Jacob Sosa
Methuen,MA
Summary
Knowledgeable Systems Analyst with history of progressive leadership and project management. Gathers requirements, develops use cases, and delivers key initiatives. Aligns teams and drive collaboration and cohesion to complete projects on time and within budget.
Results-driven business professional known for delivering impactful consulting services. Adept at identifying business needs and implementing tailored strategies. Renowned for fostering team collaboration and adapting to evolving business environments.
Overview
14
14
years of professional experience
Work History
Business Consultant
Carelon Behavioral Health
11.2024 - Current
- Cultivated and managed provider relationships, serving as the primary liaison for a portfolio of behavioral health providers, ensuring alignment with managed care policies and organizational goals.
- Researched and resolved complex provider issues and appeals, collaborating with cross-functional teams to improve service delivery and provider satisfaction.
- Conducted provider education and training sessions on Carelon’s managed care policies, reimbursement models, and programmatic initiatives, improving provider compliance and engagement.
- Communicated policy and reimbursement updates across the provider network, ensuring clarity, consistency, and adherence to administrative requirements.
- Analyzed provider utilization trends, identifying patterns that impacted service delivery quality and recommending solutions to drive efficiency and outcomes.
- Supported crisis intervention efforts (where applicable), coordinating timely referrals to appropriate behavioral health resources.
- Partnered on strategic program implementations, translating organizational strategy into actionable plans and measurable improvements across the provider network.
Systems Analyst II
Carelon Behavioral Health
09.2018 - 10.2024
- Gathered requirements and performed gap analysis through design workshops with users.
- Enhanced project management skills by defining and presenting system solutions and timelines for business needs or technical problems.
- Performed internal system acceptance to deliver well-tested enhancements and meet business requirements.
- Communicated and explained business requirements to team members to understand and implement functional demands.
- Troubleshot incidents reported by end-users to schedule system changes and identify permanent solutions.
- Analyzed existing systems and databases and recommended enhancements to solve business needs
- Executed and managed SQL queries to analyze and extract valuable insights from the database, aiding in decision-making and strategies.
- Collaborated with upper management to drive strategy and implement new processes.
Operations Analyst - Northeast Region
Beacon Health Options
10.2017 - 10.2018
- Designed plans to improve operations and suggested changes to systems for overall organization.
- Worked with engineers and technical staff to recommend hardware and software adjustments and resolve design flaws.
- Supported supervisor and associated team members to maintain system functionality.
- Created and managed operational databases to store and track data and maintain accurate information.
- Scanned system for frequent technical issues, employing troubleshooting techniques for resolution.
- Conducted data analysis to identify opportunities for streamlining client operations and improving customer satisfaction.
- Investigated and resolved alerts, conducted queries and culled records to assist with maintenance and problem resolution.
Business Systems Analyst II
Beacon Health Options
09.2016 - 10.2017
- Identified needed business improvements and determined appropriate systems required to implement solutions.
- Assessed business requirements to create focused solutions.
- Helped deploy system enhancements to improve field operations.
- Collected, defined and analyzed business requirements.
- Created and maintained standard operating procedures governing system functions and features.
- Trained business personnel in use of systems.
Senior Claims Auditor and Compliance Specialist
Beacon Health Options
10.2015 - 08.2016
- Lead internal and external claim audits to adhere to Plan, State, and Federal regulations
- Investigated claims with potential fraud waste and abuse
- Maintained monthly quality assurance reports.
- Researched issues related to claims processing to identify origins and implement corrective solutions.
- Provided high level of professionalism when speaking with customers or responding to emails to promote company's dedication to service.
- Prioritized daily tasks to satisfy workload demands and department's turnaround goals.
- Reviewed insurance claims and member eligibility to determine overpayment trends and noncompliance issues.
- Initiated cost containment by conducting thorough audits and data mining.
- Researched claims and incident information to deliver solutions and resolve problems.
Provider Data Team Lead
Beacon Health Options
09.2014 - 09.2015
- Maintain the provider network data of all contracted entities within proprietary software system
- Monitor performance and quality assurance
- Performed phone screens, interviews, and new staff training within department.
Senior Claims Specialist
Beacon Health Options
06.2013 - 08.2014
Member Services Specialist
Beacon Health Options
07.2012 - 05.2013
Multi Channel Sales Lead
Best Buy
09.2011 - 07.2012
- Provider great customer service over the phone on inquiries or purchases
- Assist customers with returns, purchasing store protection plans and service packages.
Education
Bachelors of Arts - Economics
University of Massachusetts Lowell
05.2013
Skills
- Team leadership
- Versatile in dynamic environments
- Consistent reliability
- Strong organizational skills
- Critical analysis skills
- Eagerness to learn
- Presentation skills
- Business analysis
- Business planning
- Staff mentoring
- Partnership development
- Stakeholder collaboration
- Understanding of managed care principles
- Analytical reporting skills
- Training & Facilitation
- Strategic execution
- Interdepartmental teamwork
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Business Consultant
Carelon Behavioral Health
11.2024 - Current
Systems Analyst II
Carelon Behavioral Health
09.2018 - 10.2024
Operations Analyst - Northeast Region
Beacon Health Options
10.2017 - 10.2018
Business Systems Analyst II
Beacon Health Options
09.2016 - 10.2017
Senior Claims Auditor and Compliance Specialist
Beacon Health Options
10.2015 - 08.2016
Provider Data Team Lead
Beacon Health Options
09.2014 - 09.2015
Senior Claims Specialist
Beacon Health Options
06.2013 - 08.2014
Member Services Specialist
Beacon Health Options
07.2012 - 05.2013
Multi Channel Sales Lead
Best Buy
09.2011 - 07.2012
Bachelors of Arts - Economics
University of Massachusetts Lowell
Software
SQL
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