David A Symmes
Summary
Experienced, dedicated, and motivated IT/ Operations Leader with extensive experience in the Health Insurance industry. Deep knowledge of the HIPAA 834 Enrollment transactions and EDI formats, validations, and data mapping from an operational perspective. Extensive experience with defining business requirements, data and process flows, data analysis within health Insurance enrollment and claims as well as Personal Health Spending Accounts. Extensive experience with Agile and a Certified Scrum Product Owner.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Lead Business System Analyst
Blue Cross Blue Shield of Massachusetts
Quincy, MA
01.2017 - Current
- Liaison between BCBSMA IT, External Business Partners (IBM/DXC), and BCBSMA Business Operations teams to manage the implementation of key portfolio projects. Manage the development of System requirement documents with Business partners, development teams and vendors. Assess capabilities of new technologies and align functionality with business needs. Provide Subject Matter Expertise and knowledge related to Enrollment operations business and technical needs. Participate in Risk Assessments related to new technology and projects as well as supported HITRUST Annual Audit with IT Vendor. Develop and maintain project plan, focusing on meeting all key delivery dates. Extensive experience with Agile/Jira. Certified Scrum Product Owner, Certified Six Sigma Yellow Belt
Senior Organizational Readiness Advisor – IT and Operations
Blue Cross Blue Shield of Massachusetts
Quincy, MA
01.2016 - 01.2017
- Coordinate the delivery of training, process mapping/documentation (Workflow mapping/workarounds/jobaids), risk/issue mitigation activities, change management/human performance management and post production support. Manage measurement processes to assess and track organizational adoption of process change and system changes. Develop and manage targeted organizational readiness plans to achieve business outcomes, including communications plans, sponsor engagement, training and documentation plans and post production support plans.
Manager Electronic Enrollment and PSA Operations
Blue Cross Blue Shield of Massachusetts
Quincy, MA
01.2007 - 01.2016
- Led team responsible for establishing direct data feed of enrollment data from Accounts or TPAs HRIS systems into BCBSMA enrollment system, Representing 75% of all enrollment transactions processed for BCBSMA. Partnered with Strategy and Planning on the assessment of the new Electronic Enrollment File intake solution for enhancing the Electronic Enrollment process; Successfully presented findings to CIO/SVP to obtain approval for multi-year, multimillion dollar project. Led team responsible for establishing data feeds with Personal Spending Account vendors. Establish and maintain staffing models in order to ensure business area can meet the business needs during open enrollment and other peak periods. Manage relationship with consulting firm responsible for mapping enrollment data received from accounts into the format required by our internal enrollment systems. Represented Enrollment Operations during SSAE16 yearly audit with Earnest and Young Consulting.
IT Specialist/Business Analyst
International Business Machines (IBM)
Quincy, MA
01.2001 - 01.2007
- Provided onsite technical system support for the NASCO claims processing system to Blue Cross and Blue Shield of Massachusetts. Direct point of contact for all production support issues related to the NASCO system at Blue Cross and Blue Shield of Massachusetts. Subject matter expert for the following areas of the NASCO system; Membership/Eligibility, Provider Administration data, and Referral Authorization processing. Researched Claim related system discrepancies with a solid understanding of Benefit coding and eligibility issues Developed database to track system discrepancies and research requests. Trained users throughout Blue Cross and Blue Shield on how to use this new tool. Validated user accepted test plans as well as executed test results. Coordinated and participated in system upgrade events. This included ensuring resources were aligned, test plans developed, communication plans setup. Consulted with system engineers to review detailed system requirements and ensure all requirements could be met.
Education
Bachelor of Arts -
Saint Anselm College
Manchester, NHSkills
- HIPAA (Health Insurance Portability and Accountability Act) – EDI Standards
- Advanced knowledge of Personal Health Spending Accounts and Vendors
- Self-motivated, self-starter with excellent analytical, logical and process skills
- Experienced in formulating long-term and short-term product strategies
- Proficient in Agile methodologies and Jira
- Certified in Scrum and Six Sigma methodologies
- Effective Communication and Organizational skills
- Ability to learn quickly and apply new tools and technology
Certification
- Certified Scrum Product Owner (Scrum Alliance/2025)
- Certified Six Sigma Yellow Belt (6sigmastudy/2025)
Timeline
Lead Business System Analyst
Blue Cross Blue Shield of Massachusetts
01.2017 - Current
Senior Organizational Readiness Advisor – IT and Operations
Blue Cross Blue Shield of Massachusetts
01.2016 - 01.2017
Manager Electronic Enrollment and PSA Operations
Blue Cross Blue Shield of Massachusetts
01.2007 - 01.2016
IT Specialist/Business Analyst
International Business Machines (IBM)
01.2001 - 01.2007
Bachelor of Arts -
Saint Anselm College