Brenda Long
Apison,TN
Summary
Meticulous Data Scientist accomplished in compiling, transforming and analyzing complex information through software. Expert in machine learning and large dataset management. Demonstrated success in identifying relationships and building solutions to business problems.
Overview
37
37
years of professional experience
Work History
Provider Data Lead Analyst - Provider Solutions & Operations
CIGNA Healthcare
07.2022 - Current
- In depth data analysis related to quality and consumption of provider data, including monitoring of internal service performance in accordance with State Compliance guidelines using Tableau.
- Acted as subject matter expert within organization on matters pertaining to data integrity, storage solutions, and privacy regulations.
- Collaborated closely with IT staff on development of custom integrations between various platforms, enabling more efficient sharing of information among stakeholders.
- Delivered concise presentations summarizing key findings from complex analyses to senior leadership teams, influencing strategic decisions based on empirical evidence.
- Managed vendor relations to ensure timely delivery of accurate datasets for ongoing analyses.
- Mentored approximately 12 junior analysts in best practices for data handling and analysis, elevating their expertise and productivity levels.
- Advocated for adoption of data-driven culture across all departments, educating peers on value of leveraging information as strategic asset.
- Proactively identified potential risks associated with current systems and processes, proposing actionable solutions to mitigate any adverse impact.
- Innovated new ways of extracting actionable insights from complex datasets, driving significant business improvements.
- Enhanced data quality by implementing rigorous validation processes and data management protocols.
- Optimized data workflows for increased efficiency and reduced processing times, streamlining team operations.
- Compiled, cleaned and manipulated data for proper handling.
Provider Data Advisor - Provider Operations
CIGNA Healthcare
02.2021 - 07.2022
- State compliance requirements gathering, file preparation, reporting request and Special Projects related to provider data.
- Maintained up-to-date knowledge on industry trends and regulations, ensuring accurate advice was provided to clients at all times.
- Developed long-lasting relationships with clients to ensure consistent retention and loyalty.
- Managed risk effectively by closely monitoring client portfolios and making timely adjustments.
- Mentored 8 junior advisors, fostering supportive team environment focused on growth and learning.
- Participated in ongoing professional development opportunities to stay current with industry trends and best practices.
- Fostered culture of innovation within advisory team, encouraging adoption of new technologies and methodologies.
- Enhanced advisor skills and knowledge through continuous professional development program, elevating service quality.
- Navigated complex regulatory requirements to ensure compliance in all advisory activities.
Network Operations Lead Analyst - Network Solutions & Operations
CIGNA Healthcare
02.2018 - 02.2021
- In depth data analysis and reporting creation for the Client Specific Network Mirror Process utilizing SQL, Toad, Cognos & SAS.
- Reduced downtime by proactively identifying and resolving potential network issues before being escalated.
- Monitored daily reports from various tools to assess overall health status allowing swift action when needed.
- Developed and maintained strong relationships between IT departments fostering effective collaboration on projects and initiatives.
- Reduced downtime by proactively identifying and resolving potential network issues before they escalated.
- Successfully coordinated multi-location network upgrades ensuring minimal downtime during transition period.
- Championed process improvements that increased efficiency by streamlining routine tasks across entire operation team responsibilities.
- Shadowed team of 13 network operations professionals, ensuring efficient workflow and timely task completion.
- Improved overall network stability through rigorous testing, troubleshooting, and resolution of complex technical issues.
- Mentored junior team members on best practices in networking technology and methodologies, fostering professional growth within department.
- Developed and documented network policies, procedures and standards.
- Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
- Increased efficiency by streamlining data analysis processes and implementing automation tools.
- Facilitated workshops on data visualization tools, enhancing team's reporting capabilities.
- Provided reporting for forecast analysis and ad-hoc reporting in support of decision-making.
- Proactively identified areas for improvement within existing processes leading to faster issue resolution times.
- Developed comprehensive training materials for new hires to quickly familiarize them with company systems and protocols.
- Ensured compliance with industry regulations by maintaining detailed records of all network changes and upgrades.
System Analyst SR Specialist - Facets Core & Provider
CIGNA Healthcare
04.2016 - 02.2018
- Work closely with stakeholders, business analysts, architects and developers to analyze, contribute to design and prepare application specifications for information systems solutions.
- Collaborated with cross-functional teams to develop system solutions tailored to business needs.
- Provided technical support for end-users, resolving issues promptly and effectively.
- Enhanced user experience through implementation of interface updates and usability improvements.
- Enhanced collaboration between IT teams by standardizing communication protocols around system requirements, project progress updates, and change management processes.
- Conducted comprehensive system analyses to identify areas for improvement and optimization.
- Developed detailed technical documentation to facilitate knowledge sharing among team members and aid in future troubleshooting efforts.
- Implemented rigorous testing procedures to ensure optimal performance and minimize errors in software applications.
- Collaborated with upper management to drive strategy and implement new processes.
- Assessed business requirements to create focused solutions.
- Assisted project managers in creating accurate project timelines through careful analysis of task dependencies and resource constraints within system development initiatives.
