Jacqueline O'Connor
REDFORD TWP,MI
Summary
Results-driven Senior Analyst with over 20 years of experience in the health insurance industry, specializing in NCQA HEDIS specifications, rate analysis, and comprehensive audits. Expertise in reporting utilization data across various platforms, including HMO, PPO, Marketplace, and Medicare, ensures a deep understanding of industry standards and practices. Recognized for a meticulous approach and strong teamwork skills while maintaining independence in data analysis to uphold data integrity. Seeking an analyst position that leverages extensive HEDIS experience and provides opportunities for professional growth and development.
Overview
18
18
years of professional experience
Work History
Senior Analyst - Customer Reporting
Blue Cross And Blue Shield Of Michigan
02.2024 - 08.2025
- Assisted Client Engagement Managers and Client Operation Managers in creating business reports for their assigned employer group accounts.
- Utilized SQL in Databricks to gather data for trend analysis and visual creations.
- Team lead in a five month utilization management cost saving project which illustrated how prior authorizations have assisted in reducing health care costs for various employer group accounts.
- Participated in an ad hoc project that assisted the Sales Department in relaying to employer groups how spending and membership trends will affect future spending costs.
- Identified as a "go to person" in my department who consistently helps others resolve their issues.
Senior Analyst - Clinical Data Operations
Blue Cross And Blue Shield Of Michigan
10.2022 - 02.2024
- Provide technical and analytical skills to complete assigned and ad hoc projects.
- Perform quality checks on HMO and PPO projects and data to ensure data integrity.
- Project Lead for the annual HMO Gaps in Care member letter outreach campaign which affects over 100,000 members, and an annual HMO Gaps in Care provider fax blast campaign which affects over 1,000 providers.
- Mentor and coach 2 junior staff. Advise on HEDIS audit measure drill downs, roadmaps, and reports.
- Participate on special projects or workgroup as assigned.
- Assist in updating HEDIS reports and documentation for customers.
- Complete HEDIS roadmaps, drill-down analysis, and participate in annual audits for HMO and PPO NCQA accreditation.
Analyst - Quality Management
Blue Cross And Blue Shield Of Michigan
10.2018 - 09.2022
- Provided functional technical and analytical support to various departments (Pharmacy, Senior Health Services, Quality Management, Communications, Quality and Provider Education).
- Supplied support to assigned departmental leadership through technical, analytical and subject matter knowledge.
- Researched problems reported by other staff; evaluated possible corrective actions, recommended and implemented solutions.
- Investigated and responded to inquiries from other internal departments and external entities.
- Assisted in documenting departmental procedures and updating departmental processes.
- Tested and documented new and modified system changes.
- Monitored monthly reports to support departmental performance (data integrity) and to ensure adherence to goals, internal and external customer expectations, and requirements from external entities such as CMS.
Data Technician - Quality Improvement
Blue Care Network
06.2007 - 10.2018
- Assisted assigned departments with Healthy Blue Living product questions (Grievance, Ombudsman, Field Services, Provider Affairs, Customer Service and Quit the Nic).
- Contacted providers to collect data for the Continuity and Coordination of Care Audit and document retrieval.
- Direct contact with external vendors when resolving member inquiries.
- Conducted telephone outreach to members who were in need of a preventative health screening or immunization.
- Evaluated source documents to locate information needed for each data entry field.
- Kept optimal quality levels to prevent critical errors and support team performance targets.
- Outlined appropriate processes and procedures to fulfill and complete inquiries.
Education
Bachelor of Arts - Sociology; Chinese
Oakland University
05.1997
Skills
- Oracle (SQL)
- Azure Databricks
- CPDM
- Redshift
- Microsoft Word, Excel, PowerPoint
- Inovalon -QSI/QSIXL tool
- Facets
- MACESS
- NCQA HEDIS specifications, Health Plan Ratings
- CMS STARS specifications
- Drill-down analysis, roadmaps, annual audit, dashboards
- Work with minimal supervision
Timeline
Senior Analyst - Customer Reporting
Blue Cross And Blue Shield Of Michigan
02.2024 - 08.2025
Senior Analyst - Clinical Data Operations
Blue Cross And Blue Shield Of Michigan
10.2022 - 02.2024
Analyst - Quality Management
Blue Cross And Blue Shield Of Michigan
10.2018 - 09.2022
Data Technician - Quality Improvement
Blue Care Network
06.2007 - 10.2018
Bachelor of Arts - Sociology; Chinese
Oakland University
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