Ambriana Fedrick
Stone Mountain,GA
Summary
- HSA,FSA,HRA Claims Processor
- Project manager
- Member Services Agent Aetna/CVS
- Technical Support (Apple, AT&T)
- Customer Service Representative
- Sales Representative (Verizon Wireless)
- Call Center Agent (cable, phone service)
- Retail/ Sales Associate
- Assisting Students With Their College Textbooks
- Processing Tracking Orders and Payments
Experienced Quality Auditor with well-honed analytical skills with regulatory compliance auditing experience for 3 years. Solution-focused professional highly-regarded among peers and supervisors in medical insurance industry. Skilled auditor who works diligently with all levels of peers, management and external authorities. Methodical Quality Assurance Auditor successful at standardizing compliance review and correction across all business areas. Efficient and accurate team player with demonstrated success in working in fast paced environments over 6-year career.
Overview
11
11
years of professional experience
Work History
Inpatient Coding Quality Auditor
Healthfirst
11.2021 - Current
- Enhanced product quality by conducting thorough audits and identifying areas for improvement.
- Streamlined audit processes for greater efficiency, reducing time spent on each evaluation.
- Collaborated with production teams to implement corrective actions and improve manufacturing processes.
- Identified discrepancies in product specifications and collaborated with engineering teams to resolve issues.
- Conducted root cause analysis of non-conformities, implementing appropriate corrective actions to prevent recurrence.
- Improved overall customer satisfaction by ensuring that all products met established quality standards.
- Developed comprehensive audit reports, providing valuable insights into areas requiring improvement.
- Maintained a strong understanding of industry regulations and ensured company compliance through regular audits.
- Participated in cross-functional team meetings, contributing valuable insights from an auditor''s perspective to facilitate process improvements.
- Increased accuracy of inspections by regularly calibrating measuring instruments and maintaining inspection equipment.
- Supported continuous improvement initiatives by identifying opportunities for enhancing product quality during audits.
- Assisted management in developing effective quality control strategies based on audit findings.
- Reduced risk of non-compliance with regulatory requirements by staying informed about industry updates and incorporating changes into the audit process as needed.
- Coordinated with external auditors during third-party assessments, ensuring a smooth and efficient process.
- Implemented a system for tracking audit findings and monitoring progress towards resolution, promoting accountability within the organization.
- Trained new Quality Auditors on best practices, increasing their proficiency in performing audits effectively.
Claims Examiner
Healthfirst
11.2021 - Current
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Collaborated with insurance adjusters to expedite claim settlements, ensuring fair resolutions for all parties involved.
- Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
Medical Claims Processor
Alegeus
12.2018 - 11.2021
- Increased claim processing efficiency by implementing new software and streamlining workflows.
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Maintained a high level of customer satisfaction by promptly addressing inquiries and resolving issues related to medical claims.
- Assisted in the development of training materials for new hires, improving overall team knowledge and productivity.
Chat Support Representative
Chegg
11.2017 - 12.2018
- Enhanced customer satisfaction by providing timely and accurate responses to inquiries through chat support.
- Resolved technical issues for customers by utilizing comprehensive knowledge of company products and services.
- Expedited issue resolution with efficient multitasking and prioritization of multiple chat conversations simultaneously.
- Boosted customer retention, maintaining a professional and empathetic tone throughout all interactions.
- Conducted thorough research to provide accurate information, ensuring prompt resolution of customer concerns.
- Maintained extensive knowledge of company policies, procedures, and offerings to effectively address customer needs.
- Achieved high levels of customer satisfaction by consistently meeting or exceeding response time targets.
- Contributed to a positive work environment by assisting colleagues in resolving challenging situations when needed.
Member Services Agent
CVScaremark
07.2016 - 01.2017
- Enhanced member satisfaction by promptly addressing concerns and providing accurate information.
- Resolved member issues efficiently, utilizing strong problem-solving skills and comprehensive knowledge of company policies.
- Boosted member retention rates by building rapport through personalized service and consistent followup.
- Streamlined processes for faster response times, effectively reducing member wait time during peak hours.
Appointment Setter
Sears Call Center
06.2015 - 03.2016
- Increased appointment setting success by developing targeted call lists based on potential client needs.
- Enhanced customer relationships through timely and professional follow-ups with prospective clients.
- Streamlined the scheduling process by implementing an efficient online booking system, resulting in improved organization.
- Collaborated with sales team members to share leads and strategies for securing appointments with high-level decisionmakers.
- Reduced appointment cancellations by consistently confirming dates and times with clients via phone calls and emails.
