Laurie Benavidez
Simi Valley,CA
Summary
27 years’ successful experience in WellPoint/Anthem enterprise operations Strengths in Service Operations, Quality Assurance and Auditing, Grievance & Appeals, WGS/STAR systems, workflow development, building and maintaining interdepartmental partnerships, meeting facilitation, and driving continuous improvement. Strong analytical & problem-solving skills Ability to communicate effectively, train, develop, and motivate others Proven expertise in conducting in-depth audits and devising successful improvement strategies. Methodically evaluated documents and systems and initiated corrections in compliance with established standards. Great analytical and communications skills enabled optimum results.
Overview
26
26
years of professional experience
Work History
G&A Auditor II
Anthem Inc.
Work at Home
07.2020 - Current
- Responsible for post completion audits of grievance and appeals
- Reviews case to determine relevancy of, and compliance with, federal and state regulations, enterprise policies and procedures and all related accreditation standards
- Evaluates urgency of clinical situation to assess appropriate handling
- Reviews case documentation to assess appropriate system entries have been made to ensure the course is sufficient to mitigate risk associated with regulatory reviews, accreditation reviews, and potential litigation.
Performance Quality Analyst II
Anthem Inc.
Newbury Park, CA
01.2013 - 01.2020
- E2E Process Improvement- Monitor calls for FCR root cause analysis
- Audit benefit materials Summary of Benefits, Evidence of Coverage, SPIDER, Product Management Tool for accuracy of information
- Audit Identification cards for member plan accuracy information
- Audit ACA enrollment applications.
Quality Auditor II
WellPoint Inc.
Newbury Park, CA
01.2005 - 01.2012
- Individual Small Group Enrollment & Billing and Claims / Member & Provider Services Quality
- Monitor recorded call interactions for quality, compliance, accuracy, and policy and procedures
- Audit enrollment applications to reduce Member Touch-point Measure errors
- Conduct 1:1 coaching session to improve service skills and service delivery
- Facilitate calibration sessions for consistency amongst auditors
- Facilitate in unit coaching sessions and Team Huddles to drive consistency between Service Operations and Quality Team
- Provide ongoing error, trend, and associate reporting to Operations management
- Collaborate with Operations to enhance performance and improve processes.
Supervisor (Acting) Quality Review – Operations Performance
WellPoint Inc.
Newbury Park, CA
01.2004 - 01.2005
- Lead a team of Claim and Phone Auditors
- Managed production, department goals and quality standards
- Audited to monitor efficiency and compliance with company policies and procedures
- Coached team to optimize time and prioritize duties
- Trained, coached, counseled, and evaluated performance of direct reports
- Consulted with Operations to support specific audit needs
- Facilitated Client Calibration Sessions for associates and management
- Established a Monthly Character Trait recognition program resulting in increased team motivation and appreciation
- Implemented in line Audit the Auditor program.
Sr. Quality Auditor
WellPoint Inc.
Newbury Park, CA
01.1999 - 01.2004
- Quality Review-Operations Performance
- Crossed trained to audit a client base of up to 700 associates for Individual/Small Group, Claims and Membership, New Enrollment Sales, Teleservice, Health Resource Center, Preventive Care
- Conducted up to 600 audits per month
- Provided audit feedback to associates in group sessions and one to one - to improve quality
- Through call monitoring identified and reported trends
- Conducted special audits for new hires and employee recognition
- New Hire overview introducing the Quality Review’s role in the company, the auditing criteria, explanation of our NICE monitoring system and customer service expectations
- Mentored/trained new auditors.
Education
High School Diploma -
Simi Valley High School
Simi Valley, CA06-1979
Skills
- MS Suite (Word, Excel, PowerPoint, SharePoint)
- WGS / STAR system platforms
- VERINT quality call monitoring software applications
- ULTERA imaging software
- NextGen
- OnDemand
- QUEST
- Client Care Access / Pharmacy benefits
- PMT Tool
- SPIDER
- Root Cause Analysis
- Audit Coordination
- Process evaluations
- Regulatory Compliance
- Regulatory filings
- Compliance standards
- Audit Planning
- Contract compliance
Accomplishments
- Implemented and trained of Internal Blue Cross of California QM customer service associates on Quality Monitoring Criteria
- Key contributor to 2004 Quality Review Conference
- Project team member supporting the development and implementation new auditing criteria
- Implemented in line Audit the Auditor program
- Developed Calibration Guidelines and criteria for internal Client Calibration Sessions
- Developed Small Group call coaching definitions document for call quality monitoring
Professional Development
- Management Courses- Behavioral Interviewing, ChangeABLE, HR101, Influencing Win-Win Outcomes, Moving Conflict to Collaboration
- 23 years quality auditing experience
- 10 years of management experience (Banking/Wellpoint- Quality Assurance)
Timeline
G&A Auditor II
Anthem Inc.
07.2020 - Current
Performance Quality Analyst II
Anthem Inc.
01.2013 - 01.2020
Quality Auditor II
WellPoint Inc.
01.2005 - 01.2012
Supervisor (Acting) Quality Review – Operations Performance
WellPoint Inc.
01.2004 - 01.2005
Sr. Quality Auditor
WellPoint Inc.
01.1999 - 01.2004
High School Diploma -
Simi Valley High School