REBECCA JONES
Southington,CT
Summary
Results-driven Business Analyst with 24 years of experience in the healthcare insurance industry. Proficient in analyzing and interpreting business and systems requirements, executing user acceptance testing, and providing comprehensive end-user training. Demonstrated ability to apply insights from previous roles to drive strategic decision-making for upcoming projects.
Overview
25
25
years of professional experience
Work History
Business and Data Consultant
Aetna, CVS Health
01.2024 - 08.2024
- Responsible for multiple broker incentive programs, including over $5M incentive payments to participating producers
- Served as a subject matter expert of multiple broker incentive programs, providing guidance to colleagues throughout the organization.
- Improved data quality and consistency by standardizing data formats, establishing validation rules, and implementing automated checks.
- Collaborated with cross-functional teams to develop tailored solutions addressing specific client pain points related to data management and analysis.
- Applied data validation procedures to support and enforce data integrity.
- Leveraged advanced Excel functions for data manipulation and analysis.
- Assisted with development of data entry procedures to streamline data processing.
- Employed SQL to query databases and retrieve data.
- Mapped data between source systems and warehouses.
- Tested software applications and systems to identify enhancement opportunities.
- Completed quality reviews for designs, codes, test plans and documentation methods.
- Enhanced program efficiency by streamlining processes and implementing data-driven improvements.
- Optimized data accuracy by designing and implementing efficient data models for various projects.
MGR,BUS CONSULTANT (IC) • CSO PSI-ANALYTICS-NATL
Aetna Inc.
01.2017 - 12.2023
- Provided customer level consultative analytics and reporting for Aetna’s Plan Sponsor Insights Team
- Managed necessary reporting and information to adequately support more than 4,000 customers
- Maintained strong partnerships with Clinical Program Consultants, Account Teams and external consultant groups aligned to our customers
- Assisted in the development of predictive models for various aspects of healthcare operations, such as patient readmissions, high cost claimants or emergency room visits, enabling proactive resource planning and better patient care management.
- Evaluated the effectiveness of clinical interventions by comparing outcomes against established benchmarks, informing future treatment plans and strategies.
- Developed strategic recommendations based on data-driven insights to optimize resource allocation and improve overall business performance.
- Created customized reports, summarizing and presenting data in visually appealing format that provided actionable insights, identified trends, and interpreted results to internal and external customers
- Updated and developed scripts and queries to extract and analyze data from multiple sources and generated ad-hoc reports to evaluate specific business requirements.
- Provided technical support for troubleshooting analytics and reporting issues.
- Cross-trained colleagues and team members to maximize team agility and performance.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Strong technical skills in Microsoft Excel, Access, PowerPoint, Power BI, data warehouse, Tableau, and SAS/SQL
Project Lead/Analyst
Aetna Inc.
01.2013 - 01.2017
- Business owner representative of Traditional, HMO, Medicare and Consumer Business provider and member Explanation of Benefits (EOB) and Payments
- Responsible for ensuring that the Explanation of Benefits (EOB) complied with all state and federal regulations and mandates
- Led and managed the analysis of complex issues with root cause analysis to identify and recommend process improvements, automation opportunities, and system solutions
- Analyzed data to determine cause, trends, and resolution of 35 system errors and provided detailed documentation and training for system error workflow process
- Versed in both Agile and Waterfall Project Management Methodologies
- Led projects involving Medicare updates, regulatory changes, and system improvements with budgets from $1-5M to successful completion
- Experienced in writing Business Requirement Documents, Project Scope, Cost-Benefit Analysis (CBA) and creating QA test cases for QA, Regression, and User Acceptance Testing (UAT)
- Served as single point of contact for prioritizing, scheduling, and testing of enhancement, break/fix and day to day service requests
- Performed daily, weekly, and monthly database balancing audits for over 10 applications
- Wrote and ran simple and complex SQL queries for analysis of system issues
- Commended for technical, analytical, and problem-solving skills, effective prioritization and the ability to effectively communicate with both technical and non-technical users.
Senior Application Analyst
Aetna Inc.
01.2005 - 01.2013
- Conducted requirement documentation sessions, fact-finding, and independent research to design creative, progressive IT solutions for the most complex customer issues
- Responsible for business impact analysis of system defects, control/audit deficiencies, outages and enhancement
- Handled Service Requests for new applications or modifications of existing applications, determined priorities and ensured that the Business/System needs were successfully met on a timely basis
- Developed Product Overviews, FAQs, Tool Glossaries, system training material and system user documentation to support implementation activities
- Acted as liaison between Development, QA, and Business.
- Achieved cost savings by identifying redundancies in application processes and proposing more streamlined approaches.
Application Help Desk Analyst
Aetna Inc.
01.2002 - 01.2005
- Executed specific deliverables and activities around moderately complex system issues as part of a team assigned to support the day-to-day maintenance and enhancement of business applications and projects
- Spearheaded new procedures for Help Desk documentation, enabling development of a comprehensive knowledge base of common issues and solutions to improve Help Desk efficiency.
- Provided customer support and technical support to10+ customers daily.
Claims Benefit Specialist/Team Lead
Aetna Inc.
01.2000 - 01.2002
- Processed complex medical claims while meeting established turnaround times and quality excellence
- Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations.
Education
Arts -
Tunxis Community College
Farmington, CT12.2002
Liberal Arts -
Middlesex Community College
Middletown, CT12.1993
Skills
- Microsoft Office Suite & Access
- Project management
- Requirement gathering, documenting, scripting, and defect resolution
- Familiar with medical terminology
- Systems implementation
- Medical records experience in a hospital setting
- Social Determinants of Health (SDoH) knowledge
- Solid understanding of CMS processes
- ERA/EFT
- Medicare & FSA health claim experience
- Medical, Hospital, Rx and Dental Claims
- Regression, QA and Production Analysis
- Data Storytelling
- Data Warehousing
- Business Intelligence
- Data Modeling and Mapping experience
- Problem-solving abilities
- Teamwork and Collaboration
- Multitasking Abilities
- Excellent Communication & Organizational Skills
- Agile Methodologies
Technicalsummary
- Microsoft Suite: Excel, PowerPoint, Word, Access, Teams, OneNote
- Relational databases, SAS/SQL, Power BI, Tableau, Netezza
- JIRA, QuickBase, Service Center, Service Now
- Salesforce, BAES, SRDL Workbench
Timeline
Business and Data Consultant
Aetna, CVS Health
01.2024 - 08.2024
MGR,BUS CONSULTANT (IC) • CSO PSI-ANALYTICS-NATL
Aetna Inc.
01.2017 - 12.2023
Project Lead/Analyst
Aetna Inc.
01.2013 - 01.2017
Senior Application Analyst
Aetna Inc.
01.2005 - 01.2013
Application Help Desk Analyst
Aetna Inc.
01.2002 - 01.2005
Claims Benefit Specialist/Team Lead
Aetna Inc.
01.2000 - 01.2002
Arts -
Tunxis Community College
Liberal Arts -
Middlesex Community College
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