Quality Assurance Auditor
CareFirst BCBS
11.2025 - Current
Hi, I’m
Melissa Harper
Quality Assurance Auditor
Charleston,WV
Work History
CareFirst BCBS
Quality Assurance Auditor
11.2025 - Current
Job overview
- Conducted comprehensive audits to ensure compliance with quality standards and regulatory requirements.
- Developed and implemented quality assurance protocols to enhance operational efficiency and accuracy.
- Collaborated with cross-functional teams to identify and resolve quality issues in processes and products.
- Identified issues of non-compliance and elevated reports to senior personnel.
CareFirst BCBS
Customer Service Advocate III
10.2014 - 11.2025
Job overview
- As a Customer Service Advocate in the BlueCard department, I handle provider submitted corrected claims, provider appeals, and provider inquiries that are received via mail and/or email.
- I have been on the adjustment team for 5 years and worked an assist line for my peers prior to it closing in April 2024.
- I assist with training new representatives and assist with the dedicated groups.
- Adapted quickly to changes in company policies or systems, ensuring minimal disruption in service delivery during transitions.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
Charleston Gardens
Residential Assistant
01.2013 - 01.2014
Job overview
- As a Residential Assistant I was responsible for assisting residents with their everyday needs.
- I worked the Alzheimer's unit.
Comfort Keepers
Certified Nursing Assistant
01.2012 - 01.2013
Job overview
- Provided high-quality personal care services such as bathing, grooming, dressing, and feeding to ensure patient dignity.
- Assisted patients with daily living activities for enhanced comfort and wellbeing.
- Checked patient vitals such as temperature, blood pressure, and blood sugar levels.
- Maintained a clean, safe environment by sanitizing surfaces, changing linens, and disposing of waste properly.
- Answered call lights and supported patient comfort and safety by adjusting bed rails and equipment.
- Improved patient care quality by monitoring and recording vital signs, fluid intake, and output.
Central Wv Aging Services
Certified Nursing Assistant
03.2008 - 05.2012
Job overview
- Assisted clients with daily living needs to maintain self-esteem and general wellness.
- Enhanced patient well-being by providing compassionate and attentive care in daily routines.
- Documented patient progress through detailed record-keeping, contributing to ongoing evaluation of care plans effectiveness.
- Transported individuals to events and activities, medical appointments, and shopping trips.
Ticketmaster
Director
10.2003 - 06.2004
Job overview
- Cultivated a positive work environment that fostered employee engagement, increased retention rates, and boosted overall team morale.
- Facilitated cross-functional collaboration for improved decision-making processes within the organization.
- Improved project efficiency with strategic planning, resource allocation, and time management practices.
Education
Herbert Hoover High School
High School
08.2000 - 03.2004
Garnet Career Center
No Degree from Phlebotomy
University of Phoenix Tempe, AZ
No Degree from Business Administration
Skills
Call center experience
Data entry
Assertiveness
Complaint resolution
Computer proficiency
Microsoft outlook
Live chat support
Multi-line phone talent
Escalation management
Policy review
Professional telephone demeanor
Document control
Staff education and training
Medical terminology
<Enter your own>
Quality Assurance Auditor | Performance Audit
Summary
Professional with strong background in customer interactions and service solutions. Highly skilled in conflict resolution, communication, and problem-solving, ensuring customer satisfaction and loyalty. Effective team collaborator, adaptable to changing needs, and consistently focused on achieving results through efficient and empathetic service. Known for reliability and proactive approach to meeting customer and organizational goals.
Timeline
Customer Service Advocate III
CareFirst BCBS
10.2014 - 11.2025
Residential Assistant
Charleston Gardens
01.2013 - 01.2014
Certified Nursing Assistant
Comfort Keepers
01.2012 - 01.2013
Certified Nursing Assistant
Central Wv Aging Services
03.2008 - 05.2012
Director
Ticketmaster
10.2003 - 06.2004
Herbert Hoover High School
High School
08.2000 - 03.2004
University of Phoenix
No Degree from Business Administration
Garnet Career Center
No Degree from Phlebotomy