Quality Assurance Internal Auditor
Resume:
ANN MARIE HANES
Monroe, NC 28110 951-***-****
I would like to take this opportunity to introduce myself. As I am recently divorced, I am sincerely seeking additional employment as a supplement to my full-time occupation.
My attached resume details the highlights from my years of professional experience. I am a highly motivated and progress focused Manager of Audit & Compliance with a long-standing background in the insurance industry. With over twenty-one years of experience in audit and compliance management, I bring an extensive, practical approach to auditing. My extensive work history includes a proven track record of self-initiative and dependability.
Through my years of workers’ compensation insurance, I’ve developed strong analytical skills and attention to detail enabling me to prepare clear and comprehensive reports, outlining findings and providing actionable recommendations for continued compliance. I have a proven track record of collaborating with various departments to foster a culture of transparency and accountability.
I also possess a solid understanding of healthcare insurance. I pride myself on my organizational skills, which allow me to manage priorities efficiently. In addition, my proactive communication style helps me convey complex information clearly to diverse audiences, fostering beneficial relationships across external clients as well as inter-company departments.
Thank you for considering my application. I look forward to the possibility of speaking with you soon.
Sincerely,
Ann Marie Hanes
Ann Marie Hanes
ANN MARIE HANES
6051 Waldorf Avenue
Monroe, NC 28111 951-***-****
HIGHLIGHTS OF QUALIFICATIONS
Successful, progressively responsible twenty-one year work history within Quality Assurance as a Manager of Audit & Compliance and Senior Internal Auditor reviewing multi-jurisdictional workers’ compensation claims.
Co-created internal best practices policies and procedures with implementation and follow-up to ensure compliance.
Management of all internal correspondence and all required multi-jurisdictional forms and benefit letters.
Created training materials and conducted departmental training in use and implementation.
Effective time-management and excellent verbal and written communication skills.
Effective interaction with senior management, branch management, claims level staff, insurance companies, attorneys and all clients.
Effective and proficient in using Microsoft Office programs of PowerPoint, Word and Excel.
Successful, proven responsible remote employment history of fourteen plus years.
PROFESSIONAL EXPERIENCE
Workers’ Compensation Insurance:
Audited workers’ compensation claims in multiple jurisdictions.
Created annual training schedule and training modules; managed oversight of branch trainings completed or performed.
Managed all internal correspondence within the claim system and all required jurisdictional benefit letters and forms.
Managed Quality Assurance’s Deloitte SOC I audit requirements; responsible for direct contact with the audit team.
Managed program to maintain company’s compliance of all California examiner designations.
Implemented program with continued oversight to maintain company’s compliance of all MAXIMUS Federal Services, Independent Medical Review requests.
Provided oversight and assistance to branch management in all state, external and carrier audits.
Processed workers’ compensation claims and benefits with self-insured and fully-insured clients; provided back-up assistance to supervisors.
Member of the implementation and development team ensuring for the company’s electronic document management system.
Implemented a medical coverage program combining Group Health and Workers’ Compensation plans for 24-hour coverage.
Reviewed files for settlement authority in supervisor’s absence.
Group Medical Insurance:
Performed monthly audits of both clinical review analysts and associates.
Assisted in the training of team members through all aspects and processes of clinical review analysis.
Reviewed and resolved claim issues and appeals, including those clinical in nature, generated through correspondence, service requests and provider projects in addition those received from the Attorney General’s office and the Department of Insurance.
Processed group medical claims, with account responsibility for several priority company accounts; continually exceeded production quotas.
Paid out short-term disability benefits; assisted supervisor in claims auditing.
Processed hospital audit claims for large hospital bills.
Calculated RVS fee schedules prior to payment of claims.
ANN MARIE HANES Page Two
EMPLOYMENT HISTORY
TRISTAR RISK MANAGEMENT, San Diego, California 2003 – Present
Manager, Audit & Compliance (2010 - Present)
Senior Internal Auditor (2006 - 2010)
Internal Auditor (2004 - 2006)
Senior Claims Examiner (2003 – 2004)
KEENAN AND ASSOCIATES, Riverside, California 2002 – 2003
Senior Claims Examiner
OXFORD HEALTH PLANS, Trumbull, Connecticut 1997 - 2002
Appeals Analyst (1999-2002)
Clinical Review Analyst (1998-1999)
Resolution Analyst (1997-1998)
KEENAN AND ASSOCIATES, Riverside, California 1991 – 1997 Senior Claims Examiner
ALLSTATE INSURANCE COMPANY, Brea, California 1985 - 1991
Commercial Claims Representative (1988-1991)
Claims Adjuster (1988)
Claims Service Representative (1987-1988)
Claims Examiner (1985-1987)
CONNECTICUT GENERAL LIFE INSURANCE COMPANY 1980 - 1983
Easton, Pennsylvania
Benefit Analyst
EDUCATION
RIDER COLLEGE, Lawrenceville, New Jersey
Completed one year of coursework in Business Administration, 1980
KEAN COLLEGE, Union, New Jersey
Completed one year of coursework in Business Administration, 1979
CERTIFICATES/AWARDS
Employee of the Year Award, Keenan & Associates, 1995.
Department of Insurance, California, Self-Insured Certificate, 1991.
Insurance Education Association (IEA) Certificate, 1989.
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