Taneisha Ramsey

• Serve as a healthcare quality subject matter expert supporting operational excellence, compliance, and customer satisfaction initiatives across multiple products and platforms. • Conduct comprehensive quality audits and compliance reviews to evaluate adherence to healthcare policies, procedures, regulatory requirements, and operational standards. • Analyze quality trends and audit findings to identify process improvement opportunities, operational risks, and training needs while supporting continuous improvement initiatives. • Partner cross-functionally with leadership and operational teams to recommend workflow enhancements and drive quality-focused business solutions.• Support healthcare operations by monitoring claim processing accuracy, customer service effectiveness, and compliance performance to improve operational efficiency and service quality. • Execute routine and complex quality support activities while ensuring consistency with organizational protocols, standards, and compliance expectations. • Utilize advanced Excel functions including pivot tables, formulas, and V-lookups to analyze data, track trends, and support reporting initiatives. • Provide guidance on quality workflows, systems, and operational procedures while supporting process consistency and business objectives. • Identify training opportunities and quality control recommendations based on audit results and operational performance analysis.

• Responded to complex claims and benefit inquiries from providers, agents, employers, and members while delivering high-quality customer service and issue resolution. • Interpreted healthcare benefits, policy provisions, and plan documents to ensure accurate communication and claims support. • Facilitated claims adjustments and issue resolution to support accurate claims processing and member satisfaction. • Maintained detailed and accurate documentation of customer interactions and operational activities within internal systems. • Supported operational efficiency and customer satisfaction by resolving escalated claims and benefits concerns in a timely manner.