Summary
Overview
Work History
Education
Skills
Timeline
Generic

Valinda Saunders

Virginia Beach,VA

Summary

Experienced Business Analyst who enjoys taking on new challenges. Driven to exceed goals and expectations. Knowledgeable in providing friendly, thorough customer service. Skilled at problem solving and conflict resolution, and able to help encourage teamwork. I will bring dedication, energy, and impeccable attention to detail. Insightful Business Analyst known for high productivity and efficient task completion. Possess specialized skills in data analysis, process improvement, and project management. Excel in critical thinking, communication, and problem-solving to deliver effective solutions. Committed to leveraging these abilities for success in challenging business environments.

Overview

19
19
years of professional experience

Work History

Business Analyst Senior

Wipro Technologies
Virginia Beach, VA
03.2022 - Current
  • Design and build new complex non-standard benefit plans, review, and analyze benefit summaries; and identify best approach to code/develop benefits to achieve optimum adjudication levels
  • Maintain avoidance to negative financial, regulatory, and operational impact
  • Perform testing and quality assurance of new product developed
  • Research and analyze RFP proposals, and product projects
  • Create and maintain issue log on appropriate tool, resolve defects based on knowledge and analysis of system functionality
  • Research and respond to complex inquiries from various departments
  • Consult with and mentor less experienced team members
  • Serve as trainer for standard and highly customized benefit configuration
  • Represent department in production related meetings including product development, design, and implementation
  • Must be able to perform all duties of lower-level positions as directed by management
  • Medicaid and Medicare benefit configuration knowledge
  • Analytical and critical thinking skills
  • Microsoft Access, SQL, and Advanced Excel
  • Effective Communication skills (written and verbal)
  • The ability to interpret data
  • Tech knowledge of data management software
  • Lead teams of analysts assigned to complex projects
  • Determines specific business application software requirements to address complex and varied business needs
  • Analyzes and designs solutions to address complex and varied business needs
  • Consults with business partners concerning the application and implementation of technology

Benefits Analyst II - FACETS

Anthem Insurance Companies, Inc.
12.2020 - 03.2022
  • Responsible for identifying complex business needs and translating the needs to application software requirements in support of operations, production, and projects
  • Designs and builds benefit standard and non-standard benefit plans, analyzes business rules to identify best approach to code/develop benefits in the benefit configuration database to achieve optimum claims adjudication levels
  • Performs testing and quality assurance of new product developed to avoid negative financial, regulatory, and operational impact
  • Resolve system configuration defects based on knowledge and analysis of system functionality in conjunction to the benefit plans
  • Researches and responds to complex inquiries from various departments

Business Info Analyst II

Anthem Insurance Companies, Inc.
06.2018 - 12.2020
  • Researched, developed, and validated new prepayment processes to prevent incorrect payments and to promote claims payment project and best practices
  • Performed data mining utilizing CPT, HCPCS, DRG and ICD-10 coding best practices
  • Collaborated with key business partners to accomplish assigned goals
  • Served as liaison to solve problems and address concept specific questions
  • Researched and documented overpayment recovery concepts to confirm accuracy and proof of concept
  • Ran queries to retrieve data to capture additional claims that may be included in recovery concept
  • Committed to deliverables and maintain timely turnaround times
  • Monitored prepayment concepts below performance thresholds to notate deviations and anomalies
  • Maintained and used concept management database to track business performance

Business Analyst II

Anthem Insurance Companies, Inc.
01.2016 - 06.2018
  • Analyzed data and summarized performance to develop reporting and recommendations
  • Requested complex data analysis from internal IT team for recurring reporting needs to customers
  • Proactively led concept enhancements with business partners to optimize recovery projects
  • Ensured review of Forager pipeline and reports, tracking financial impact and identify lead trends
  • Requested and/or ran queries as needed to retrieve data; submitted requests for database updates

Recovery Audit Analyst II

Anthem Insurance Companies, Inc.
04.2014 - 01.2016
  • Audited paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research methods
  • Performed collection activities for overpayment recoveries and negative balance accounts
  • Worked closely with provider relations to identify and correct contractual issues
  • Interpreted provider contracts in compliance with state and federal rules and regulations
  • Conducted complex case research and resolution for projects involving overpayments
  • Analyzed and validated contract documents to resolve and respond to state complaints

