Michelle Powis
Newark
Summary
To obtain a position within a that fosters an environment where I can work independently but likewise allows me to be an essential part of a team.
Overview
26
26
years of professional experience
Work History
Analyst, Quality Audit Control Ops
Aetna
04.2020 - Current
- Audit Prepayment claims in QNXT with a higher level of complexity to validate financial accuracy.
- Audit stratified and post payment claims for financial accuracy.
- Specialized target audits/Internal Project Audits.
- Exceed my daily production goals with exceptional accuracy.
- Work from Home
System Analyst-Testing
Aetna
Newark, Delaware
10.2007 - 04.2010
- Develop and execute comprehensive testing processes for compliance and audit purposes.
- Preparation and maintenance of a comprehensive test plan to provide quality audits for vendor contracts.
- Monitor compliance and audit findings to ensure that they adhere to contractual guidelines.
- Validate test results, documents discrepancies, and follow through with resolutions to ensure all issues are resolved.
- Communicate with peers and management with audit findings.
Technical Integrated Claims Specialist
Fleet Credit Card Services
Newark, Delaware
10.2004 - 10.2007
- Review and process medical claims from various providers within established guidelines.
- Ensure compliance with HIPPA and other federal and/or state laws.
- Research mail correspondence claim errors and reprocess for correct payment to provider.
- Communicate with providers to resolve billing issues and discrepancies.
Senior Operations
Fleet Credit Card Services
Newark, Delaware
09.1999 - 10.2004
- Analyze and research bank accounts to ensure compliance with the bank's credit balance policy.
- Approve and issue credit balance refunds to clients.
- Review credit card account for fraud related issues.
- Initiate and process adjustments to transfer funds to clients.
- Communicate with other banking institutions to resolve any applicable issues.
- Assessed fees to credit card for returned credit card payments.
Education
High School -
Glasgow High School
Newark, DE01.1995
Skills
- Problem-solving skills
- Effective time management
Timeline
Analyst, Quality Audit Control Ops
Aetna
04.2020 - Current
System Analyst-Testing
Aetna
10.2007 - 04.2010
Technical Integrated Claims Specialist
Fleet Credit Card Services
10.2004 - 10.2007
Senior Operations
Fleet Credit Card Services
09.1999 - 10.2004
High School -
Glasgow High School