Tonnette Taylor
Houston,TX
Summary
Multifaceted quality assurance professional with 9+ years experience in the healthcare and insurance sectors focusing on quality assurance software testing. Effective in aligning business processes with organizational objectives, while maintaining strict adherence to policies and regulatory standards. Demonstrated the ability to collaboratively work with cross-functional teams for system improvements. Possess an outstanding capacity in analytical, communication, research, decision making, and problem-solving skills.
Overview
8
8
years of professional experience
Work History
UAT Sr. Technical Claims Specialist
Universal American
Houston, Texas
02.2014 - 04.2015
- Developed and executed test case scenarios based on the business owners' needs utilizing various testing methods for multiple lines of businesses.
- Enhanced testing process by meticulously documenting testing results and defect tracking, increasing overall testing efficiency and accuracy.
- Performed manual testing on system for functionality, usability, compatibility, and system integration.
- Engaged with cross-functional teams to identify and resolve defects, resulting in a 30% reduction in claims rework and a 15% increase in efficiency.
- Applied root cause analysis for defective claims, improving payment accuracy by 98% through system modifications.
- Mentored and audited offshore staff members throughout the testing process to ensure overall accuracy and project completions.
Claims Quality Auditor
Universal American
Houston, Texas
08.2012 - 02.2014
- Audited claims adjudication of examiners' processing and payment accuracy.
- Provided constructive feedback to examiners, backed by comprehensive documentation to rectify errors.
- Ensured 100% precision in automated claim payments, leading to streamlined processes and improved operational efficiency.
- Devised process improvements aligned with department processes and Medicare regulatory standards for operational efficiency.
- Implemented root cause analysis that identified trending errors driving continuous improvement within the Claims department.
- Collaborated with department managers to address error trends and outstanding audits to promote best practices, achieving a 95% department standard accuracy rate.
Claims Team Lead
Universal American
Houston, Texas
09.2007 - 08.2012
- Spearheaded a team of 10 examiners, streamlining Medicare advantage claims processing across multiple business lines.
- Managed daily tasks and trained team members on system updates, new processes, and complex claim issues ensuring efficient claim resolution.
- Extracted, imported, exported, and converted inventory files of 90,000+ daily to Excel workflow reports for distribution.
- Coordinated and supported offshore staff with work inventory to monitor smooth workflow processes and timely claim processing turnarounds.
- Generated insightful metric reports, providing visibility on inventory volume, backlogs, and progress towards goals.
- Proactively resolved 95% of provider grievances with regional provider relations reps, preventing CMS complaints and maintaining high company ratings.
- Tested new benefits, provider agreements, fee schedules, and system configuration enhancements, validating its accuracy and performance efficiency.
- Improved operational efficiency through successful test case executions as defined by business analysts with system modifications, resulting in effective claims processing and reduced turnaround time.
Education
BBA in Management Information Systems -
University Of Houston Downtown
Houston, TexasAAS in Health Information Technology -
Houston Community College
Houston, TexasSkills
- Access
- Analytical Skills
- Bug Tracking
- Critical Thinking
- Cross Functional Skills
- Data Analysis
- Database
- Decision-Making
- Excel
- Facets
- Google Suite
- Interpersonal Skills
- Java
- Lean Six Sigma
- MS Office
- MS Project
- NetSuite
- Network Configuration
- NetworX
- Problem-solving
- Regression Testing
- Root Cause Analysis
- Serena TeamTrack
- SharePoint
- Software Testing
- SQL
- User Acceptance Testing
- Visio
References
References available upon request.
Timeline
UAT Sr. Technical Claims Specialist
Universal American
02.2014 - 04.2015
Claims Quality Auditor
Universal American
08.2012 - 02.2014
Claims Team Lead
Universal American
09.2007 - 08.2012
BBA in Management Information Systems -
University Of Houston Downtown
AAS in Health Information Technology -
Houston Community College
Similar Profiles
Jasper ArroyoJasper Arroyo
Customer Service Representative at Universal AmericanCustomer Service Representative at Universal American
April RazzoukApril Razzouk
Security Gate Officer at Allied Universal / American SecuritySecurity Gate Officer at Allied Universal / American Security
Felix LemayianFelix Lemayian
Physical Education Support Teacher at Universal American School DubaiPhysical Education Support Teacher at Universal American School Dubai
Malcolm ConeoMalcolm Coneo
Life Insurance Agent at Bankers Life Insurance Company Of AmericaLife Insurance Agent at Bankers Life Insurance Company Of America
SHARON GUERREROSHARON GUERRERO
Logistics Specialist at Army National GuardLogistics Specialist at Army National Guard