Amanda Cermak
Columbus,OH
Summary
Quality Analyst adept at performing data analysis and recognizing key problem areas to assist in root cause identification. Exceptionally talented at auditing data on regular basis to provide data integrity and quality.
Overview
8
8
years of professional experience
Work History
Quality Analyst
Alliance One
03.2023 - Current
- Prepares and analyzes internal and external quality reports for management staff review
- Viewed reports regularly to make sure processing was conducted efficiently.
- Researched claims and incident information to deliver solutions and resolve problems.
- Analyzed large amounts of data to find patterns of fraud and anomalies
- Developed and implemented quality assurance processes to check accuracy of claims processing.
Customer Service Associate
Independence Blue Cross
08.2022 - 03.2023
- Investigate financial discrepancies and claim issues to ensure our members and clients are billed appropriately
- Provide exceptional customer service through inbound/outbound calls in a modern, fast-paced, remote contact center environment
- Act as an advocate for our members by communicating with network liaisons, clinical professionals and finance staff members at hospitals and medical offices
- Assist with questions related to insurance benefits, provider contracts, eligibility and claims
- Consistently meet and attain required Key Performance Indicators (KPIs)
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Responded to customer calls and emails to answer questions about products and services.
- Kept detailed records of customer interactions to track and resolve issues quickly.
- Maintained up-to-date knowledge of product and service changes.
- Met customer call guidelines for service levels, handle time and productivity.
Financial Crimes Specialist
Wells Fargo
01.2018 - 01.2021
- Monitor accounts for fraudulent activity and documenting suspicious transactions
- Manage claims, route/queues, and ECHS, within specify turn- around time parameters
- Accurately creating and processing Visa disputes
- Provided members educational lessons regarding fraud and identity theft daily
Prior Authorization Representative
Express Scripts
10.2017 - 01.2018
- Handle inbound telephone and written inquiries from pharmacists and doctors regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria
- Provide accurate procedures for medication exceptions
- Facilitate resolution of drug coverage issues and pro-actively address, research and resolve issues while maintaining accurate and complete documentation of all inquiries for continuous improvement
- Provide exceptional customer service through inbound/outbound calls in a modern, fast-paced, remote contact center environment
- Verified eligibility and compliance with authorization requirements for service providers.
- Resolved patient billing inquiries and other issues efficiently.
- Tracked referral submission during facilitation of prior authorization issuance.
Sales Support Associate
Apercu Global
03.2017 - 10.2017
- Complete pre-sales activities, such as preparing customer quotes and obtaining required paperwork to complete the sale for non-automated transactions
- Generate accurate customer agreements
- Ensure timely trafficking of sales calls that may require additional follow-up
- Evaluate simple sales to ensure they are operationally sound and customers will be billed correctly for services ordered
- Place new simple orders and prepare information for billing system entry
- Enters orders as needed
- Manage the sales order queues and dashboards.
- Managed customer accounts, responding to inquiries and resolving customer service issues
- Documented customer complaints and completed corrective action requests.
Service Center Representative
Sedgwick Claims Management Services
01.2016 - 10.2016
- Acts as primary liaison with customer in solving problems related to the application process and service
- Communicates clearly and professionally with the customer by telephone and/or written correspondence regarding all aspects of claims process
- Educates and informs the customer by telephone, written correspondence and/or the claims system about the documentation required to process a claim, required time frames, payment information and claim status
- Enters verbal and written application information that meets both the internal and external
- Assigns new claims to the appropriate claims handler.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Answered constant flow of customer calls with minimal wait times.
- Updated account information to maintain customer records.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Education
High School Diploma -
Columbus City Schools
Columbus OH06.2009
Skills
- Quality Assurance
- Customer Service
- Project Management
- Administrative and Office Support
- Document and Records Management
- Database Maintenance
- Time Management
- Organizing and Prioritizing
- Claims Review
- Understanding of Medical Terms
- Document Workflow
- Proficient in Excel
Timeline
Quality Analyst
Alliance One
03.2023 - Current
Customer Service Associate
Independence Blue Cross
08.2022 - 03.2023
Financial Crimes Specialist
Wells Fargo
01.2018 - 01.2021
Prior Authorization Representative
Express Scripts
10.2017 - 01.2018
Sales Support Associate
Apercu Global
03.2017 - 10.2017
Service Center Representative
Sedgwick Claims Management Services
01.2016 - 10.2016
High School Diploma -
Columbus City Schools
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