MANDY ALLEN
Port Royal,PA
Summary
Executed comprehensive audits of appeals and complaints within medical insurance sector, ensuring compliance and accuracy.
Overview
23
23
years of professional experience
Work History
Analyst, Quality Audit Control I OPS
Aetna
Harrisburg, PA
01.2024 - Current
- Conducted comprehensive random and targeted audits of pre-service and post-service grievance and appeal files to ensure strict compliance with internal and regulatory guidelines.
- Evaluated clinical and non-clinical appeal files systematically to measure adherence to corporate policy, documenting detailed assessment scores and delivering actionable insights that reduced processing errors across the department.
Analyst, Complaint and Appeals
Aetna, Inc.
Harrisburg, PA
07.2016 - 01.2024
- Responsible for logging, researching, and resolving complex complaints and appeals, communicating final decisions through formal correspondence. Serves as a dedicated analyst for high-profile client accounts and mentors onboarding team members to ensure operational excellence.
Integrated Services Specialist
Coventry Health Care, Inc.
Harrisburg, PA
11.2013 - 07.2016
- Answered telephone calls from employees about their health insurance. Responsible for responding to employer group questions via e-mail and telephone calls when issues arose with an employee/employer. Processed medical claims.
Customer Service Associate
Coventry Health Care, Inc.
Harrisburg, PA
07.2008 - 11.2013
- Answered customer telephone calls to provide correct information on their health insurance policy. Replied to emails from employer groups in regards to escalating issues that arose with an employee/employer.
Teacher’s Aide
Rainbow Connection Daycare
Thompsontown, PA
01.2006 - 07.2008
- Supported teachers by helping to supervise activities in the classroom and worked with children on an individual, small group or whole class basis.
Dietary Aide
Brookline Manor
Mifflintown, PA
10.2003 - 01.2006
- Responsible for preparing meals, assisting in clean up, kitchen maintenance, delivering food to residents, preparing snacks and taking inventory of food and kitchen supplies.
Education
Associate Degree - Elementary Education
Harrisburg Area Community College
05.2008
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Juniata High School
06.2005
Skills
Microsoft office
Analytical thinking
MS Excel
Time management
Attention to detail
Documentation and reporting
Excel proficiency
Information gathering
Critical thinking
Data research and validation
Decision-making
Timeline
Analyst, Quality Audit Control I OPS
Aetna
01.2024 - Current
Analyst, Complaint and Appeals
Aetna, Inc.
07.2016 - 01.2024
Integrated Services Specialist
Coventry Health Care, Inc.
11.2013 - 07.2016
Customer Service Associate
Coventry Health Care, Inc.
07.2008 - 11.2013
Teacher’s Aide
Rainbow Connection Daycare
01.2006 - 07.2008
Dietary Aide
Brookline Manor
10.2003 - 01.2006
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Juniata High School
Associate Degree - Elementary Education
Harrisburg Area Community College