Candice Parker
Duluth,GA
Summary
Quality assurance and healthcare operations professional with 10+ years of combined experience spanning healthcare quality, federal government operations, benefits administration, documentation review, data analysis, regulatory compliance, and customer service. Experienced in reviewing complex records and documentation, identifying discrepancies and quality issues, analyzing data, researching policies and regulations, preparing detailed reports, and implementing process improvements. Background includes healthcare quality control within a hospital environment and federal experience with the Social Security Administration, including complex case research, benefit determinations, policy interpretation, and technical problem resolution. Proven ability to communicate complex requirements clearly, collaborate with cross-functional teams, provide training and technical guidance, and maintain accuracy while managing high-volume workloads. More than six years of successful remote work experience requiring independent judgment, organization, accountability, and effective communication. Former federal employee who separated at the GS-7, Step 2 level.
Overview
1
1
Certification
18
18
years of professional experience
Work History
Quality Assurance Specialist
OneDigital
12.2024 - Current
- Develop and implement quality assurance processes aligned with organizational objectives, customer service standards, operational requirements, and compliance expectations.
- Conduct detailed quality audits and reviews to identify documentation, process, and performance issues and ensure established standards are consistently met.
- Analyze quality and performance data to identify trends, recurring issues, and opportunities for improvement.
- Prepare reports and communicate findings to management and cross-functional teams to support data-driven decisions and continuous quality improvement.
- Perform root cause analysis and develop corrective actions to address recurring quality issues, reduce errors, and improve operational outcomes.
- Collaborate with Customer Success, Member Success, and Customer Management teams to promote consistent application of policies and procedures.
- Monitor customer satisfaction and quality metrics, identify performance trends, and provide recommendations for process improvements.
- Provide education, guidance, and ongoing support to internal teams regarding quality expectations, procedures, and process changes.
- Maintain accuracy and confidentiality while reviewing sensitive information and handling high-volume workloads in a fully remote environment.
- Independently manage competing priorities, deadlines, and workload requirements while maintaining consistent quality standards.
- Remote
- Developed and executed comprehensive test plans to ensure product quality and compliance with industry standards.
- Collaborated with cross-functional teams to streamline quality assurance workflows, improving communication and efficiency.
Benefit Representative
American Income
08.2022 - 11.2024
- Review and analyze individual client needs and complex insurance policies to determine appropriate coverage and clearly explain policy provisions.
- Conduct detailed needs analyses and translate complex information into clear, understandable guidance for clients.
- Review policy and coverage information for accuracy and communicate coverage positions in a professional and concise manner.
- Manage inbound customer calls and respond to questions involving benefits, coverage, and policy requirements.
- Conduct virtual presentations and educational sessions using Zoom, followed by detailed written communications and documentation.
- Maintain accurate client information and establish professional relationships through clear, timely, and confidential communication.
- Apply established policies and procedures while exercising sound judgment when addressing client questions and complex situations.
- Remote
Benefit Authorizer
Social Security Administration
09.2019 - 08.2022
- Reviewed and analyzed complex benefit cases and supporting documentation to make accurate final determinations in accordance with federal policies, regulations, procedures, and program requirements.
- Researched applicable policies, source documents, and case information to resolve complex issues and support accurate determinations.
- Reviewed incoming documentation and information for completeness, accuracy, and relevance to individual cases.
- Interpreted and applied detailed federal policies and procedures when evaluating benefit-related matters.
- Prepared detailed written analyses, correspondence, memoranda, and other materials concerning complex case issues.
- Communicated with courts, attorneys, beneficiaries, and other stakeholders regarding special cases and documentation requirements.
- Identified workload issues and developed efficient solutions to support program objectives, accuracy, and timely completion of assignments.
- Prioritized and managed multiple complex cases while consistently meeting established deadlines and production requirements.
- Applied independent judgment and problem-solving skills when researching discrepancies and resolving complicated cases.
- Maintained confidentiality when handling sensitive personal and benefit information.
- Worked independently in a remote environment while maintaining productivity, accuracy, communication, and accountability.
- Federal Employee — Separated at GS-7, Step 2
Quality Control Associate
Mercy Medical Center
04.2018 - 09.2019
- Monitored hospital areas and conducted quality control activities to evaluate compliance with established healthcare standards and departmental requirements.
- Conducted audits across multiple hospital units and identified quality issues requiring follow-up or corrective action.
- Gathered, compiled, reviewed, and analyzed healthcare quality data to identify trends and make recommendations for improvement.
- Developed and maintained data sheets and tracking tools for hospital supplies and equipment.
- Reviewed hospital supplies and monitored expired materials to support patient safety and operational compliance.
- Provided technical guidance and training to colleagues and third-party administrators regarding quality processes and requirements.
- Facilitated quality-related meetings and developed presentations and educational materials using Microsoft PowerPoint.
- Coordinated quality department communications, including documentation transmitted through electronic correspondence and fax.
- Successfully negotiated and resolved liability claims within the hospital's established deductible.
- Maintained patient follow-up through telephone communication after discharge and documented relevant information.
