Quality Assurance Manager

Ronald D. Pope

San Diego, CA

Methodical Quality Assurance Manager with superb problem-solving and analytical abilities.

Keeps meticulous records and identify and troubleshoot problems. Specialties include operational

improvements, program implementation and documentation.

Work Experience

Claims and Quality Assurance Manager

TransGeneral Life Insurance Co.-Pittsburgh, PA

June 1999 to June 2009

• Enhanced product quality by implementing comprehensive QA processes and procedures.

• Mentored junior staff members in best practices for quality management, contributing to overall team

growth and development.

• Assessed product quality by monitoring quality assurance metrics, reports and dashboards.

• Conducted regular audits to ensure adherence to established protocols, maintaining consistency across

the organization.

• Implemented corrective action plans based on audit findings, resulting in measurable improvements

over time.

• Conducted process and system audits to identify areas of improvement and enforce compliance with

industry standards.

• Evaluated new technologies and methodologies for potential implementation within the organization''s

quality assurance program, staying ahead of industry trends.

• Investigated customer complaints and performed corrective actions to resolve quality issues.

• Monitored staff organization and suggested improvements to daily functionality.

• Recorded, analyzed, and distributed statistical information.

Medical Claims Examiner, Quality Assurance Auditor

HealthAmerica, Inc.-Pittsburgh, PA

March 1994 to October 1998

• . Achieved excellent outcomes for both patients and healthcare providers by applying sound judgment

in adjudicating complex medical claims.

• Streamlined workflow for faster resolution of medical claims through effective prioritization and

organization.

• Enhanced claim processing efficiency by conducting thorough investigations and maintaining accurate

documentation.

• Identified fraudulent activities by analyzing patterns, trends, and discrepancies in medical claims data.

• Developed expertise in specialized areas such as workers'' compensation or disability claims

management to better serve diverse client needs.

• Negotiated fair settlements with healthcare providers to minimize financial risk while ensuring adequate

compensation for services rendered.

• Collaborated with healthcare providers to obtain necessary medical records, ensuring timely and

accurate claim adjudication.

Education

Baccalaureate Degree in Education And Advanced Biological Sciences

Waynesburg College - Waynesburg, PA

September 1988 to May 1993

Skills

• Policy reinforcement

• Pre-implementation audits

• Arbutus Analyzer

• Staff training and development

• Operational budget forecasting

• Systems Analysis

• Employee supervision

• Audit reporting

• Quality assurance background

• ACL Audit Exchange

• Fraud analysis

• Data analysis

• Knowledge of quality systems

• IDX expert

Additional Information

There is quite a long time that I have been away from my career goals.

Please know that the reason for this absence is due to a long term disability.

Honestly, the time off has been debilitating.

However, my team that oversees my care are all in agreement and I have been given the 2 thumbs up

from all of them and frankly I feel blessed because of my treatment and so I am ready and willing to

move forward with my endeavors.

Thanks for your time with reading my personal portrait.

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