Resume Sample for Compliance Audit & Monitoring Auditor


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The following is an example of Compliance Audit & Monitoring Auditor resume sample. Reviewing the candidate's full work experience, outlining key-qualifications, duties and responsibilities for the Auditing job title/field.

Resume Writing Example for Compliance Audit & Monitoring Auditor | CV Format

Compliance Audit & Monitoring Auditor – Health Net, a Centene Corp

Canoga Park, CA

Work Experience

Compliance Audit & Monitoring Auditor

Health Net, a Centene Corp

Woodland Hills, CA

February 2015 to Present

Create Excel spreadsheets for auditing and review 
• Create and implement production tracker spreadsheets for a team of eight associates 
• Created 4 department Policy and Procedures 
• Assist in the gathering and review of data provided for a SOX audit 
• Led two department audits and participated on three other department audits 
• Record and report findings as required by the specific department 
• Collect and provide data in order to develop reports based on the quality monitoring results 
• Provide coaching, advice and guidance as needed to a team of four associates 
• Worked on and completed 40 plus audit worksheets 
• Identify root cause of complaints and implement changes to address issues 
• Proposed a process improvement for audit tracker of pertinent information, that enhanced productivity 
• Research and review documentation to ensure we remain compliant 
• Maintain a comprehensive working knowledge of policies, procedures, and benefits across all product lines 
• Participate in training within the department based on performance feedback/trend reports 
• Assess and route project issues appropriately and timely 
• Assist in developing and implementing audit programs 
• Upload documents and policies and procedures into Compliance 360 and SharePoint 
• Order office supplies for the department on the Tejas website 
• Coordinate and communicate with Business Analysis Department to implement technological functions to appropriately fit Appeals & Grievance Quality Assurance

Medicare Appeals and Grievance Auditor/Coordinator

Health Net, Inc

Woodland Hills, CA

May 2013 to 2015

Process, research, investigate and resolve administrative member disputes and complaints 
• Audit appeal and grievance letters for CA, AZ, and OR/WA 
• Document the results of complaints and dispositions at all levels including notification to providers and members 
• Work on projects delegated by Supervisor 
• Trained in a mentoring capacity with new hires 
• Compose resolution letters to members regarding their grievance 
• Request medical records requests from providers and facilities 
• Production goals met and exceeded for two years 
• Highest Overall average audit score of 99.15 percent

Customer Service Representative

Medicare Retention Unit

Woodland Hills, CA

November 2010 to May 2013

Knowledge of Medicare Advantage (MA) plans in California, Oregon, Arizona and Prescription Drug 
• Directed and monitored daily activities of the staff to ensure customer service productivity and goals were met. 
• Assisted new and tenured associates with processing requests and handling calls 
• Making outbound welcome calls to new members to ensure they are enrolled in the appropriate plan 
• Making outbound calls to complete Health Risk Assessment Questionnaire with Medicare members 
• Handled general inbound and outbound calls regarding member’s questions for their plans in California, Oregon, and Arizona 
• Assisted new and tenured associates with processing requests and handling calls 
• Worked on special projects delegated by my Supervisor 
 
Awards and Recognitions 
* Highest average for quality audit score of 99.15 percent. 
* Chosen to mentor new hires.

Education

Certificate

Los Angeles Valley College

Certificate of Completion

California State University

Fullerton, CA

Diploma

Notre Dame High School

Sherman Oaks, CA

Skills

Microsoft Office (5 years), Typing (10+ years), Excel (4 years)

Additional Information

Eager and willing to learn and adapt to a new environment. Always meeting goals and setting new goals to achieve.

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