Chad Gale
Henderson,NV
Summary
Seeking a position in which I can utilize my interpersonal, problem solving and technological skills and knowledge. Qualified Business Intelligence Analyst versed in data mapping and user acceptance testing to solve complex problems in high-pressure environments. Activates strong analytical skills to investigate trends in large amounts of data and formulate conclusions based on findings. Excels at cultivating, managing and leveraging client relationships to foster extended engagements and business opportunities.
Overview
25
25
years of professional experience
Work History
Electronic Enrollment Specialist II
04.2022 - Current
- Setup and test new electronic file feeds for large group
- Review the test files once they are received and check for mapping issues
- Work with the vendors to implement the process and report feedback to vendors and clients if there are problems that need to be corrected on the test file
- Once the file is moved to production, I monitor it for any errors file feed errors and make sure the files are process according to there schedules
- If there is a file feed error I reach out to the group and vendor to let them know what the error is and how to correct it
- Review data sets in TSOA to see how the file looks and if it is passing correctly and monitor the pass percentage of the file and see if there is anything needs correcting
- Work with sales when a group asked about a member and provide feed back if they are passing correctly on the file
- Lead conference calls with groups and venders on new setups
- Provide them with expectations and technical information that is need for 834 and 1000 byte files
- Extract data and create custom reports with excel for vendors and groups when file feeds fail which assist in correcting the error.
Membership Representative III and LG Enrollment and Case Install
10.2019 - Current
- Responsible for 150+ Large Group cases for Nevada and Colorado
- Works with Sales, Groups, Brokers and Third-Party Administrators to asset with enrollment issues and file feed or EDI issue that might arise
- Works with the Large Group EDI team to resolve file issues that the group might have
- Proses group tape and EDI file feeds for the groups and help maintain that the files integrity is in good standing
- Assist with census file loads and implementation of new groups that are coming to anthem for the first time
- Liaison between sales/groups and the EDI team to assist with tape files
- Communicating with groups though email or phone to help with problems they might be having with their enrollment or Employer Access
- Provide groups with audits when request using Excel.
Enrollment Data Analyst II
Anthem
Las Vegas, NV
07.2018 - 10.2019
- Provides Process oversight of daily business operations to the enrollment analysts to provide resolutions
- Acts as a subject matter expert for the enrollment depart for assigned markets
- Monitors market service level agreements per assignment and ensure that agreements are met or escalated as needed
- Works with state agencies, health plans and other internal departments as needed to assist with investigating and resolving complex enrollment issues
- Involved in market meetings and audits to provide details regarding enrollment and reconciliation processes.
Community Manager
First Service
Upland, CA
01.2016 - 02.2017
- Management 14 communities daily
- Completed monthly board meetings and solicited new clients
- Complete weekly inspections as well as violation reports
- Handled customer service and customer complaints for the communities.
Community Manager
Ideal Community Management
Las Vegas, NV
08.2012 - 04.2015
- Manage 12 communities daily
- Completed monthly board meetings and solicited new clients
- Complete weekly inspections as well as violation reports
- Handled customer service and customer complaints for the communities.
Remote Accesses Specialist
Affiliated Computer Service – Xerox
Westlake Village, CA
07.2008 - 08.2012
- Involved in training of New Hires continually serving as a trainer/mentor daily
- Design, develop, and create spread sheets for all departments based upon specific job requirements
- Research and analyze claim overpayments for Aetna and Cigna adhering to stringent crucial time constraints and deadlines to meet monthly projected goals set by each vendor
- Generate and transmit monthly reporting of claim figures to the VP for vendor reporting
- Provide input on system integration to attain optimum functionality for business needs
- Assist management in troubleshooting and problem solving for escalated complex system issues
- Compose new workflows for all departments to improve productivity, achieve optimum efficiency, and assist those that need a better understanding of daily processes
- Works with multiple databases on a daily basis
- Proficiency in the medical claims process including claims reporting procedures.
