carlos User
@carlosuser9
I’m a Quality Assurance Specialist who audits compliance, coaches agents, and improves bilingual campaign performance.
HondurasWhat I'm looking for
I’m a multi-skilled BPO professional focused on Quality Assurance across Tier 2 technical support, escalations, QA, and agent training in bilingual (English/Spanish) operations.
In my current role as a Quality Assurance Specialist at ResultsCX, I audit and score calls for Humana Medicare Advantage campaigns—medical and Rx coverage, claims, prior authorizations, and provider inquiries—against CMS and HIPAA requirements. I verify accurate handling of medical and pharmacy claims, denials, and disclosures, flagging compliance risks that protect the account during AEP.
I track quality trends across claim types and partner with training to close knowledge gaps and lift first-contact resolution and CSAT. I also provide short classes to reinforce content to production phone representatives.
Before QA, I worked as a Corporate Trainer and an Insurance Agent at ResultsCX, and earlier as a Tier 2 customer service representative at Allied Global. I still bring that end-to-end mindset to every audit and coaching session—de-escalating tense calls, preventing cancellations, and helping agents succeed faster through knowledge checks and targeted coaching.
Experience
Work history, roles, and key accomplishments
Quality Assurance analyst for Humana Medicare Advantage campaigns in a bilingual BPO, auditing calls across medical and Rx coverage, claims, prior authorizations, and provider inquiries for compliance and accuracy.
Audit and score calls covering medical insurance benefits, Part D (Rx) coverage, prior authorizations, and IPA/provider network questions against CMS and HIPAA requirements.
Verify accu
New-hire trainer for Humana Medicare campaigns in a bilingual BPO, preparing agents to handle Medicare Advantage and Part D enrollment, benefits, and compliance.
Deliver classroom and nesting training on Humana Medicare products (Medicare Advantage, Part D), CMS guidelines, and HIPAA compliance.
Prepare agents for Annual Enrollment Period (AEP) surges — getting new hires call-ready and certified o
Provided insurance support in a bilingual BPO setting, focusing on claims-related work and enrollment services for Medicare products. Supported customers with analytical case handling to resolve issues and improve outcomes.
Representante de atención al cliente
Allied Global
Nov 2021 - Apr 2023 (1 year 5 months)
Delivered tier 2 technical support and escalation handling in a bilingual (English/Spanish) BPO environment, resolving cases first-line agents could not close. Diagnosed and resolved technical issues remotely, de-escalating tense calls, documenting cases, and surfacing process improvements.
Tier 2 technical support and escalation handling in a bilingual (English/Spanish) BPO environment, resolving the cases first-line agents can't close.
Diagnose and resolve technical issues remotely, owning each case end-to-end and cutting down repeat contacts.
Handle the most complex escalated calls — de-escalate tense situations, rebuild customer trust, and prevent cancellations.
Document and anal
Education
Degrees, certifications, and relevant coursework
Universidad Nacional Autónoma de Honduras
PHYSICAL SCIENCES
Universidad Nacional Autónoma de Honduras
Physical Sciences
2021 -
Studied Physical Sciences at Universidad Nacional Autónoma de Honduras (UNAH) in 2021.
Tech stack
Software and tools used professionally
Availability
Location
HondurasAuthorized to work in
Job categories
Skills
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