- Improved systems with addition of new features and infrastructure.
- Spearheaded data migration projects, ensuring seamless transfer of information between systems.
- Gathered requirements and performed gap analysis through design workshops with users.
- Analyzed existing systems and databases and recommended enhancements to solve business needs
Plan Implementation SR Assoc- CSN (Client Specific Network)
CIGNA Healthcare
10.2013 - 04.2016
- Responsible for maintenance of Client Specific Network provider demographics and fee schedule creation/maintenance.
- Maintained accurate network documentation, allowing for efficient management and future planning efforts.
- Advanced overall network stability by performing regular maintenance updates.
- Trained 14 junior staff members on networking principles, fostering culture of continuous learning within Network Operations Organization.
- Ensured seamless communication between departments by maintaining and upgrading system processes.
- Performed and adhered to change management requirements.
- Planned, implemented and maintained network strategy and operation.
- Performed day-to-day network administration, maintenance, and support.
- Identified and immediately resolved issues with network setup or provider data loads.
SR Technical Lead - PDM (Provider Data Management)
Multiplan
05.2012 - 10.2013
- Serve as Subject Matter Expert on issues related to technical and business aspects of Provider Data Management for Credentialing and PDM matrix partners.
- Assessed project milestones and team performance to keep staff on-task.
- Championed continuous integration practices within team by automating build processes and deploying effective version control systems.
- Boosted operational efficiencies via automation of manual tasks, allowing team members to focus on more strategic projects.
- Optimized infrastructure performance with thorough analysis and implementation of necessary upgrades, ensuring smooth running of applications at peak times.
- Developed technical solutions to diverse operational problems.
- Managed team of 16 personnel focused on implementing resolutions and updates.
- Established positive work culture within technical team through transparent communication channels and motivational leadership tactics.
- Improved employee retention rates within Provider Operations team by promoting professional growth opportunities such as training programs or mentorship arrangements.
- Led development and execution of end-to-end testing strategies for complex projects, ensuring high-quality deliverables that met client expectations.
- Implemented rigorous quality assurance processes through regular audits of Provider contract set up and loading into system of record, reducing error rates considerably over time.
- Improved systems with addition of new features and infrastructure.
Manager - Credentialing
Multiplan
11.2009 - 05.2012
- Managed assigned staff of 32 on initial and re-credentialing verification activities for physicians and allied professionals according to accreditation standards or equivalency
- Manage Joint Operating Committee (JOC), including agenda development, facilitating appropriate meeting participation and follow up activities.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Accomplished multiple tasks within established timeframes.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
- Built high-performing teams through effective recruitment, onboarding, and talent development initiatives.
- Reduced operational costs through comprehensive process improvement initiatives and resource management.
- Streamlined workflows by identifying bottlenecks in existing systems and implementing appropriate solutions.
- Organized professional development programs for staff, leading to improved performance and skill sets.
- Boosted employee morale and reduced turnover through development and implementation of comprehensive rewards and recognition program.
- Facilitated team brainstorming sessions that led to innovative solutions for long-standing operational challenges.
- Established team priorities, maintained schedules and monitored performance.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Leveraged data and analytics to make informed decisions and drive business improvements.
Manager - Provider Demographics-Mail Operations
Multiplan
07.2007 - 11.2009
- Managed assigned staff of 28 on site and off site for all incoming provider demographic add/term/change request and Network load fallout.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
- Built high-performing teams through effective recruitment, onboarding, and talent development initiatives.
- Reduced operational costs through comprehensive process improvement initiatives and resource management.
- Streamlined workflows by identifying bottlenecks in existing systems and implementing appropriate solutions.
- Organized professional development programs for staff, leading to improved performance and skill sets.
- Boosted employee morale and reduced turnover through development and implementation of comprehensive rewards and recognition program.
- Facilitated team brainstorming sessions that led to innovative solutions for long-standing operational challenges.
- Established team priorities, maintained schedules and monitored performance.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
- Accomplished multiple tasks within established timeframes.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Cross-trained existing employees to maximize team agility and performance.
QA Functional Test Lead, Service Operations Claims Test Practice
CIGNA HealthCare
01.2001 - 07.2007
- Responsible for creation of BSD (Business System Design) of all Front-End applications, including management of Test Scenario development and End to End testing through implementation with assigned staff.
- Executed test cases and documented defects, confirming resolution and mitigation of defects.
- Spearheaded training initiatives aimed at enhancing competency levels of existing test personnel while building strong pipeline of new talent in support of future growth objectives.
- Collaborated with developers and product owners to stay current on product features and intended functionality.
- Created accurate and successful test scripts to manage automated testing of certain products and features.
- Delivered high-quality products on schedule through effective use of automated regression tests, minimizing human error during repetitive tasks.
- Leveraged industry best practices and emerging trends to inform ongoing refinement of test processes and methodologies.
- Conducted risk assessments for various projects, prioritizing test efforts based on potential impact and resources available.
- Provided reports on milestones, issues and test concerns to project managers for assistance.
