Sabrina Evans
Fredericksburg,VA
Summary
Detail-oriented healthcare professional with extensive experience in claims processing, quality auditing, and regulatory compliance within the health insurance industry. Proven ability to analyze complex healthcare documentation, identify discrepancies, and implement quality improvement strategies. Strong background in auditing processes, root cause analysis, and training development. Recognized for analytical thinking, accuracy, and improving operational performance in fast-paced healthcare environments.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Senior Quality Consultant
Aetna
Fredericksburg, VA
02.2023 - Current
- Promoted to Senior Quality Consultant in July 2025, demonstrating expertise in quality assurance.
- Designed and executed quality assessment audits and measurement programs for plan document drafting team.
- Developed and implemented internal and external performance benchmarks to enhance evaluation processes.
- Executed quality reviews and analyzed data trends to enhance operational performance.
- Conducted comprehensive root cause analysis to identify factors affecting documentation accuracy and quality.
- Spearheaded enhancements to business processes, policies, and system infrastructure to elevate plan documentation quality.
- Developed and executed comprehensive data collection strategies, encompassing system reports, surveys, and feedback tools.
- Facilitated coaching and mentoring sessions for employees based on audit findings and performance evaluations.
- Designed and updated training materials, including manuals, job aids, and instructional guides.
- Orchestrated training program coordination and facilitation for new and existing team members.
- Facilitated advanced training sessions and provided subject matter expertise to enhance plan document drafting team capabilities.
Claims Benefit Specialist
Aetna
Pittsburgh, PA
04.2019 - 02.2023
- Reviewed and processed healthcare claims submitted by providers, ensuring accuracy and compliance with insurance policies.
- Assessed patient insurance plans and policy provisions to determine eligibility and benefit coverage.
- Evaluated claims for coding accuracy, medical necessity, and documentation compliance.
- Executed assignment of appropriate codes, modifiers, and claim information within internal processing systems.
- Executed thorough investigations on claims necessitating further validation to guarantee accurate resolution.
- Oversaw claims processing activities to ensure compliance with regulatory requirements, industry standards, and company policies.
- Oversaw meticulous documentation to enhance claims processing decisions.
Customer Service Representative
Alorica
- 04.2019
- Provided customer support and resolved account issues through phone and digital communication channels.
- Maintained accurate documentation of customer interactions and account activity.
- Assisted customers with billing questions, service issues, and account updates.
- Demonstrated strong problem-solving skills while maintaining high customer satisfaction.
Education
BBA - Health Care Administration
University of Phoenix
Tempe, AZAssociate of Applied Science - Medical Assistant
Sanford–Brown
Pittsburgh, PA03.2013
Skills
- Oversaw comprehensive audits of medical records and claims to enhance accuracy and compliance Led initiatives to improve auditing processes, resulting in increased efficiency Mentored junior staff in best practices for record management and claims analysis
- Ensured alignment with healthcare regulations to maintain operational integrity
- Led quality assurance programs to elevate product standards and drive continuous improvement Oversaw process enhancement projects to optimize efficiency and effectiveness across departments Championed cross-functional collaboration to foster a culture of quality and accountability
- Performed detailed root cause analysis to enhance operational efficiency and prevent recurrence of problems
- Evaluated healthcare documentation to support regulatory adherence and enhance patient care quality
- Led data analysis initiatives to identify trends and inform decision-making Oversaw reporting processes to ensure accuracy and clarity of information Collaborated with teams to enhance data-driven strategies and outcomes
- Led training development initiatives to enhance staff capabilities Oversaw coaching programs to foster professional growth among team members Collaborated with management to align training objectives with organizational goals
- Maintained high standards of coding and documentation accuracy to support compliance and patient care
- Monitored and enforced compliance with organizational policies and procedures to mitigate risks
- Optimized electronic claims processing systems to enhance operational efficiency
- Ensured accuracy and precision in deliverables to uphold quality standards
- Utilized strong problem-solving and decision-making skills to enhance operational efficiency
- Utilized strong written and verbal communication abilities to enhance team interactions and stakeholder engagement
- Utilized critical thinking and advisory skills to enhance decision-making processes
- Assessed workload demands and independently managed responsibilities to ensure timely completion
- Utilized effective time management and organizational strategies to streamline workflows and meet deadlines
Ensured precision and thoroughness in tasks to maintain high standards in rapidly changing settings
Certification
Certified Quality Improvement Associate (CQIA)
Timeline
Senior Quality Consultant
Aetna
02.2023 - Current
Claims Benefit Specialist
Aetna
04.2019 - 02.2023
Customer Service Representative
Alorica
- 04.2019
BBA - Health Care Administration
University of Phoenix
Associate of Applied Science - Medical Assistant
Sanford–Brown