Denise Wheeler
Lehigh Acres,FL
Summary
Accomplished Senior Business Operations Analyst with a proven track record at Facets and BCBSMo, excelling in Facets Product Configuration and Project Management. Demonstrated expertise in analyzing and resolving system defects with a 99% accuracy rate in reporting, showcasing exceptional analytical and problem-solving abilities.
Overview
34
34
years of professional experience
Work History
Senior Business Operations Analyst
Facets
07.2014 - 08.2020
- Successful completion of building annual renewals for both individual and employer group products in Facets platform
- Use of SQL Access for queries, Excel, Facets Product for system defects
- Analysis of the defects were reviewed and corrected
- Testing of the defects was completed to ensure accuracy
- Quality Assurance also reviewed the defects for accuracy
- Managed cross functional projects to ensure timely completion and that we were in alignment with other projects
Benefit Analyst III
Facets
07.2014 - 08.2020
- Successful completion of building annual renewals for both individual and employer group products in Facets platform
- Use of SQL Access for queries, Excel, Facets Product for system defects
- Analysis of the defects were reviewed and corrected
- Testing of the defects was completed to ensure accuracy
- Quality Assurance also reviewed the defects for accuracy
- Managed cross functional projects to ensure timely completion and that we were in alignment with other projects
Benefit Review Specialist II
Facets
12.2002 - 07.2014
- Successful completion of building annual renewals for both individual and employer group products in Facets platform
- Use of SQL Access for queries, Excel, Facets Product for system defects
- Analysis of the defects were reviewed and corrected
- Testing of the defects was completed to ensure accuracy
- Quality Assurance also reviewed the defects for accuracy
- Managed cross functional projects to ensure timely completion and that we were in alignment with other projects
Special Correspondent
BCBSMo
01.1987 - 12.2002
- Lead correspondent handled ERISA Appeals, Department of Insurance inquiries
- Handled member calls and correspondence addressed to the President of BCBSMo
- Attended first and second level Appeals Committee
- Extensive research is required for this position
- Researched all pertinent information, Including a detailed history of the issue, medical records and reviews by internal physicians
- Delivered reporting with 99% accuracy by checking all of all facts present
- Worked closely with the Legal department gathering all pertinent information to cases and conducted thorough reviews of the case
- On one occasion, I was a witness in a case in which I created a summary of the related claims and how they would have paid if benefits were available
- Handled members who came to the office for any number of things
Customer Service Representative
BCBSMo
05.1986 - 12.1990
- Managed telephone calls from members regarding claims inquiries and benefits
- Initiated Individual Consideration reviews and physician reviews on behalf of the member
Education
Medical Terminology -
BCBSMo
01.1986
High School Diploma -
O’Fallon Township High School
01.1985
Skills
- Facets Product Configuration
- SQL
- Microsoft Word
- Microsoft Excel
- Analytical Skills
- Problem Solving
- Project Management
- Subject Matter Expertise in Facets
- Benefits administration
- Documentation and reporting
- Policy interpretation
- Benefits interpretation
- Healthcare benefits
Additional Information
08/01/20, Illness, On Social Security Disability, eager to return to work
Timeline
Senior Business Operations Analyst
Facets
07.2014 - 08.2020
Benefit Analyst III
Facets
07.2014 - 08.2020
Benefit Review Specialist II
Facets
12.2002 - 07.2014
Special Correspondent
BCBSMo
01.1987 - 12.2002
Customer Service Representative
BCBSMo
05.1986 - 12.1990
Medical Terminology -
BCBSMo
High School Diploma -
O’Fallon Township High School
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