- Identified productivity challenges and introduced process improvements to improve operational efficiency.
- Collaborated with healthcare and administrative personnel to support quality, documentation, and patient-care-related objectives.
- Developed and maintained documentation for quality assurance processes and protocols.
- Conducted thorough inspections of medical supplies and equipment to ensure compliance with quality standards.
Administrative Specialist I
Maryland Public Service Commission
10.2017 - 04.2018
- Reviewed high-volume electronic applications and confidential supporting documentation for completeness, accuracy, and compliance with established requirements.
- Evaluated applications to determine whether they should be approved, rejected, or returned for additional information.
- Entered, reviewed, and validated supplemental documentation and data in agency databases.
- Examined vehicle, insurance, inspection, and other supporting documentation for accuracy and completeness.
- Managed sensitive information while maintaining attention to detail and adherence to agency procedures.
- Prepared information and provided testimony at scheduled administrative hearings.
- Performed research and administrative analysis to support agency operations.
Sales Associate
South Moon Under
08.2016 - 12.2017
- Provided professional customer service and managed inbound and outbound communications.
- Created schedules and daily reports using Microsoft Excel and Word.
- Trained new and existing employees on procedures and customer service expectations.
- Maintained operational standards and accurately processed financial transactions.
Production Intern
The Vanity Room
03.2016 - 06.2016
- Performed quality checks, inventory verification, and documentation review at manufacturing facilities.
- Supported production team operations and maintained communication regarding workflow and project requirements.
- Provided administrative support to Human Resources, Information Systems, and Accounting departments.
- Assisted with records management, filing, report preparation, document conversion, and data storage.
Sales Associate
Zara
10.2015 - 06.2016
- Provided customer service, answered product and service questions, and resolved customer concerns.
- Maintained knowledge of company policies, procedures, payment requirements, and security practices.
- Performed register reconciliation and maintained accurate transaction records.
Recon Clerk
Social Security Administration
06.2008 - 09.2011
- Investigated, analyzed, and responded to complex inquiries involving earnings records, Social Security policies, regulations, and laws.
- Reviewed documentation and supporting records to identify and resolve earnings discrepancies.
- Researched information across multiple sources, retrieved records, and analyzed data to support accurate case resolution.
- Communicated with employers, beneficiaries, private-sector organizations, IRS personnel, and other government components regarding documentation and discrepancy resolution.
- Prepared written correspondence and provided clear explanations of applicable requirements and documentation needs.
- Provided administrative and technical support to management and assisted with workload prioritization.
- Assisted management with difficult and complicated earnings cases requiring research, analysis, problem-solving, and policy interpretation.
- Scanned, indexed, organized, and retrieved incoming documentation and maintained accurate electronic records.
- Performed high-volume data entry and administrative processing while maintaining accuracy and confidentiality.
Education
Bachelor of Business Administration - Merchandising
LIM College
New York, NY05.2016
Skills
- Clinical quality management
- Quality assurance in documentation
- Data analysis in healthcare
- Regulatory & Policy Compliance
- Quality Audits & Process Improvement
- Corrective action implementation
- Healthcare Operations
- Confidential & Sensitive Information
- Data Validation & Reporting
- Policy & Procedure Interpretation
- Research & Case Analysis
- Technical Guidance & Staff Training
- Provider/Staff Education Support
- Written & Oral Communication
- Microsoft Word, Excel & PowerPoint
- Remote Workforce Operations
- Cross-Functional Collaboration
Certification
- Life and Health Insurance License
- Exemplary Contribution Service Award — Social Security Administration
- Microsoft Office Suite: Word, Excel, PowerPoint
- Adobe Photoshop
- Web PDM
- More than 6 years of remote professional work experience
- Federal government experience; former GS-7, Step 2 employee
RELEVANT STRENGTHS FOR CDIS / MEDICAL RECORDS ROLE
- Healthcare quality assurance and hospital quality-control experience
- Documentation review and data validation
- Experience interpreting and applying complex policies and regulations
- Healthcare data collection, analysis, and reporting
- Quality audits and identification of documentation/process deficiencies
- Staff education, training, and technical guidance
- Root cause analysis and corrective action
- Confidential information and sensitive records
- Federal government experience and understanding of government procedures
- Strong written documentation and case analysis
- High-volume workload management and prioritization
- Extensive experience working independently in remote environments
Timeline
Quality Assurance Specialist
OneDigital
12.2024 - Current
Benefit Representative
American Income
08.2022 - 11.2024
Benefit Authorizer
Social Security Administration
09.2019 - 08.2022
Quality Control Associate
Mercy Medical Center
04.2018 - 09.2019
Administrative Specialist I
Maryland Public Service Commission
10.2017 - 04.2018
Sales Associate
South Moon Under
08.2016 - 12.2017
Production Intern
The Vanity Room
03.2016 - 06.2016
Sales Associate
Zara
10.2015 - 06.2016
Recon Clerk
Social Security Administration
06.2008 - 09.2011
Bachelor of Business Administration - Merchandising
LIM College