Business Analyst I
Wellpoint Inc.
Newbury Park, CA
09.2007 - 02.2008
- Possess understanding of business processes and systems capability adhering to time-sensitive deadlines
- Consistent follow up within several departments to ensure tasks are on course in order to meet defined time sensitive goal at hand
- Design, develop, and create spreadsheets and benefit grids for internal tracking purposes and vendor reporting
- Implement new processes and procedures, developing small system change requirements, to achieve optimum efficient results
- Translate business requirements to technical staff to ensure that requirements are incorporated into system design
- Serve as a liaison with the IT departments to analyze and problem solve current department issues resulting in an effective systematic solution to perform our business
- Work with IT on UAT testing for implementation of new system enhancements
- Complete regression testing to ensure new system implementations are functioning accurately without impairment to other areas
- Submit and follow up with progress on IT intake request
- Updating EDI tables and scheduling for system integration.
Lead Enrollment Specialist
Wellpoint Inc.
Newbury Park, CA
09.2005 - 09.2007
- Helped with the creation and implementation of policies, procedures and workflows for the Medicare Part D unit
- Controlling all of membership enrollments and disenrollment’s to ensure compliance with CMS
- Work closely with RVP of Compliance and Appeals to ensure work is processed effectively and efficiently to meet the allotted timeframe by CMS
- Created spreadsheets for executive management team to be implemented in the department
- Created training documents to ensure customer service representatives are trained accurately and gain proficient product knowledge
- Selected to serve as a mentor and trainer for a new call center consisting of 140 associates in Corpus Christi, TX
- Work with Business Analysts for UAT testing and implementation of new system functions on WGS.
Senior Membership Specialist
Wellpoint Inc.
Newbury Park, CA
11.1999 - 09.2005
- Underwriting medical applications adhering to specific guidelines to determine eligibility for medical insurance
- Implemented and controlled 5 correspondence queues to streamline the distribution process for efficiency
- Assigned work to associates adhering to workflow guidelines
- Regression tested all new products and system implantations on STAR
- Assisted lower level associates with complex issues and supervisor calls
- Trained all new hire associates and current employees
- Subject matter expert for the Medicare Part D implementation
- Worked with finance and membership systems to enhance and reconcile premiums to member’s policies.
Clerical Associate
Wellpoint Inc
Newbury Park, CA
09.1999 - 11.1999
- Logged all newly received applications into a spreadsheet to record accurate accounting of daily inventory
- Audited all applications for accuracy and timeliness
- Researched undeliverable mail and tried to determine and locate the correct address to mail back to the members.
Education
Southern New Hampshire University
03.2024
Sys-tem-a-tion – Business Analysis Certification course completed -
12.2007
Diploma -
ACHS
01.1998
Skills
- I am self-motivated and dedicated individual consistently striving to achieve the goal in hand I understand the importance of being a team player as well as working diligently as an individual I work well under pressure and excel in multi-tasking, troubleshooting, and problem solving
- Client Relationship Building
- Data Management
- Data Analysis
- Client Account Management
References
References are available on request.
Timeline
Electronic Enrollment Specialist II
04.2022 - Current
Membership Representative III and LG Enrollment and Case Install
10.2019 - Current
Enrollment Data Analyst II
Anthem
07.2018 - 10.2019
Community Manager
First Service
01.2016 - 02.2017
Community Manager
Ideal Community Management
08.2012 - 04.2015
Remote Accesses Specialist
Affiliated Computer Service – Xerox
07.2008 - 08.2012
Business Analyst I
Wellpoint Inc.
09.2007 - 02.2008
Lead Enrollment Specialist
Wellpoint Inc.
09.2005 - 09.2007
Senior Membership Specialist
Wellpoint Inc.
11.1999 - 09.2005
Clerical Associate
Wellpoint Inc
09.1999 - 11.1999
Southern New Hampshire University
Sys-tem-a-tion – Business Analysis Certification course completed -
Diploma -
ACHS
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