Pauline Cox
Perry Hall,Maryland
Summary
Dedicated Quality Assurance Installation Auditor with extensive experience in quality audits and claims processing. Known for effective communication of errors and commitment to compliance, eager to contribute to enhancing organizational performance.
Overview
28
28
years of professional experience
Work History
Quality Assurance Installation Auditor
CRC GROUP
Baltimore, MD
09.2005 - 04.2026
- Performed quality audits of all group set-ups including benefits, eligibility, codes, rates and enrollment prior to transmission to carrier systems. Audited all carriers, medical, dental, vision, and ancillary products
- Communicated errors to improve quality.
- Applied knowledge of insurance procedures, including Cobra and HIPAA.
- Serviced customers and employers by processing enrollment and documents within carrier guidelines.
Audit/Claims Manager
Fidelity Insurance Group
Baltimore, MD
03.1998 - 06.2005
- Ensured compliance in claims processing by overseeing adherence to company policies.
- Reviewed complex claims for accuracy and completeness.
- Identified overpayments and system problems by handling various post paid reports.
- Managed a team of adjusters to enhance operational efficiency.
- Developed training materials for new staff on claims procedures.
- Handled the training of all new employees as well as existing employees.
- Investigated customer service, claims, and provider relation questions.
- Maintained claim protocols and manuals to support operational consistency.
Education
High School Diploma -
Mercy High School
Baltimore06-1976
Education
Towson University
Baltimore, MDSkills
- Quality auditing
- Quality improvement
- Compliance oversight
- Insurance guidelines
- Claims processing
- Team management
Timeline
Quality Assurance Installation Auditor
CRC GROUP
09.2005 - 04.2026
Audit/Claims Manager
Fidelity Insurance Group
03.1998 - 06.2005
High School Diploma -
Mercy High School
Education
Towson University