Summary
Overview
Work History
Education
Skills
Timeline
Core Qualifications
Received Excellence Award for Exceptional Leadership as POD Lead
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Jennifer Napper

Orlando,FL

Summary

Detail-oriented healthcare operations professional with 10+ years of experience in quality analysis, claims processing, and encounter data reporting. Skilled at data validation, root-cause analysis, and producing actionable insights that enhance accuracy and compliance. Seeking an Analyst role to apply technical and analytical expertise in driving data-driven decision making and process efficiency.

Overview

24
24
years of professional experience

Work History

Quality Analyst

CVS/Aetna
03.2023 - Current
  • Serve as liaison with providers to analyze member and provider encounter data trends.
  • Educate providers on NCQA HEDIS measures and how to close gaps in care for Aetna members.
  • Collect, interpret, and report on quality improvement activities in line with NCQA and HEDIS measures.
  • Lead initiatives to close care gaps and ensure regulatory compliance and accurate encounter submissions.
  • Perform data validation, error resolution, and root-cause analysis to improve reporting accuracy.
  • Produce tools to educate members on the importance of receiving preventive health screenings.

Quality Associate

01.2022 - 03.2023
  • Monitored and evaluated agent calls and order workflows to ensure accuracy and compliance with standards.
  • Implemented process improvement initiatives that improved customer satisfaction and reduced order errors.
  • Provided analytical insights from surveys and operational data to management.

Patient Care Advocate

CVS Specialty Pharmacy
02.2021 - 12.2021
  • Resolved patient pharmacy escalation issues, including claims, billing disputes, and prior authorizations.
  • Mentored service representatives on pharmacy workflows, HIPAA compliance, and quality standards.

Orlando Ultra Touch PSR

CVS Specialty Pharmacy
02.2017 - 02.2021
  • Managed data entry and claim escalations including prior authorizations and copay assistance.
  • Resolved high-level patient account issues while ensuring compliance with payer requirements.
  • Coordinated with foundations to secure financial assistance programs for patients.

Patient Service Representative

CVS Health
04.2016 - 02.2017
  • Processed claims, insurance updates, and prior authorization approvals.
  • Assisted patients with specialty medication refills and escalated claim resolution.
  • Exceeded company metrics consistently; recognized with above-average quarterly performance scores.

Service Lead

Winn Dixie
01.2002 - 01.2016
  • Supervised 20+ team members; managed schedules, audits, and compliance.
  • Achieved 100% on Asset Protection audits for consecutive years.
  • Delivered customer service excellence and drove team performance.

Education

Bachelor of Science - Health Service Administration

University of Central Florida
Orlando, FL
05.2014

Associate of Science - General Studies

Valencia Community College
Orlando, FL

Skills

  • Microsoft Office Suite
  • Training implementation
  • Software testing
  • Audit processes
  • Quality improvement
  • Quality processes
  • Data analysis
  • Customer focus
  • Project management
  • SOP development
  • Teamwork and positive attitude
  • Workload management

Timeline

Quality Analyst

CVS/Aetna
03.2023 - Current

Quality Associate

01.2022 - 03.2023

Patient Care Advocate

CVS Specialty Pharmacy
02.2021 - 12.2021

Orlando Ultra Touch PSR

CVS Specialty Pharmacy
02.2017 - 02.2021

Patient Service Representative

CVS Health
04.2016 - 02.2017

Service Lead

Winn Dixie
01.2002 - 01.2016

Bachelor of Science - Health Service Administration

University of Central Florida

Associate of Science - General Studies

Valencia Community College

Core Qualifications

  • 10+ years in healthcare administration, claims resolution, encounter data analysis, and regulatory compliance.
  • Skilled in HIPAA transactions, NCQA & HEDIS measures, and encounter data reporting.
  • Hands-on experience with claims adjudication, prior authorization, insurance processing, and patient/provider issue resolution.
  • Strong analytical and problem-solving skills with advanced proficiency in Microsoft Office (Excel, Access), data collection, and reporting.
  • Proven ability to work cross-functionally with internal teams, providers, and vendors to improve processes and data accuracy.

Received Excellence Award for Exceptional Leadership as POD Lead

Recognized for exceptional leadership as a POD lead for the Individual Family Plan largest Qualified Health Plans. I was able to guide my team to successfully collect 92% of targeted records and advanced 5 HEDIS measures to a 4 star performance rating. 

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