Espreail Marker
Melbourne
Summary
Detail-oriented Configuration Analyst with 4+ years of experience in healthcare payer systems, specializing in contract configuration, QA validation, and data analysis. Proven ability to translate complex plan designs into system logic, perform audits, troubleshoot configuration issues, and ensure high-quality, defect-free outcomes. Strong proficiency in BigQuery (SQL), Google Sheets, and data reporting, with experience collaborating across engineering, product, and compliance teams. Adept at identifying workflow improvements and supporting scalable configuration processes.
Overview
12
12
years of professional experience
2010
2010
years of post-secondary education
Work History
Configuration Analyst
Oscar Health
Melbourne
11.2021 - Current
- Configure and maintain complex health insurance contracts, translating plan designs and reimbursement methodologies into system logic to support accurate claims adjudication.
- Perform configuration QA and validation checks, ensuring accuracy, consistency, and compliance with internal standards and regulatory requirements.
- Execute targeted audits and data quality reviews to confirm system behavior aligns with expected outcomes and identify discrepancies prior to production impact.
- Utilize BigQuery (SQL) to analyze large datasets, validate configurations, investigate issues, and support troubleshooting efforts.
- Track, document, and manage configuration work, defects, and escalations using Jira, ensuring clear visibility, prioritization, and timely resolution of issues.
- Generate ad hoc and recurring reports using SQL and Google Sheets to support operational insights, issue tracking, and stakeholder communication.
- Develop and optimize custom SQL queries to improve workflow efficiency, automate validation checks, and streamline data analysis processes.
- Research, troubleshoot, and resolve configuration and data issues; escalate complex problems with clear documentation and root cause analysis.
- Collaborate cross-functionally with engineering, product, compliance, and operations teams to improve system functionality and resolve data gaps.
- Identify workflow inefficiencies and recommend process improvements to enhance configuration accuracy and operational efficiency.
- Maintain 99%+ data accuracy while managing high-volume configuration updates in a fast-paced environment.
- Support onboarding and knowledge sharing by assisting team members with configuration processes and best practices.
Claims Processor/Customer Service Representative
Blue Shield of California
Redding
01.2014 - 02.2021
- Processed high volumes of healthcare claims with 99.8% accuracy, ensuring compliance with HIPAA and internal guidelines.
- Conducted data validation, audits, and discrepancy resolution to ensure correct claims processing and reimbursement.
- Investigated and resolved claim issues, collaborating with internal teams and escalating when necessary.
- Provided training and support to team members to improve accuracy and efficiency in claims processing workflows.
- Developed a strong foundation in health plan benefits, coding concepts, and reimbursement logic.
Education
Clinical Medical Assistant -
Lake College
Skills
- Configuration validation
- QA/QC protocols
- Audits
- Defect identification
- SQL (BigQuery)
- Data analysis
- Reporting
- Large dataset manipulation
- Google Sheets
- Google Docs
- Jira (familiar)
- Looker (exposure)
- SQL databases
- Claims processing
- CPT/HCPCS familiarity
- Reimbursement methodologies
- Benefit design
- Troubleshooting
- Cross-functional collaboration
- Process improvement
- Attention to detail
Timeline
Configuration Analyst
Oscar Health
11.2021 - Current
Claims Processor/Customer Service Representative
Blue Shield of California
01.2014 - 02.2021
Clinical Medical Assistant -
Lake College