Summary
Overview
Work History
Education
Skills
Title
Accomplishments
Languages
Timeline
Generic

NATHALI ALMANZAR

Orlando,FL

Summary

Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.

Overview

6
6
years of professional experience

Work History

Quality Assurance Analyst

WellCare/ Centene, Corp.
11.2022 - Current
  • Analyze, compile, and report actionable Sales insights to company leadership on weekly and monthly timeline to share emerging trends, performance guidance and overall business operation perspectives within Sales Department
  • Oversee internal tracking systems designated to ensuring department compliance of CMS requirements including Quality Resolution Plans, audit dispute report and W2/vendor monthly data
  • Develop and implement strategies to increase positive consumer interactions, identifying areas of improvement through audit investigation and data trend reports
  • Assisted ad hoc department requests and projects
  • Translated policies during Annual enrolment Period to Spanish for Operations dept
  • Assists Director, QI in preparation for audits by regulatory agencies and review organizations
  • Attentive and adaptable learner- efficient in many different applications such as Salesforce, Ascend, Sensentia, CentralPoint, MediaVault, PowerPoint, Microsoft Outlook, Google Suite, Calabrio, Excel, ICBM, Adobe, and TPG
  • Documents, tracks, resolves, and responds to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner

Senior Quality Specialist

WellCare/ Centene, Corp.
07.2021 - 11.2022
  • Design and implement quality programs throughout the health plans to drive contact center key performance indicators and support business initiatives
  • Developed and analyzed quality reporting to identify trends and recommend improvements
  • Analyze and compiled data into spreadsheets and databases
  • Ensure tasks are being processed within defined policy and procedure to maintain audit accuracy greater than 95%

Quality Specialist II

AcariaHealth
Orlando, FL
11.2018 - 07.2021
  • Root cause analysis using quality tools and methodologies to develop solutions leading to increased timeliness and efficiency of the audit process
  • Complaint resolution, including risk management and sentinel events related to quality-of-care issues
  • Staff auditing, including error identification and resolutions in data and reporting, as well as presenting improvement recommendations to leadership
  • Action plan development to resolve deficiencies such as target audits, metrics, audit methodology, tools, and outputs (reports, graphs, metrics, corrective action plans)

Education

Bachelor of Arts - Psychology

Florida International University
01.2018

Skills

  • Excel
  • PowerPoint
  • Reporting
  • Problem-solving
  • Complaint Resolution
  • Root Cause Analysis
  • Bilingual (English & Spanish)
  • Cross-Training
  • Experience with Specialty Pharmacy, PDP, Medicare, and Medicaid lines of business
  • Strong organization and communication skills
  • Excellent interpersonal skills
  • PC proficiency to include NICE, OMNI, CALABRIO, Tableau, TPG, Salesforce, Sales, PowerBI, Central Point, Service Now, SharePoint, ICBM

Title

Quality Analyst

Accomplishments

  • Developed corrective action plans to prevent reoccurrence of trends.
  • Assisted in training Centene Senior Quality Specialist’s on the Call Calibration process.
  • Deliberated, developed, and lead multiple projects, including prioritizing and managing through execution.
  • Assisted with the creation of the QA Power BI reporting for DTC department.
  • Supported Compliance department with inquires and CTM requests.
  • Assisted with translating AEP scripts to Spanish for DTC.

Languages

Spanish
Professional

Timeline

Quality Assurance Analyst

WellCare/ Centene, Corp.
11.2022 - Current

Senior Quality Specialist

WellCare/ Centene, Corp.
07.2021 - 11.2022

Quality Specialist II

AcariaHealth
11.2018 - 07.2021

Bachelor of Arts - Psychology

Florida International University

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NATHALI ALMANZAR