Gwendolyn Phelps

• Perform plan sponsor installation audits to ensure the accuracy of the data. Enter results found into QuickBase for reporting and tracking of trending errors.
• Fully trained on Middle Market, Key & Select, CPQ, and National Accounts markets.
• Conducted audits to ensure compliance with industry regulations and standards.
• Conducted internal audit reviews to ensure compliance with established procedures.

Moved into this role from the previous role of Quality Auditor under Coventry Healthcare.

• Conducted thorough audits of healthcare processes and documentation.
• Collaborated with teams to identify areas for quality improvement.
• Analyzed audit findings and prepared detailed reports for management.
• Provided training sessions on quality assurance best practices for staff.
• Facilitated meetings to discuss audit results and corrective actions.
• Created reports on audit findings, including recommendations for improvements.
• Collaborated with production staff to resolve quality issues in a timely manner.
• Conducted internal audits to ensure compliance with quality standards.

Promoted to Quality Auditor from Enrollment Representative. Was in this role when Aetna and Coventry merged.

• Processed applications and ensured compliance with regulatory guidelines and policies.
• Assisted members with enrollment inquiries.
• Maintained accurate records of member interactions for future reference and analysis.
• Answered member, provider, and employer phone calls, faxes, and written communication.
• Handled all COB enrollment, letters, and training for other members of the department. Commericial and Medicare.
• CMS audits for verification of Medicare COB, yearly.

• Maintained accurate records of all data collected during analysis processes.
• Maintained positive working relationship with fellow staff and management.
• Handled claims information indicating possible other commercial insurance, sent out letters, and updated company systems once the letter was received back with the correct COB information.
• Commercial insurance was the primary focus, but it did help out in the Motor Vehicle and other insurance departments.
• Handled employer group requests for verification of proper COB handling for their employees; this was handled on a monthly basis, and included reports, phone calls, and written communication.