Vacation Sales Representative
Universal Orlando(Apple One)
08.2014 - 04.2015
- Boosted customer satisfaction by providing exceptional service and addressing vacation inquiries.
- Increased sales conversions by effectively presenting vacation packages tailored to client needs.
- Enhanced team performance through active participation in training sessions and sharing best practices with peers.
- Exceeded sales targets consistently by employing persuasive communication skills and establishing rapport with clients.
- Collaborated with team members to develop effective strategies for improving overall sales numbers and meeting company goals.
- Streamlined customer follow-up process, ensuring timely communication and increased likelihood of securing bookings.
- Expanded clientele base by proactively seeking referrals from satisfied customers and generating new leads.
- Maintained accurate records of customer interactions, transactions, comments, and complaints for future reference and continuous improvement efforts.
Customer Sales Representative
Verizon Wireless
09.2013 - 06.2014
- Improved sales revenue with effective communication of product features, benefits, and promotions.
- Increased customer satisfaction by addressing and resolving issues promptly and professionally.
- Built strong relationships with clients through attentive service, leading to repeat business and referrals.
- Assisted in developing marketing materials that showcased the unique selling points of our products or services effectively to potential customers.
- Navigated complex situations diplomatically by using professional problem-solving techniques tailored to specific customer needs.
- Provided after-sales support as needed, further strengthening relationships with clients and promoting long-term retention rates.
- Conducted thorough research on competitor offerings regularly, staying informed about industry trends and using this knowledge strategically during sales interactions.
Education
Associate of Science - Business Administration
Norwalk Community College
Norwalk, CT05.2014
High School Diploma -
Stamford High School
Stamford, CT06.2012
Skills
- Internal Auditing
- Investigation leadership
- Standards Compliance
- Continuous Improvement
- Data Collection
- Product Quality Requirements
- Documentation Review
- Quality Management Systems
- Documentation Management
- Root Cause Analysis
- Report Preparation
- Compliance requirements
- Compliance standards
- Document Review
- Account Reconciliation
- Project Management
- Process Implementation
- Training and coaching
Employment Overview
- Healthfirst, 11/01/21, 01/01/24
- Alegeus, 12/01/18, 11/01/21
- Chegg, 11/01/17, 11/01/18
- Xerox CVS, 07/01/16, 01/01/17
- Sears Holding, 06/01/15, 03/01/16
- NBCUniversal, 08/01/14, 04/01/15
- Verizon Wireless, 09/01/13, 06/01/14
- Bowtie Cinemas, 11/01/12, 07/01/13
- Stop & Shop, 12/01/11, 08/01/12
Experience Highlights
- Inpatient Coding Quality Auditor
- Medicare and Medicaid claims processor.
- Three years of facet knowledge..
- Medical claims processor. Processed claims for the following clients. American fidelity ,BCBS,anthem,plansource,zenefits,first financial and act wise etc. Met processing deadlines and processed over 430 claims a day accurately and met monthly and quarterly goals.
- Technical support/troubleshooter for At&t, Vacation sales for Universal Studios, timeshare provided excellent sales in mobile devices for Verizon wireless. Call Center agent, Grocery associate, movie theater Attendant, Retail Experience.
- Medicare Member services, assisting members with Medicare plans, as well as filling Rx orders and contacting members of local pharmacies.
- General Information for SeaWorld Parks and Entertainment answered guest questions ,sold park tickets,and assisted guests with all other inquiries they had about all 15 theme parks in the United States.
- Customer Service /Technical Support: Provided Tier 2 Technical Support to Existing AT&T customers, Troubleshooting smart devices for Apple and Samsung.
- Vacation Ticket Sales: Assisted Guest with their Vacation Needs with five-star hotel and resorts for Universal Studios, working with travel agencies airlines, and sold gate tickets as well worked with guest services to provide our guest with the utmost experience
- Sales: sold smart devices to customers as well as assisting with their monthly bill with Verizon Wireless.
Timeline
Inpatient Coding Quality Auditor
Healthfirst
11.2021 - Current
Claims Examiner
Healthfirst
11.2021 - Current
Medical Claims Processor
Alegeus
12.2018 - 11.2021
Chat Support Representative
Chegg
11.2017 - 12.2018
Member Services Agent
CVScaremark
07.2016 - 01.2017
Appointment Setter
Sears Call Center
06.2015 - 03.2016
Vacation Sales Representative
Universal Orlando(Apple One)
08.2014 - 04.2015
Customer Sales Representative
Verizon Wireless
09.2013 - 06.2014
Associate of Science - Business Administration
Norwalk Community College
High School Diploma -
Stamford High School