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PROFILE
15 year Health Insurance Industry professional with extensive experience in Quality Analysis,
Audit Support & Analysis, and Process Improvement. Exhibits great knowledge and strengths in
customer service having served and resolved issues for national accounts and several UnitedHealth
teams. Experienced in designing and refining quality programs and processes. Known as a self-
motivated team leader and subject matter expert who connects well with others and is willing to
jump in wherever needed. Works well in telecommuting environment.
SPECIALTIES
• Quality Control • Project Management • Process Improvement
• Quality Analyst • Data Analysis • Reporting Data
• Remediation • Health Care Claims • Customer Care
• HIPPA • NAC Clearance • CAC Clearance
EXPERIENCE
UnitedHealth Group – Minneapolis, MN Aug. 2000 - Present
Clinical Quality Analyst, TRICARE Utilization Management Team Oct. 2015 - Present
• Work directly with clinical nurses providing data analysis and reporting for Military and Veterans
Utilization Audits.
• Assign audits to Clinical staff and managing capacity plans; maintain rosters for auditees.
• Provide weekly audit results to TRICARE regional office as well as individual reports for five
clinical audits to the TRICARE Utilization Management Team.
• Create monthly PowerPoint presentation presenting data to UM Leadership and TRICARE.
• Assist with development of process improvements to design a more streamlined audit to be
implemented 2016. Project includes new reporting database and new reporting suite.
• Manage team SharePoint; full control owner with authority for continued design, security access,
and maintenance.
• Design, implement, and audit the auditor program planned for 2016.
• Provide monthly scorecard metrics for audit staff.
• Manage correspondence audit involving collection of monthly data from five different areas,
compiling results and pointing out key areas needing remediation.
• Compile quarterly CDRL providing a detail listing of errors and accuracy rate for Tricare Office.
Penalties ensue for not completing task on time each quarter; have meant deadline for past three
years.
TRICARE Provider Data Analyst Feb. 2012 – Oct. 2015
• Participate in inventory management for Audit Team, assigning audits, capturing results and
regulating workflow to auditors.
• Report Analysis, providing weekly and monthly audits to TRICARE regional office.
• Full control ownership of team’s SharePoint.
• Military and Veteran Reporting: weekly and monthly reporting for TRICARE Referral Audit.
• Prepared and presented monthly Quality Council Deck as PowerPoint to business partners;
oversee process improvements.
• SOP/P&P: wrote processes and instructions for use for audit/audit tools.
• Created and maintained InfoPath audit form.

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• Won Above and Beyond awards: in 2014 for developing remediation form for Audit Team; in
2015 for designing new audit tool for Referral Management segment of Quality Insight Team.
Report Analyst May 2008 – Feb. 20012
• Created reporting for Customer Care senior leadership.
• Designed SSRS and SQL reporting based on ad hoc requests.
• Worked with Six Sigma team to streamline ad hoc process.
• Monitored, managed and delegated reporting issues and requests arriving through Customer Care
mailbox; oversaw delegation and work flow for team.
• Report Analysis, providing weekly and monthly audits.
• Prepared and presented monthly Quality Council Deck as PowerPoint to business partners;
oversee process improvements.
• Nominated for Service Hero award.
Senior Project Coordinator July 2005 – April 2008
• Member of the End to End Resolution Committee.
• Handled audits and remediation reviews.
• Serves as Subject Matter Expert for Customer Care Team.
• Trained Customer Care Representatives.
• Helped supervisor staff write process improvements.
Rapid Resolution Expert April 2003 – June 2005
• Researched complex claims issues.
• Handled escalated supervisor calls.
• Processed simple claim adjustments.
• Worked with management to resolve complex issues.
Customer Care Professional – Subject Matter Expert Aug. 2000 – March 2003
• Served General Motors account exclusively.
• Processed simple claim adjustments.
• Reviewed and researched claim and benefit issues.
• Handled Union Leaders’ customer care issues and requests.
• Trained General Motor Benefit Representatives.
COMPUTER SKILLS
• InfoPath • Share Point • Quality Insight Audit Application
• ORS • Unet • Omega
• Excel • Access • PowerPoint
EDUCATION
1999 – Herkimer County Community College – Herkimer, NY
AAS – Business Administration
2015 – Empire State College – Saratoga, NY
BS – Business Administration
2016 anticipated – Empire State College – Saratoga, NY
Masters Certificate Program – Project Management

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