Skills
Accounting > Claims Processing
2-5 Years
Customer Support > Insurance > Prior Authorization
2-5 Years
Office and Administration > Quality Assurance
5-10 Years
5-10 Years
Credentialing
2-5 Years
Customer Support > Email Support > Back Office > Subject Matter Expert (SME)
2-5 Years
Experience highlights
Manager Assistant, Performance Enhancement
Carelon Global Solutions
·
April/2025
–
Present
Oversaw documentation accuracy and QA across nine lines of business including prior authorization, credentialing, eligibility, benefits, and claims. Designed provider demographic verification framework and maintained cross-account reporting logs for leadership.
Senior Performance Quality Auditor
Carelon Global Solutions
·
April/2023
–
Present
SME for Government Business Insurance documentation review including Medicare, MAPD, and GRS. Reviewed 50+ transactions weekly and mentored auditors on quality standards.
Performance Quality Auditor
Carelon Global Solutions
·
December/2020
–
Present
Audited Government Business Insurance documentation across eligibility, benefits, and claims. Fed denial trends into appeals and resubmission workflows while maintaining 100% audit accuracy on 50+ weekly transactions.
Quality Assurance Analyst
Hinduja Global Solutions
·
December/2017
–
Present
Audited dental documentation for Humana Medicare and reviewed CPAP/DME provider files. Performed benefits verification and authorization checks across multiple insurers including Tricare, Medicaid, Medicare, and others.
Healthcare Associate
Hinduja Global Solutions
·
May/2016
–
Present
Verified insurance eligibility and authorizations for CPAP DME orders using HCPCS/CPT codes.
