Vanessa Vega
La Puente,CA
Summary
Dynamic Quality Audit Specialist with a proven track record at Blue Shield Promise Health Plan, leveraging quality assurance expertise and cross-functional teamwork to enhance product quality. Championed continuous improvement initiatives, resulting in streamlined processes and informed decision-making. Skilled in risk assessment and customer service, fostering a culture of excellence and accountability.
Overview
14
14
years of professional experience
Work History
Quality Audit Specialist
Blue Shield Promise Health Plan
Monterey Park, CA
01.2020 - 04.2025
- Collaborated with cross-functional teams to address identified quality issues, resulting in more efficient processes and improved products.
- Participated in regular meetings with senior leadership to communicate progress on quality initiatives and discuss strategies for further improvement.
- Provided training to production personnel on quality assurance best practices, contributing to a culture of continuous improvement throughout the organization.
- Developed comprehensive reports summarizing audit results, enabling management to make informed decisions about resource allocation and process improvements.
- Improved overall product quality by conducting thorough audits and identifying areas for improvement.
- Maintained accurate records of audit findings, allowing for effective tracking of progress toward quality goals and identification of recurring issues.
- Championed a proactive approach to problem-solving by anticipating potential issues before they escalated into larger problems, ultimately minimizing disruptions in production schedules.
- Supported continuous improvement efforts by analyzing audit findings and recommending corrective actions.
Customer Service Representative
Blue Shield Promise Health Plan
Monterey Park, CA
04.2018 - 01.2020
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Responded promptly to customer inquiries, resolving complaints to build trust and satisfaction.
- Ensured high satisfaction rates by providing personalized solutions for complex issues.
- Trained new staff on support tools, boosting team efficiency and service standards.
- Consistently delivered beyond expectations, contributing to outstanding customer service ratings
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
Claim Specialist
MHExpress
San Dimas, CA
06.2016 - 04.2018
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
Hearing Representative
MHExpress
San Dimas, CA
02.2015 - 06.2016
- Worked alongside attorneys and professionals to develop compelling cases for clients requiring representation.
- Conducted thorough research to support evidence-based decision-making during hearings and negotiations.
- Managed multiple deadlines efficiently while maintaining high-quality work output under pressure.
Office Manager
At Home Respiratory Care
Rowland Heights, CA
06.2013 - 02.2015
- Handled sensitive information with discretion, maintaining confidentiality of company documents and personnel records.
- Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence.
- Maintained accurate financial records by reconciling accounts payable/receivable transactions regularly to ensure balanced budgets.
- Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving to prevent shortages
- Oversaw facility maintenance requests, coordinating with building management to address repairs or improvements efficiently
Medical Assistant
Dr.prakash T. Patel
Covina, CA
01.2011 - 04.2013
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Obtained client medical history, medication information, symptoms, and allergies
- Performed medical records management, including filing, organizing and scanning documents.
- Coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.
Education
General Studies
Mt. San Antonio College
Walnut, CAMedical Assistant
Medical Assistant School
West Covina, CA06.2011
Skills
- Quality assurance expertise
- Continuous improvement strategies
- Risk assessment
- Cross-functional teamwork
- Auditing standards compliance
- Customer service
- Data entry
- Call center experience
- Team leadership
- Time management
- Decision-making
Timeline
Quality Audit Specialist
Blue Shield Promise Health Plan
01.2020 - 04.2025
Customer Service Representative
Blue Shield Promise Health Plan
04.2018 - 01.2020
Claim Specialist
MHExpress
06.2016 - 04.2018
Hearing Representative
MHExpress
02.2015 - 06.2016
Office Manager
At Home Respiratory Care
06.2013 - 02.2015
Medical Assistant
Dr.prakash T. Patel
01.2011 - 04.2013
General Studies
Mt. San Antonio College
Medical Assistant
Medical Assistant School