Jennifer Roath
Meridian,ID
Summary
Experienced Configuration Analyst with a background in testing, quality assurance, and conducting thorough internal and external audit reviews. Proficient in proposing, testing, and troubleshooting system transitions. Proven ability to ensure system integrity and optimize performance through analysis and problem solving. Collaborates effectively with stakeholders to align technology solutions with business needs.
Overview
15
15
years of professional experience
Work History
CONFIGURATION ANALYST
BLUE CROSS OF ID
Meridian, ID
04.2021 - Current
- Provide support in developing, implementing, and testing system upgrades.
- Configure Facets tables or applications to ensure accuracy and efficiency, collaborating with IT to complete final system configuration as required.
- Research, analyze, and document business requirements and functional specifications.
- Collaborates and participates in cross-departmental, cross-functional data teams.
- Maintain Business Rules and Requirements for CMS audits: HPMS and ODAG.
- Maintain Business Rules and Requirements for MCAS NAIC data reporting for Commercial lines of business.
- Contributed to the validation of complex process flow documents in support of claims processes for final versions.
- Executed and coordinated business user acceptance, regression testing, and peer review.
- Assisted in helping to develop Microsoft SQL queries to handle retro review adjustment tickets involving updates and changes made to provider contracts, pricing, fee schedules, and product information.
- Performed analysis on existing configurations to identify areas for improvement or optimization.
GRIEVANCE AND APPEALS SPECIALIST
BLUE CROSS OF ID
Meridian , ID
02.2017 - 04.2021
- Ensures cases are properly classified and categorized.
- Prepares comprehensive case histories for presentation and consideration at committee meetings and audits.
- Determines if additional information or documentation is needed to make appropriate decisions.
- Coordinated with internal departments to ensure timely resolution of appeals.
- Identified trends in the types of appeals received, and reported those findings to management.
- Maintained up-to-date knowledge of applicable laws, regulations, policies and procedures related to appeals processing.
- Collaborated with provider relations staff to resolve disputes between providers and health plans concerning payment for services rendered.
- Participated in training sessions on new rules or regulations affecting the appeals process.
- Interprets and applies business rules, policies, and contracts.
- Prepare appeal cases to send to an independent specialty reviewer.
- Presents appeal case information to a multi-department committee.
- Provide support and documentation for case preparation, as well as verifying case accuracy.
MA/MMCP CUSTOMER SERVICE ADVOCATE
BLUE CROSS OF ID
Meridian, ID
11.2009 - 02.2017
- Responds to inquiries from policyholders, providers, and brokers.
- Performs research to respond to inquiries and interprets policy provisions to determine the most effective response.
- Documents interactions through internal tracking system.
- Assist with new member education and maintain member files.
- 5 years assisting with town hall meetings and meeting with members individually on a 1:1 basis to discuss benefit program changes.
- Perform other duties and responsibilities as assigned.
- Maintained records of customer interactions and transactions.
- Developed relationships with customers through friendly conversations.
- Worked closely with other departments to ensure quality customer service delivery.
Education
High School Diploma -
Payette High School
05.2000
Some College (No Degree) - Business Administration
Independence University
Phoenix, AZSkills
- Compliance
- Testing and Validation
- Monitoring
- Documentation
- MSSQL
- Microsoft Programs
- Fortitude
- Adaptability
- Reliable
- Observant
- Focused
- Detail oriented
- Process Mapping
- Test Planning
- Troubleshooting
- Interpersonal Skills
- Team Collaboration
References
References available upon request.
Timeline
CONFIGURATION ANALYST
BLUE CROSS OF ID
04.2021 - Current
GRIEVANCE AND APPEALS SPECIALIST
BLUE CROSS OF ID
02.2017 - 04.2021
MA/MMCP CUSTOMER SERVICE ADVOCATE
BLUE CROSS OF ID
11.2009 - 02.2017
High School Diploma -
Payette High School
Some College (No Degree) - Business Administration
Independence University