Detail-oriented and results-driven professional with a strong background in quality auditing, claims administration, and operations coordination. Expert in process improvement, data analysis, and cross-functional collaboration. Known for managing complex tasks efficiently while ensuring high standards of accuracy and professionalism. Bilingual in English and Spanish, with outstanding communication and leadership skills.
Experience
Amerihealth
Aug 2023 – Present
Remote
Quality auditor
• Lead the process for maintaining a strong internal Layered Process Auditing system
• Strong Benefit knowledge to understand how the claim should be processed correctly
• Work with production associates to assure the proper usage of internal audits while supporting the
correct type of audit write ups that make the organization better
• Create and maintain all required documents for Internal and External audits
• Perform root cause analysis with direct correlation to audit findings with a focus to improve the overall
environment
• Develop and maintain schedules report finding and track closure
• Communicated major status of projects to the QA Manger
