Healthcare Provider Service Representative | Quality Assurance Analyst
Pampanga
I’m a healthcare support professional with over five years of experience specializing in insurance verification, claims review, prior authorization follow-ups, and peer-to-peer scheduling. Throughout my career, I’ve developed a strong understanding of healthcare workflows and payer processes, allowing me to efficiently navigate complex cases while maintaining accuracy and compliance. My background includes extensive experience handling both inbound and outbound client interactions, where I consistently delivered clear communication and reliable support. I also bring a solid administrative foundation, ensuring that documentation, coordination, and process management are handled with precision. I was promoted to a Quality Assurance Analyst role, where I audited calls and workflows to ensure strict adherence to HIPAA regulations and internal standards. This role strengthened my attention to detail, analytical thinking, and commitment to compliance, as I helped maintain high-quality performance across the team. What sets me apart is my ability to combine operational efficiency with a strong compliance mindset. I understand the importance of accuracy, confidentiality, and professionalism in healthcare, and I take pride in delivering work that meets both client expectations and regulatory standards. I’m confident in my ability to contribute value through my experience, adaptability, and dedication to quality in every task I handle.
TaskUs, full_time
Jan 2021 to Sep 2025
• Furnishing members and health care practitioners with details regarding members’ benefits • Protected member privacy and sensitive health data by adhering to HIPAA compliance standards and best practices • Advising providers about the member’s outstanding co-payments • Providing status, denial reasons, payment status of a claim • Providing status of a prior-authorization • Providing denial rights and turn-around-time when prior-authorization was denied • Scheduling a peer-to-peer to Providers and Clinicians • Recognize flaws in the production process and provide recommendations to eliminate flaws • Advise, carry out, and keep track of preventive and corrective measures to guarantee that quality assurance criteria are met • Auditing teammates’ calls and provide recommendations to parameter that needs improvement • Sending weekly team’s quality score through email • Conducting Quality Talk weekly to discuss the team’s opportunity and provide recommendations • Ensured member health information was handled in compliance with HIPAA regulations • Conducting internal and external calibration to ensure clients, operations, and quality are aligned with the process