Brenda Anderson
Claims Auditor Analyst Sr
Houston,TX
Summary
Results-driven Claims Quality Analyst Sr at Optum with expertise in data analysis and quality improvement. Successfully identified and resolved financial discrepancies, enhancing compliance and audit processes. Demonstrated strong problem-solving and collaboration skills, leading to significant improvements in operational efficiency and accuracy. Committed to continuous learning and organizational excellence.
Overview
24
24
years of professional experience
Work History
Claims Quality Analyst Sr
Optum
08.2001 - Current
- Utilize data and algorithmic guidelines as defined by Advanced Analytics to identify potential anomalies, either pre or post pay
- Analyzes claims/member/provider data against applicable policies and regulations to identify potential issues (e.g., member benefits, provider contracts, billing anomalies, payment accuracy, claims processing system issues, state mandates).
- Calculates dollar amount of financial errors/defects
- Ensures compliance with applicable audit and rebuttal timelines (e.g., calibration timelines, rebuttal timelines/form completion, workflows, turnaround time).
- Manages audit inventory to ensure proper workload balance, coverage and closure.
- · Identify/communicate escalated errors/defects and ensure proper resolution, as needed (e.g., calibrations, rebuttals, appeals).
- Identify, communicates and implement opportunities for improving internal audit/rebuttal processes.
Education
Associate of Arts - Executive Assistant Jr
Massey Business College
Houston, TXSkills
- Audit processes
- Quality improvement
- Quality processes
- Data analysis
- Problem solving
- Flexibility
- Collaboration
- Communication
- Organization
- Teachability
Recognitions
Bravo Awards-
• Collaboration-July 2025
• Quality-March 2025
• Performance-January 2025
• Collaboration-September 2024
Timeline
Claims Quality Analyst Sr
Optum
08.2001 - Current
Associate of Arts - Executive Assistant Jr
Massey Business College
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