- Managed cross-functional teams, providing guidance and supervision to 17 testers and ensuring proper adherence to best practices.
- Wrote detailed requirements to create robust test plans and realistic work estimates for testing phases.
- Reduced defect leakage rate by conducting thorough root cause analyses and proactively addressing areas of concern in future release cycles.
- Provided expert insight into system requirements, collaborating with stakeholders to establish clear expectations for project outcomes.
- Streamlined testing processes to identify areas in need of improvement.
- Established regular communication channels between onsite and offshore team members, ensuring seamless coordination despite geographical barriers.
- Enhanced product performance with thorough troubleshooting and identification of critical defects.
- Worked with supervisors to improve testing capabilities.
- Monitored resolution of bugs, tested fixes, and helped developers tackle ongoing problems by providing QA perspective.
- Documented testing procedures for developers and future testing use.
Complex Claims Manager - Service Operations
CIGNA HealthCare
02.1995 - 01.2001
- Managed as assigned staff of 21 employees on efficient claims administration for complex claims, such as per diem, case management, transplants, CPS, surcharges, PHCS, and potential fraud providers.
- Collaborated with other departments to improve overall organizational effectiveness in addressing client needs.
- Enhanced customer satisfaction with timely and accurate claims resolutions.
- Streamlined communication between claim adjusters and clients, expediting claim resolution times.
- Improved claims processing efficiency by implementing streamlined workflow procedures.
- Conducted thorough investigations of complex claims, gathering evidence to support decision-making processes.
- Established strong relationships with external partners such as medical providers, members and clients.
- Mentored new hires on company policies/procedures enabling them to quickly become proficient in managing claims.
- Analyzed claims data, identifying trends and areas for improvement in processes and policies.
- Researched claims and incident information to deliver solutions and resolve problems.
- Implemented quality assurance measures, monitoring staff performance and providing constructive feedback for continuous improvement efforts.
Claims Administration Coordinator - Service Operations
CIGNA HealthCare
08.1987 - 02.1995
- Completion of accurate and timely claim payment while assisting claim manger and claim team with complex issues identified by policy holders, sales, and service.
- Entered data, generated reports, and produced tracking documents.
- Improved team productivity with regular communication and progress updates, fostering collaborative work environment.
- Enhanced operational workflows by maintaining well-organized documentation systems and updating records accurately as needed.
- Gathered and organized materials to support claim operations.
- Developed comprehensive training materials for new staff, leading to quicker onboarding and higher initial productivity levels.
- Boosted team morale and productivity by organizing team-building activities and maintaining feedback and concerns.
- Coordinated individual duties after careful evaluation of each employee's skill level and knowledge.
Education
Some College (No Degree) -
Chattanooga State Community College
Chattanooga TNNo Degree - Base SAS Program
SAS INSTITUTE-SAS SOFTWARE
Orlando, FL09.2016
No Degree - Project Management
CIGNA Healthcare
Bloomfield, CT06.1998
Skills
- Staff Management
- Operations Management
- Healthcare claim payment
- Internal and External Audits
- Project Management
- Data Quality Assurance
- Teamwork and Collaboration
- Problem-Solving
- Time Management
- Attention to Detail
- Problem-solving abilities
- Multitasking
- Reliability
- Excellent Communication
- Organizational Skills
- Active Listening
- Adaptability and Flexibility
- Decision-Making
- Task Prioritization
- Self Motivation
- Analytical Thinking
- Problem-solving aptitude
- Analytical Skills
- Data operations
- Tableau Software
- Cognos
- Data Visualization
- Advanced data mining
BASE SAS PROGRAMMING
SAS Programming I & II
Timeline
Provider Data Lead Analyst - Provider Solutions & Operations
CIGNA Healthcare
07.2022 - Current
Provider Data Advisor - Provider Operations
CIGNA Healthcare
02.2021 - 07.2022
Network Operations Lead Analyst - Network Solutions & Operations
CIGNA Healthcare
02.2018 - 02.2021
System Analyst SR Specialist - Facets Core & Provider
CIGNA Healthcare
04.2016 - 02.2018
Plan Implementation SR Assoc- CSN (Client Specific Network)
CIGNA Healthcare
10.2013 - 04.2016
SR Technical Lead - PDM (Provider Data Management)
Multiplan
05.2012 - 10.2013
Manager - Credentialing
Multiplan
11.2009 - 05.2012
Manager - Provider Demographics-Mail Operations
Multiplan
07.2007 - 11.2009
QA Functional Test Lead, Service Operations Claims Test Practice
CIGNA HealthCare
01.2001 - 07.2007
Complex Claims Manager - Service Operations
CIGNA HealthCare
02.1995 - 01.2001
Claims Administration Coordinator - Service Operations
CIGNA HealthCare
08.1987 - 02.1995
Some College (No Degree) -
Chattanooga State Community College
No Degree - Base SAS Program
SAS INSTITUTE-SAS SOFTWARE
No Degree - Project Management
CIGNA Healthcare
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