Open To Work
Diana Manuel
Work Preference
Summary
Quality Assurance Specialist experienced in remote call monitoring within call centers. Expertise in compliance auditing, performance coaching, and continuous improvement initiatives. Solid understanding of billing processes and insurance authorizations, with strong knowledge of HIPAA regulations. Effective communicator skilled in fostering trusted relationships with patients and team members.
Overview
7
7
years of professional experience
4
4
years of post-secondary education
Work History
Quality Assurance Specialist
WellBe Medical Group
Chicago, USA
07.2024 - Current
- Provide coaching and feedback to improve agent performance and quality scores
- Score calls using standardized QA scorecards and conduct calibration sessions to maintain scoring consistency
- Evaluate inbound and outbound calls to ensure compliance with QA standards and company KPIs
- Prepare QA reports and analyze trends to recommend performance improvement strategies
- Support QA initiatives including scripting pilots, DNC compliance reviews, and escalation audits
Outreach Specialist
WellBe Medical Group
Chicago, USA
01.2023 - 07.2024
- Built strong relationships with high-risk members to increase engagement in services
- Coordinate and schedule in-home visits for nurse practitioners serving Medicare patients with different insurance
- Documented customer interactions accurately across multiple systems
- Supported operational teams with ongoing special projects prior to transition into QA role
Patient Account Lead
IKS Health
Burr Ridge, USA
11.2020 - 12.2022
- Resolved escalated billing issues and insurance discrepancies to enhance patient satisfaction
- Reviewed documentation and workflows to ensure billing and insurance accuracy
- Analyzed EOBs and clarified itemized bills for patients to improve understanding
Referral Specialist Assistant (Contract)
AIM Specialty Health
Westchester, USA
06.2019 - 09.2019
- Processed and communicated pre-authorization approvals and denials to physician offices, ensuring timely decisions for patient care
- Coordinated peer-to-peer physician reviews to facilitate authorization decisions, streamlining communication between providers
- Supported specialty departments, including rehab, cardiology, and radiology, by managing authorization requests and ensuring compliance with guidelines
Customer Service Representative
Follett Corporation
Woodridge, USA
11.2018 - 05.2019
- Handled escalations for orders, pricing, and product inquiries to resolve customer issues effectively
- Processed fraud complaints, password resets, and shipping claims to ensure customer satisfaction
- Assisted managers with training materials and team tasks to enhance departmental operations
Education
Bachelor of Science - Business Administration
Calumet St. Joseph
Whiting, IN 04.2022 - 04.2026
Skills
- Quality Assurance & Remote Call Monitoring
- Mentoring, Training, and Performance Feedback
- HIPAA Compliance
- CRM Navigation
- NICE & RingCentral QA Monitoring Tools
- Authorization
- Customer Service, Billing Support and Escalation Resolution
- AI-Assisted Coaching, Speech, and Sentiment Analysis Tools
- Team Collaboration and Communication
Timeline
Quality Assurance Specialist
WellBe Medical Group
07.2024 - Current
Outreach Specialist
WellBe Medical Group
01.2023 - 07.2024
Bachelor of Science - Business Administration
Calumet St. Joseph
04.2022 - 04.2026
Patient Account Lead
IKS Health
11.2020 - 12.2022
Referral Specialist Assistant (Contract)
AIM Specialty Health
06.2019 - 09.2019
Customer Service Representative
Follett Corporation
11.2018 - 05.2019