Jennifer Whittaker
Katy,TX
Summary
Detail-oriented Healthcare Audit and Quality Professional with 10 years of experience in claims, benefits, quality analytics, and auditing. Conduct 250 post-pay claims audits weekly, identifying discrepancies and ensuring payment integrity. Expertise in healthcare compliance, benefit plan configuration, and process improvement, with a proven record of presenting findings to leadership and driving accuracy and cost-reduction initiatives.
Overview
2027
2027
years of professional experience
Work History
Quality Review & Audit Lead - Post Pay
Cigna
Katy, TX
08.2024 - Current
- Reviewed claims for payment accuracy, including benefits, eligibility, authorization, contractual requirements, and applicable plan provisions.
- Audited approximately 250 post-pay healthcare claims weekly to identify overpayments, underpayments, and other payment discrepancies.
- Managed a high-volume audit workload while consistently meeting established quality, accuracy, and turnaround-time requirements.
- Presented audit results to Cigna leadership and business partners, communicating trends, discrepancies, and areas requiring attention.
- Identified opportunities for improvement through analysis of audit findings, payment discrepancies, and recurring issues.
Quality Review & Audtit Lead - Proclaim
Cigna
Katy, TX
05.2023 - 08.2024
- Conducted quality reviews and audits of Proclaim benefit plan configurations to evaluate accuracy and adherence to established requirements.
- Reviewed benefit plan setup and configuration, identifying discrepancies and potential issues impacting downstream claims processing.
- Analyzed benefit requirements, policies, procedures, and applicable mandates, assessing compliance and accuracy of plan configuration.
- Performed focused and targeted audits based on identified risks and audit referrals, ensuring alignment with business requirements.
Quality Analytics Auditor - CIT
Cigna
Katy, Texas
03.2022 - 05.2023
- Audited client account projects to confirm compliance of new and existing benefit plans with established requirements.
- Managed audits through all stages of the process, achieving expected turnaround times and maintaining quality standards.
Client Grievance Coordinator
Cigna
Katy, TX
2018 - 2022
- Reviewed claims and benefit information to resolve grievances and ensure compliance with plan requirements.
- Investigated complex healthcare grievances involving claims, benefits, eligibility, and plan administration.
- Conducted research and analysis to identify root causes of member and provider issues, facilitating effective resolutions.
- Performed quality reviews of grievance cases to assess accuracy and adherence to policies and procedures.
Customer Service Representative
Cigna
Katy, Texas
2016 - 2018
- Delivered customer support for healthcare benefits, claims, eligibility, and plan information, ensuring members received accurate guidance.
- Investigated and resolved member inquiries and claims-related issues, enhancing member satisfaction.
- Analyzed account and benefit information to ensure accurate, timely resolutions for member concerns.
Education
Bachelor of Science - Exercise Science
Missouri State University
Springfield, MO07-2015
Skills
- Post-Pay Claims Audit
- Healthcare Claims Auditing
- Overpayment & Underpayment Identification
- Payment Integrity
- Audit Reporting
- Quality Assurance & Quality Review
- Benefit Plan Configuration
- Healthcare Compliance
- Process Improvement & Trend Analysis
Timeline
Quality Review & Audit Lead - Post Pay
Cigna
08.2024 - Current
Quality Review & Audtit Lead - Proclaim
Cigna
05.2023 - 08.2024
Quality Analytics Auditor - CIT
Cigna
03.2022 - 05.2023
Client Grievance Coordinator
Cigna
2018 - 2022
Customer Service Representative
Cigna
2016 - 2018
Bachelor of Science - Exercise Science
Missouri State University