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Quality Assurance Manager Resume

Horsham, PA

SUMMARY:

  • 30+ years of Healthcare insurance experience includes Software Quality Assurance Testing (System Integration, Functional, User Acceptance, Smoke and Regression), Claims Processing, Coding, Benefits Analysis, Enrollment and Customer and Provider Services.
  • Self - motivated, detail-oriented and dedicated professional.
  • Accomplished team player and an asset to any team joined.

TECHNICAL SKILLS:

  • Windows (95, 98, 2000, XP, 7) Processing System Assembla
  • Microsoft Word / Excel / PowerPoint MetaVance SQL
  • MetaVance Web Client Rational ClearQuest Android / iOS / Windows
  • Protractor Automation Tool

PROFESSIONAL EXPERIENCE:

Confidential, Horsham, PA

Quality Assurance Manager

Responsibilities:

  • Manage the day-to-day activities of the QA team
  • Develop Test Plans, Test Cases and Test Data
  • Establish that all business requirements have been implemented completely and correctly and are traceable to system requirements
  • Manually execute Smoke, Functional & Negative testing on web based applications within an Agile environment
  • Execute Regression & Load testing via automated testing tool Perform iOS, Android and Windows mobile device testing
  • Identify and report defects. Track and verify resolution
  • Work with engineers to understand and resolve bugs
  • Train and mentor QA interns

Confidential, Philadelphia, PA

BUSINESS SYSTEMS ANALYST / SOFTWARE QUALITY ASSURANCE TESTER

Responsibilities:

  • Responsible for delivery of all project deliverables within contractually mandated timeframes
  • Interpreted system requirements for new and existing application
  • Performed System Integration, Functional, Regression and User Acceptance Testing of Membership and Billing system
  • Executed test using predefined business cases against a test environment Validated data sets via manual tests as well as automated tests
  • Performed Configuration changes in multiple system environments
  • Identified, managed & documented defects
  • Work with engineers to understand and resolve bugs
  • Performed analysis of requirements and scopes to assess customers’ business needs

Confidential, Baltimore, MD

BUSINESS ANALYST

Responsibilities:

  • Derived functional requirements from business rules and developed testing strategies
  • Developed test case specifications and claim selection templates Supported test transaction development Supported analysis of identified anomalies after execution Researched various sources for Confidential policies and guidelines
  • Participated in a Test Process Improvement Group (Project Planning)

Confidential, Owings Mills, MD

ASST SUPERVISOR/TEAM LEADER/BENEFITS ANALYST/ CLAIMS ANALYST

Responsibilities:

  • Assisted with supervising four teams of nine Claims Processors. Participated in the establishment and implementation of claims processing standards, goals, guidelines and policies
  • Responsible for a team of nine processors
  • Performed daily audits
  • Assisted with training new employees
  • Processed and adjudicated managed care behavioral health claims and COB claims
  • Maintained and entered benefits into system for all new and renewing accounts
Confidential, Baltimore, MD

ACCOUNT EXECUTIVE

Responsibilities:

  • Enrolled Confidential recipients in Confidential
  • Verified all recipients Confidential eligibility and status
  • Completed and submitted paperwork to State for processing

Confidential, Virginia Beach, VA

GROUP BENEFITS ANALYST/CUSTOMER SERVICE REPRESENTATIVE

Responsibilities:

  • Responded to members inquiries concerning benefits and claims payments
  • Received and entered referrals into system

Confidential, Owings Mills, MD

FULL-SERVICE CUSTOMER REPRESENTATIVE/ Confidential CLAIMS EXAMINER/CLAIMS CODER

Responsibilities:

  • Responded to members inquiries to resolve benefits and claims issues
  • Adjusted claims processed incorrectly
  • Recouped overpayments from providers and members
  • Utilized ICD - 9 and CPT-4 manuals
  • Consistently met or exceeded quality and quantity standards
  • Responsible for the accurate and timely coding of all incoming claims

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