedures
• and methodologies are being followed. Documents findings of analysis and prepares recommendations for implantation of new systems
• procedures
• or organizational changes to reduce errors.
• Proficiency with BCBSSC/subsidiary systems. DB2
• SQL or related
• Identifies areas of weakness and communicates recommendations on changes and improvements to training materials. Provides feedback to management on errors detected
• ensures errors are resolved
• and provides long-range solutions to causes. Develops and implements a quality control and improvement program based on targets identified through the quality reviews. Monitors and evaluates the implementation of corrective action plans.
• Compiles data
• provides feedback
• and generates reports for operations and/or training areas on quality performance. Trains new employees and remains current with all guideline changes
• work instructions
• etc. Writes or assists in writing desk procedures and training materials for departments.
Hazard Insurance Processor, Assurant/Olsten
• Assurant/Olsten Performs a proactive approach to insurance processing and auditing in the mortgage industry
• identifying potential issues through critical thinking and meticulous attention to detail.
• Engaged in effective problem-solving through inbound and outbound calls to ensure active coverage
• ensuring accuracy and compliance.
• Collaborated effectively on team projects
• contributing problem-solving skills to address complex tasks within specified timeliness.
• Employed strategic critical thinking in the assessment of insurance for mortgage loans
• meticulously conducted audits of homes and loans to proactively identify potential issues.
2011 - 2013
Data Entry Specialist, Assurant/Olsten
• Ladder/Olsten
• Implemented proactive problem-solving strategies through precise document filing and scanning
2008 - 2010
• identifying
• and resolving potential issues to enhance the efficiency of departmental processes.
• Engaged in collaborative efforts with teams
• employing critical thinking skills to discern and propose enhancements for streaming administrative tasks
• thereby elevating operational efficiency.
EDUCATION
Bachelor of Art:Business Administration
• Strayer University,
Present
High School Diploma
• Wilson High School, Florence, SC
2002
administrative tasks
assessments
attention to detail.
auditing
audits
SKILLS
Experienced
Experienced
Experienced
Experienced
Experienced
English
LANGUAGES
CERTIFICATIONS
• HIPAA
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