Cheryl Smith
Cincinnati
Summary
Dynamic Quality Assurance Specialist with a proven track record at Ensemble, excelling in process improvement and regulatory compliance. Leveraged root cause analysis to enhance product quality, achieving a 20% reduction in defects. Skilled in data analysis and customer relationship management, fostering collaboration and driving impactful solutions. Passionate about continuous improvement and delivering exceptional results.
Overview
2026
2026
years of professional experience
1
1
Certification
Work History
Quality Assurance Specialist
Ensemble
Cincinnati
08.2021 - Current
- Conducted thorough inspections of products to ensure quality standards were met.
- Collaborated with production teams to identify and resolve quality issues promptly.
- Documented quality assurance processes and maintained accurate records for compliance.
- Assisted in developing quality control procedures and best practices for operations.
- Trained staff on quality standards and inspection techniques to enhance performance.
- Analyzed defect trends to propose improvements in manufacturing processes effectively.
- Consulted with management and personnel to educate on QA standards.
- Prepared reports to communicate results of quality inspection activities to management.
- Analyzed data from inspection results for trends in order to recommend process improvements.
- Maintained knowledge of current industry developments and regulatory requirements for quality assurance purposes.
- Monitored QA procedures for adherence by employees, notifying personnel of non-compliance issues.
- Performed root cause analysis of defects identified during testing cycles.
- Utilized root cause analysis techniques to identify and rectify quality-related problems.
Insurance Authorization Specialist
Ensemble
Cincinnati
05.2014 - 08.2021
- Processed insurance authorizations for medical services and procedures.
- Communicated with healthcare providers to gather necessary documentation.
- Educated patients on insurance benefits and authorization processes clearly.
- Analyzed trends in denials due to improper coding or lack of documentation, providing feedback as needed.
- Assisted in resolving any discrepancies between submitted claims and insurance requirements.
- Managed daily workflow related to obtaining authorizations from various health plans including Medicare and Medicaid and commercial carriers.
- Reviewed medical records to ensure accuracy of diagnosis codes prior to submitting claims.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Analyzed trends in authorization denials and reported findings to management for quality improvement initiatives.
- Coordinated with healthcare providers to gather necessary patient information for prior authorization requests.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients.
Implementation Specialist
Humana
Cincinnati
06.2009 - 06.2014
- Served as liaison between customer support team and technical team members in order to resolve any issues or questions that arose during implementation.
- Provided feedback on product features or design elements that could improve usability or performance.
- Identified discrepancies to devise and initiate cost-effective solutions.
- Maintained detailed records of all changes made during the implementation process.
- Coordinated installation activities with external providers as needed.
- Identified issues and made potential solution recommendations as problems developed, enabling quick project modifications.
- Developed and executed test plans to ensure software functionality meets client expectations.
- Streamlined implementation processes to increase efficiency and reduce project delivery times.
- Coordinated with cross-functional teams to troubleshoot and resolve implementation issues.
- Performed quality assurance checks throughout the implementation process to verify accuracy of data entries.
Claims Representative
humana
Cincinnati
06.2005 - 06.2009
- Reviewed and processed claims for accuracy and compliance with company policies.
- Coordinated with healthcare providers to gather necessary documentation for claims.
- Investigated discrepancies in claims to ensure timely resolutions.
- Maintained detailed records of claims and customer interactions in the system.
- Educated customers about the appeals process for denied claims.
- Processed a high volume of claims efficiently while maintaining quality standards.
- Maintained detailed records of all communication with customers, claimants, providers, and internal departments.
- Ensured timely submission of required documentation from claimants prior to approval of payment.
- Participated in audits and reviews of claims to ensure accuracy and adherence to guidelines.
- Maintained detailed records of claims, decisions, and financial transactions in compliance with regulatory requirements.
Customer Service Representative
Humana
Cincinnati
10.2004 - 06.2005
- Assisted customers with inquiries and provided timely solutions.
- Managed high-volume calls while maintaining professionalism and courtesy.
- Documented customer interactions using CRM software for future reference.
- Handled complaints by actively listening and addressing concerns promptly.
- Trained new representatives on company policies and customer service protocols.
- Monitored service levels to ensure compliance with industry standards and policies.
- Resolved complex problems by working with other departments to provide solutions that meet customer needs.
- Identified areas of improvement in customer service processes and suggested changes accordingly.
Quality Assurance Specialist
Ensemble
Cincinnati
Education
Associate of Science - Business
Southwestern Business
Cincinnati, OH08-1987
Southwestern Business
Cincinnati, OHSkills
- Process improvement and project management
- Attention to detail
- Problem-solving
- Audit documentation and reporting
- Requirements analysis
- Data migration strategies
- Complex issue resolution
- Written communication
Certification
CRCR Certification May 2024
Timeline
Quality Assurance Specialist
Ensemble
08.2021 - Current
Insurance Authorization Specialist
Ensemble
05.2014 - 08.2021
Implementation Specialist
Humana
06.2009 - 06.2014
Claims Representative
humana
06.2005 - 06.2009
Customer Service Representative
Humana
10.2004 - 06.2005
Quality Assurance Specialist
Ensemble
Associate of Science - Business
Southwestern Business
Southwestern Business
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