Recovery Specialist I

Anthem Insurance Companies, Inc.
06.2013 - 04.2014
  • Worked with recovery and collection vendors to validate overpayments and vendor invoices
  • Performed claim and trend analysis, validation, and recovery of claims payment errors
  • Completed over 20,000 annual provider identified adjustments
  • Ran daily check inventory reports to help with daily work distribution across the team
  • Identified and documented business requirements to improve daily check run inventory management
  • Determined and calculated number of overpayments; issued refund request letters and notice letters

9-1-1 Dispatcher

City of Virginia Beach
03.2011 - 12.2012
  • Answered emergency calls requiring immediate medical, police and/or fire department assistance
  • Rendered telephonic life-saving support communications until first responders arrived at the scene
  • Received, processed, and relayed requests for police, fire, or emergency medical services
  • Operated non-emergency telephone system receiving calls for non-emergency police service, requests for information, complaints, or other miscellaneous situations
  • Operated a multi-screen computer connected to a Computer Aided Dispatch system and telephone equipment to receive and process emergency calls and non-emergency calls
  • Located and verified location of incident and/or caller using Geographical Information System software and other sources of information
  • Consulted available resources to obtain information to respond to and document calls
  • Classified and assigned nature codes to ensure proper communication of situation
  • Received 'Life-Saver Award' for outstanding commitment and lifesaving efforts displayed

Claims Service Representative

Social Security Administration
04.2009 - 04.2010
  • Interviewed claimants to determine eligibility while reviewing job history and health information
  • Conducted interviews and helped claimants develop their claims for retirement, survivors, and disability benefits and/or supplemental security income
  • Worked with claimants to establish continuing eligibility for payment; assisted claimants in filing for administrative appeals, adjudicated claims and authorized them for payment, provided referral services
  • Answered questions, resolved problems regarding requirements and provisions of benefit programs
  • Researched insurance claim discrepancies and made recommendations for resolution
  • Drafted correspondence to the public and assisted the public with completion of various benefit forms

Claims Analyst II

Amerigroup Corporation
02.2006 - 06.2009
  • Processed intermediate and advanced level claims transactions using the Facets and Amisys
  • Accurately interpreted and understood Medicaid contracts and state guidelines and regulations
  • Implemented appropriate claims processes and courses of action when adjudicating claims
  • Examined reconsideration requests and recommended payment decisions
  • Examined coding of operative reports, procedures, and multiple and complicated surgeries
  • Performed length of stay reviews to determine reasonable, necessary, and appropriateness of stay
  • Secondary review of bills on which providers questioned the appropriateness of payments authorized
  • ICD-9/CPT coding and third-party payer insurance verification processes and medical terminology

Education

MBA - Business Administration

Western Governors University
Salt Lake City, UT
01.2012

Bachelor of Arts - Liberal Arts Management

Virginia Wesleyan College
Norfolk, VA
01.2009

Skills

  • Project management
  • Facets & Macess experience
  • Data management
  • Works well under pressure
  • Time management
  • Proficient in Microsoft Office programs
  • Adobe
  • Oracle
  • Workflow Analysis
  • Quality Assurance
  • Data Mapping
  • Business process improvement
  • Data Analysis
  • Data Mining
  • Requirements Gathering
  • Excel proficiency
  • MS Word, Excel, and Outlook
  • Excellent communication skills
  • Excellent organizational abilities
  • Excellent problem solver
  • Excellent work ethic
  • Excellent Written and Verbal Communication
  • Excellent listener

Timeline

Business Analyst Senior

Wipro Technologies
03.2022 - Current

Benefits Analyst II - FACETS

Anthem Insurance Companies, Inc.
12.2020 - 03.2022

Business Info Analyst II

Anthem Insurance Companies, Inc.
06.2018 - 12.2020

Business Analyst II

Anthem Insurance Companies, Inc.
01.2016 - 06.2018

Recovery Audit Analyst II

Anthem Insurance Companies, Inc.
04.2014 - 01.2016

Recovery Specialist I

Anthem Insurance Companies, Inc.
06.2013 - 04.2014

9-1-1 Dispatcher

City of Virginia Beach
03.2011 - 12.2012

Claims Service Representative

Social Security Administration
04.2009 - 04.2010

Claims Analyst II

Amerigroup Corporation
02.2006 - 06.2009

MBA - Business Administration

Western Governors University

Bachelor of Arts - Liberal Arts Management

Virginia Wesleyan College

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