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United Health Care - Senior Quality Auditor Resume Example

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Charles Collins
XXXXX XXXXX XXXX XXXXX , Magalia , CA 95954 | (H) XXX XXXXXXXX | XXXXXXXXXXXXXXXXXXXXXXXXXXXX
Professional Summary

Reliable Customer Service Representative and Quality Auditor with a 15 year background in medical insurance benefits and claims.  10 years in retail management and stylist at hair salons. 5 years experience as a receptionist at a health club.  4 years experience as a board member of a non profit charity for animals.  Core competencies include research, data entry, customer service and preparing reports as well as excellent communication and time management skills. Handles tasks ethically with accuracy as well as efficiency.

Skills
  • Customer and Personal Service
  • Negotiation
  • Complex Problem Solving
  • Judgment and Decision Making
  • Administration and Management
  • Communications and Media
  • Operation Monitoring
  • Telecommunications
  • Production and Processing
  • Quality Control Analysis
  • Troubleshooting
Experience
Senior Quality Auditor 01/2010 to Present
United Health Care Chico, Ca
  • Performing quality assurance audits of customer service representatives , claims processors and internal business partners transactions and customer interactions to help identify opportunities to improve the operation and efficiency of business processes and customer service relationships.
  • Provide reports for  clients and other internal business partners on topics such as accurate claims processing, customer service , call handling, documentation and adherence to company and federal policies
Customer Service Representative 01/2001 to 02/2014
United Health Care Chico, Ca
  • Confer with insurance members by telephone  to provide information about products or services, provide medical claim and health benefit information to members.
  • Confer with physician offices, hospitals and other health care providers about claims processing, benefits and billing questions
  • Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
Call Quality Auditor 02/2007 to 01/2010
United Health Care Chico, Ca
  • Audit the work of  customer service employees to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors or problems.
  • Provide employees with guidance in handling difficult or complex problems or in resolving escalated complaints or disputes.
  • Make recommendations to management concerning such issues as training opportunities and  procedural changes.
Resolution Expert 02/2004 to 02/2007
United Health Care Chico, Ca
  • Confer with customers by telephone on calls for issues that have been escalated from the customer service representatives due to the complexity of the issue or the insistence of the customer. To provide information about products or services.
  • Resolve the customer's complaint by performing tasks such as processing  medical and flexible spending account claims or conferring with other internal or external business partners  
  • Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken to resolve the customers issue.
  • Acted as a subject matter expert for front line customer service representatives by assisting with research on company and federal policies, medical claims processing information and customer plan data.
Education
General Education Cosmetology: Business Dec 1990 Butte College - Oroville , Ca
Community Service

2009 - 2014 President and Co Founder of  Back In The Saddle Project , a non profit charity helping animals and owners in crisis.

2005-2009 Volunteer at Horse Plus Humane Society a non profit for horses  

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Resume Details

This is a real resume for a Senior Quality Auditor in Magalia, California with experience working for such companies as United Health Care. This is one of the hundreds of Senior Quality Auditor resumes available on our site for free. Use these resumes as templates to get help creating the best Senior Quality Auditor resume.

Previous Companies:

  • United Health Care

Previous Job Positions:

  • Senior Quality Auditor
  • Customer Service Representative
  • Call Quality Auditor
  • Resolution Expert

Schools:

  • Butte College

Level of Education:

  • General Education Cosmetology

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