Elizabeth Payton
Everett,WA
Summary
Driven Quality Assurance professional offering dynamic understanding of manual and automated testing strategies. Highly communicative and experienced in data analysis. Eagerly collaborates with development teams to identify and resolve issues. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
28
28
years of professional experience
Work History
Quality Assurance Analyst / Claims Trainer
Welfare and Pension Administration Services
2020.01 - Current
- Mentored and coached team members on QA topics and strategies.
- Evaluated trainee progress and provided constructive feedback, fostering professional growth and development.
- Promoted a positive learning environment through motivational techniques, boosting morale and enhancing overall job satisfaction among staff members.
- Collaborated with management to identify training needs and develop appropriate solutions, resulting in improved employee competency.
- Reduced errors in claim processing by emphasizing accuracy and attention to detail during hands-on exercises.
- Provided coaching and mentoring to employees.
- Facilitated virtual, and blended learning sessions.
- Wrote SOPs for the Claims Department according to strict company guidelines.
- Tailored instructional strategies based on individual learning styles, promoting a more inclusive training environment for diverse participants.
- Conducted regular reviews of training materials to ensure alignment with industry standards and best practices, optimizing content relevancy.
- Authored and maintained well-organized, efficient, and successful manual test cases for the Claims Department.
- Streamlined the claims process for increased efficiency through continuous improvement of training materials.
- Delivered clear instructions on complex claims procedures, simplifying difficult concepts for better understanding among trainees and adjusters.
- Worked independently with minimal supervision, setting priorities and demonstrating excellent project management skills.
- Streamlined QA processes for increased efficiency and reduced time spent on redundant tasks.
- Developed and maintained comprehensive documentation, including test cases, results, and improvement recommendations, for stakeholder review.
Claims Business Analyst
Welfare and Pension Administration Services
2011.04 - 2020.01
- Researched plan guidelines and limitations of Auto Adjudication.
- Runs Daily, Weekly, and Monthly Reports for claims inventory, Auto Adjudication statistics, and weekly paid claim statistics.
- Writes rules as needed for auto adjudication. Answers questions from claims staff regarding errors/issues relating to Auto Adjudication.
- Investigate errors/issues involving Auto Adjudication and report results to the Programming staff.
- Researched plan guidelines and limitations for implementation of Auto Adjudication.
- Writes rules to accommodate accurate plan benefit application.
- Works with Programming staff to test and clarify the rules.
- Coordinates audits of Auto Adjudication and works with adjusters to ensure timely reporting of errors during testing and live phases.
- Audited specific claim types to increase the volume of claims paid by Auto.
- Categorizes error type to determine why a claim did not get paid through AUTO.
- .Summarizes results and reports to management.
- Maintains knowledge of general claim processing and related procedures to be able to assist claim processors with claims as needed.
- Optimized workflow processes to enhance overall productivity and achieve operational excellence.
- Collaborated with IT to develop business intelligence tools, enhancing researched plan guidelines and limitations of Auto Adjudication.Quality of data-driven decision-making.
Claims Adjuster Senior 2
Welfare and Pension Administration Services
1997.01 - 2011.04
- Achieved high customer satisfaction ratings by providing clear and timely communication throughout the claims process.
- Evaluated coverage accurately by interpreting complex insurance policies and applying them to specific claim scenarios.
- Provided exceptional customer service, addressing concerns, and answering questions promptly.
- Conducted thorough investigations of complex insurance claims.
- Trained claims personnel as instructed by the Quality Assurance and Training Supervisor.
- Contributed to a positive work environment through active participation in team meetings and collaborating on cross-functional projects.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Researched claims and incident information to deliver solutions and resolve problems.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Directed claims payments within allowable limit of $100,000.00.
- Followed up with insured individuals regarding premium and deductibles payments.
Education
High School Diploma -
Edmonds Highschool
Edmonds, WA06.1988
Skills
- ICD10
- Current CPT coding
- HCPC CODES
- REV CODES
- Mentoring and training
- Quality Assurance Controls
- Call Monitoring
- Report Analysis
- Documentation skills
- Training and Onboarding
Timeline
Quality Assurance Analyst / Claims Trainer
Welfare and Pension Administration Services
2020.01 - Current
Claims Business Analyst
Welfare and Pension Administration Services
2011.04 - 2020.01
Claims Adjuster Senior 2
Welfare and Pension Administration Services
1997.01 - 2011.04
High School Diploma -
Edmonds Highschool
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