Summary
Overview
Work History
Education
Skills
Timeline
Generic

Holli Pawley

Leitchfield,Ky

Summary

  • Claims Quality Audit Professional with 20 years of experience in training program design and quality assurance auditing. Specializes in data analysis and corrective action planning to enhance operational efficiency. Demonstrated success in fostering collaboration and driving continuous improvement in claims processing.

Overview

21
21
years of professional experience

Work History

Claims Quality Audit Professional 2

Humana Inc.
Louisville, Kentucky
03.2023 - Current
  • Oversee, direct, and facilitate all facets of training initiatives for participants throughout the organization. Integrate both instructor-led and virtual instructor-led formats.
  • Chosen relevant materials to optimize educational effectiveness.
    Cultivate engaging environment promoting learning and knowledge sharing.
    Encourage learner engagement to meet defined objectives.
  • Construct and record facilitation process to facilitate effective education and comprehensive documentation
  • Monitor personnel records to ensure that employees have met training requirements for the company, quality, and regulatory compliance.
  • Review course evaluations to measure training session impact and apply enhancement suggestions.
  • Utilize online resources to enhance the facilitated experience in relevant fields.
  • Analyze department strategies and organizational objectives, identifying linkages to related areas.
  • Navigate complex situations by making informed choices on work methods independently
  • Consult resources when necessary to maintain consistency with operational goals.

Claims Quality Audit Professional 1

Humana Inc.
06.2006 - 02.2023
  • Utilized expertise in multiple system platforms to identify inconsistencies in claim adjudication process.
  • Recommended and communicated corrective action plans to operational leadership.
  • Maintained impartiality while forming judgments based on documented facts.
  • Documented and maintained various audit databases with precision.
  • Articulated perspectives clearly in verbal, graphical, and written formats to support sound decision-making.
  • Met monthly deadlines consistently to deliver accurate feedback to operational management.
  • Interacted professionally with internal and external colleagues to enhance departmental reliability.
  • Collaborated with teammates to address additional educational needs and requests.

Supervisor

Humana Inc.
05.2004 - 05.2006
  • Hired, coached, and led team of 10+associates, including Sr. Quality Audit Specialists.
  • Trained new staff on company policies and operational procedures.
  • Guided audit practices and removed barriers to enhance operational efficiency.
  • Maintained proactive communication with departments for timely responses to customer needs.
  • Identified and communicated improvement opportunities in medical product adjudication processes.
  • Recommended and implemented process improvements to optimize organizational operations.
  • Ensured key performance measures met through comprehensive data analysis.
  • Developed and motivated associates by addressing variations in performance effectively.
  • Directed staff planning and coordinated work assignments to maximize productivity.

Education

Business -

University of Indiana Southeast

Business -

University of Louisville

Skills

  • Claims Management
  • Quality Assurance Auditing
  • Process Improvement
  • Data Analysis
  • Training Program Development
  • Medical Claims
  • Medicare/Medicaid

Timeline

Claims Quality Audit Professional 2

Humana Inc.
03.2023 - Current

Claims Quality Audit Professional 1

Humana Inc.
06.2006 - 02.2023

Supervisor

Humana Inc.
05.2004 - 05.2006

Business -

University of Indiana Southeast

Business -

University of Louisville

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