Quality Control N A
Resume:
JESSICA
GIDDENS
*******@*****.***
ngs, FL 34689
S K I L L S
Data collection management
Business performance analysis
Support case resolution
Compile data
Monitor quality control
Customer relations
Problem-solving
Regulatory compliance
Investigate claims
Effective communicator with
strong interpersonal and
leadership skills
P R O F E S S I O N A L S UMMARY
To secure a key role that will benefit from my dedication to excellence and diversity of experience.
E X P E R I E N C E
D A T A A N A L Y S T
Sourcetek Contract for Innovation Refunds
Tampa/Remote, FL
August 2022 September 2023
Request and obtain documentation from small business clients who are applying for the Federal Government
EmployeeRetention Credit program.
Review and analyze businesses Form 941 for accurate reporting of wages/taxes.
Review Profit & Loss statements.
Review Form 3508 for PPP loans for accurate company name, address, consistent EIN number and coverage period. Review 24 months of Payroll for gaps, inconsistency and deductions from pay.
Assist clients with writing a COVID narrative to explain how their business functioned prior to COVID and explain how COVIDimpacted the business from an Operational and Revenue perspective.
Prepare notes for Tax Professionals to explain any situations that are outside of the norm and/or justify missingrequired documentation.
Participate in the Know Your Customer (KYC) program to ensure there isn't misrepresentation of the clientbusiness or documentation.
Ensure all files are processed and complete in compliance with standard operating procedures; paying close attention to detail. Consistently meeting monthly production and quality assurance goals.
Developed solutions to defined tasks, problems and projects using specialized foundational knowledge.
C L A I M S A U D I T O R
United Health Care
Greensboro/Remote, NC
November 2014 July 2022
Management of incoming Financial Protection claims and follow-up to claim assignment with our partners domestic and global to ensure that claim reports are handled timely and accurately
Documenting claim data into the claims management system; requesting outstanding information; and analyzing responses Provide expertise or general claims support by reviewing, researching, investigating, processing and adjusting claims information
Document appropriate payment or refer claims to investigators for further review
Analyze and identify trends and provides reports as necessary Consistently meet established productivity, schedule adherence, and quality standards
Complete necessary adjustments to claims and ensure the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g
Claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
Computer experience
Able to navigate between multiple applications and input data quickly
Emotional fortitude for high stress situations
Ability to Learn and leverage new systems and training resources to help apply claims processes/procedures.
Kept all involved parties updated on status of submitted claims, applying wide range of information about company's policies, procedures and benefits.
Processed new claim suspensions and reprocessed discrepancies accordingly and reviewed other documentation for edits and consistency.
Effectively resolved complex claims with severe exposure levels by using exceptional file handling abilities.
R A P I D R E S O L U T I O N E X P E R T / T I E R 2 United Health Care
Greensboro/Remote, NC
February 2014 November 2014
Perform all types of complex adjustments and closed, denied, and simple adjustments
Processed claims in a timely manner for members and providers Comply with all current policies, procedures and workflows Maintain proficiency in all technical applications
(technical skills and system knowledge)
Being responsible for any follow-up work needed for resolving and closing issues
Identifying and resolving anticipated Provider issues to prevent future calls
Maintaining accurate documentation in ORS Record.
H E A L T H A D V I S O R
United Health Care
Greensboro, NC
July 2011 February 2014
Help members maximize the value of their health plan benefits Assist as team lead with escalations
Commitment Champion for my team: Manage and Report commitment trends to management
Own problem through to resolution on behalf of the member in real time or through comprehensive and
Timely follow-up with the member
Help members navigate myuhc.com and other UnitedHealth Group websites
Research complex issues across multiple databases and work with support resources to resolve member issues
Educate members about the fundamentals of consumer-driven Knowledgeable in medical and dental coding and claims Processing
2year's experience with Medicare & Retirement.
E D U C A T I O N
E A R L Y C H I L D H O O D E D U C A T I O N / S P E C I A L E D U C A T I O N
University of North Carolina at Charlotte
Charlotte, NC
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