Hardworking and highly motivated IT Business Analyst with over 10 years of analytical and problem solving polished in maintaining system processes, conducting requirement analysis and defining configuration specifications.
Work History
Manager, IT- Business Operations (IT Business Analyst)
CVS Healthcare
Application development environment experience with Agile development practices, including Scrum
Applied EDF- Enterprise Delivery Framework methodology to Identify internal procedures and tools and identifying areas for methodology improvement
Including, documenting and storing all appropriate documentation in the respective repositories
Contribute collaboration to the design and mapping of data conversion strategies
Participated in collaborative requirement, system and data design sessions with the user community, technical architecture resources, and development resources
Complete project activities on time and within budget, and proactively identifies and communicates issues that may jeopardize milestones or project budget to the Project Manager and Scrum master
Experience using SQL for data analysis
Provide technical support (internal & external clients), developers and QA Testing teams
Facilitate proactive and timely communication between internal and external stakeholders
Onboard and implement new eligibility files and PBM integrations with established and new external vendors
Manage relationships with external clients and vendors to streamline the implementation & renewal process
Prioritize and manage multiple projects and support tickets simultaneously
Designed configuration and training for online enrollment tools
Customer-focused, with demonstrated ability to understand and align to the strategic impact/value of the business needs and the flexibility to quickly adjust to changing needs and priorities
Provide detailed understanding of the business strategies needs and process within aligned domain; clearly explain them to the delivery team
Collaborate with project team, business user groups, technical systems groups and external clients
Gather and document business and technical requirements, facilitate evaluation and selection of solutions, developing and deploying testing, training and documentation
Assist in design and development of new and improved processes, tools and system enhancements to support business unit requirements
Partnered with customer and IT colleagues to design, develop and execute all test plans associated with deploying a solution
Collaborated with IT developers in testing for system fixes, new releases and enhancements, changes and implementations, in order to ensure functionality and user acceptance
Provide a key role in the analysis and design of system solutions from business and technical perspectives
Prioritize and categorize defect/bugs and enhancement requests
Collaborated with other departments to ensure timely completion of projects within budget constraints.
Collaborated with cross-functional teams to define product requirements and roadmap objectives.
Analyzed customer feedback to inform product decisions, prioritize feature requests, and develop user stories.
Created detailed documentation on product specifications, use cases, and release notes.
Sr. Plan Programmer/ IT Business Analyst
Healthcare Management Administrators
Application development environment experience with Agile development practices, including Scrum
Experience using SQL for data analysis
Maintain EDI x12 834 integrations, including but not limited to, daily file processing, ongoing maintenance, technical support (internal & external clients), and EDI System configuration
Facilitate proactive and timely communication between internal and external stakeholders
Onboard and implement new 834 x12 and PBM integrations with established and new external Vendors
Perform end-to-end troubleshooting in Edifecs & processing system
Manage relationships with external HRIS Vendors to streamline the implementation & renewal process
Prioritize and manage multiple projects and support tickets simultaneously
Complete configuration and training for online enrollment tools
Customer-focused, with demonstrated ability to understand and align to the strategic impact/value of the business needs and the flexibility to quickly adjust to changing needs and priorities
Detailed understanding of the business strategies needs and process within aligned domain; clearly explain them to the delivery team
Collaborate with project team, business user groups, technical systems groups and external clients
Gather and document business and technical requirements, facilitate evaluation and selection of solutions, developing and deploying testing, training and documentation
Assist in design and development of new and improved processes, tools and system enhancements to support business unit requirements
Work with customer and Technology Services colleagues to develop and execute all test plans associated with deploying a solution
Participate with Technology Services developers in testing for system fixes, new releases and enhancements, changes and implementations, in order to ensure functionality and user acceptance
Provide a key role in the analysis and design of system solutions from business and technical perspectives
Prioritize and categorize defect/bugs and enhancement requests
Provided system technical and business process support, answer user questions, monitor & report on metrics, and provide user training for enterprise knowledge management processes and solutions managed by the Enterprise Knowledge Management Team
Served as Project Manager and/or IT Business Analyst on technology projects supporting enterprise knowledge management solution enhancements, replacement, or new technology development
Collect and report on knowledge management metrics for processes and systems
Lead issue troubleshooting, resolve root cause, and update process and documentation to avoid similar future scenarios
Identified opportunities to streamline and scale processes that align for organizational goals
Administer and managed technical report system and applications across the organization
Facilitate and communicate opportunities for continual improvement of knowledge management process supported.
Discovery Auditor III, Quality Improvement Auditor II, Correspondence Representative, Technical Support Specialist, Customer Representative
PREMERA BLUE CROSS
Review claims and provider/member/group web portals for accuracy, completeness, and timeliness
Identify, analyze and research errors
Complete assigned audits by department due dates and within required turnaround time goals
Maintain in-depth working knowledge of procedural changes, audit techniques, plan automated systems, subsystems, file designs, manuals and reference materials for audit functions
Provide input to improve procedures as needed
Facilitate and participate in meetings to discuss work schedules, work distribution and exchange information, workgroups; including Value Stream Mapping, Incentive Teams and Calibration groups
Coordinate with appropriate departments to reach consensus on errors
Identify trends of errors and recommend improved procedures and guidelines, offering proactive solutions to operations proactively
Work with management to review errors each month for accuracy and consistency
Facilitate meetings and work groups regarding system and client specific goals, discrepancies, and updates
Identify overpayments through standard and ad hoc reporting processes
System analytic testing for both product configuration and client specific requirements
Test new system policies, requirements and ad hoc reports for potential overpayments
Respond to written inquiries regarding benefits, claims adjudication, eligibility issues in a timely and professional manner
Document and researching inquiries using the appropriate systems
Request to the reprocessing of claims, claims history review, resolving eligibility issues, and researching system errors
Recognize the need for procedural updates and taking the appropriate steps to have the procedures clarified or changed
This has resulted in a higher level of accuracy and fewer inquiries
Perform in-team audits of team members and given feedback when appropriate
Assist my supervisor and team members with correspondence either in person or through their question folders
Research the correspondence teams aging reports and offering assistance when needed.
Education
Some College (No Degree) - Business Administration And Management
Edmonds Community College
Edmonds, WA
Skills
8 years experience with Cognizant Facets QNXT QicLink Market Prominence
10 years experience in Health Insurance industry including CMS, Medicaid, ASO, Self-Insured and third party administrators
Claims Operations Manager of Ancillary Department & Supervisor of Claims Operations at Allied BenefitClaims Operations Manager of Ancillary Department & Supervisor of Claims Operations at Allied Benefit
Claims Operations Manager of Ancillary Department & Supervisor of Claims Operations at Allied BenefitClaims Operations Manager of Ancillary Department & Supervisor of Claims Operations at Allied Benefit