Virginia Reed
Operations System Analyst
Fort Worth,TX
Summary
Knowledgeable Operations Systems Analyst with history of progressive leadership. Gathers requirements, develops test cases and delivers key initiatives. Drives collaboration and cohesion to complete projects on time. Subject Matter Expert (SME) in Life & Health Claims Support. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
28
28
years of professional experience
Work History
Lead Operations System Support Analyst
Tata Consultancy Services
04.2018 - Current
- Provided client support on system operation and troubleshooting for Life & Health Claims Operations.
- Investigate system issues and escalate problem tickets to resolve user issues.
- Define and document scope of projects for distribution to team.
- Assist in troubleshooting/resolution of production issues and coordinate with technical staff.
- Prepare test cases based on knowledge of how system is designed, requirements and expected results.
- Coordinate and conduct UAT testing to ensure the reliability, accuracy and functionality of system changes and/or enhancements.
- Establish specifications and coordinate production and projects with software programmers and end users.
- Assist with coaching and development of team members.
- Liaison with software programmers and business areas impacted (claims, finance, third party vendors, admin etc.).
- Facilitate meetings and effectively lead discussions between impacted business areas and technology.
- Maintained knowledge of benefits claim processing, claims principles, and procedures and HIPAA regulations.
- Review and analyze Life & Health claims data reports for state and compliance reporting.
- Review and analyze Life & Health Market Conduct Annual Statement initiatives for claims.
Operation System Support Analyst
Transamerica Life Insurance
10.2015 - 04.2018
- Provided client support on system operation and troubleshooting for Life & Health Claims Operations.
- Investigated system issues and escalated problem tickets to resolve user issues.
- Defined and documented scope of projects for distribution to team.
- Assisted in troubleshooting/resolution of production issues and coordinated with technical staff.
- Prepared test cases based on knowledge of how system is designed, requirements and expected results.
- Coordinated and conducted UAT testing to ensure the reliability, accuracy and functionality of system changes and/or enhancements.
- Established specifications and coordinated production and projects with software programmers and end users.
- Liaison with Technology and business areas (claims, finance, third party vendors, admin etc.).
- Facilitate meetings and effectively lead discussions between impacted business areas and technology/software programmers.
- Maintained knowledge of benefits claim processing, claims principles, and procedures and HIPAA regulations.
- Review and analyze Life & Health claims data reports for state and compliance reporting.
- Review and analyze Life & Health Market Conduct Annual Statement initiatives for claims.
Long Term Care Claims Trainer
Transamerica Life Insurance
07.2009 - 10.2015
- Develop documentation and support materials.
- Work with the business teams to document processes/procedures.
- Deliver and assess process and system training.
- Maintain process and system training curriculum.
- Independently perform, understand, and explain the complex functions within the team and department.
- Assist with coaching and development of team members at all levels, including facilitating team meetings and trainings.
- Assist team members with interpretation of policy contracts and terminology.
- Support continuous improvement initiatives and identify service gaps, root cause analysis and propose process improvements.
- Review, analyze, investigate and authorize payments of Nursing Home, Assisted Living, Home Health Care and Alternate Plans of Care within authority guidelines and determines payment by referring to policy coverage, language and limits.
Long Term Care Claims Examiner Lead
Transamerica Life Insurance
08.2006 - 07.2009
- Independently perform, understand, and explain the complex functions within the team and department.
- Process complex claims.
- Review and release claims which exceed team member limits.
- Assist with training of new employees.
- Assist team members with interpretation of policy contracts and terminology.
- Review, analyze, investigate and authorize payments of Nursing Home, Assisted Living, Home Health Care and Alternate Plans of Care within authority guidelines and determines payment by referring to policy coverage, language and limits.
- Review and perform file audits on LTC claims.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Monitored and updated claims status in claims processing system.
Long Term Care Claims Examiner III
Transamerica Life Insurance
05.2003 - 08.2006
- Analyze information/documentation received to determine how to process Long Term Care claims.
- Process complex claims and elimination period reworks.
- Handles the maximum benefit audits on Long Term Care Claims.
- Process and review Consumer Affairs files, which involves reviewing complaints, re-working previous claims processed or auditing prior claims.
- Examined claims forms and other records to determine insurance coverage.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Major Medical Claims Examiner
Ascent Management
01.1998 - 05.2003
- Process major medical claims for individual policy holders.
- Investigate claims that are within pre-existing and contestable periods.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Researched and resolved complex medical claims issues to support timely processing.
- Examined claim forms and other records to determine insurance coverage.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Paid or denied medical claims based upon established claims processing criteria.
Medicare Supplement Claims Examiner
Ascent Management
01.1996 - 01.1998
- Process Medicare supplement claims.
- Policy interpretation skills
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denial.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Education
Medical Assistant -
National Education Center
Fort Worth, TX1991
GED -
Diamond Hill Jarvis
Fort Worth, TX1990
Skills
- Operational Systems
- Develop Test Plans and Cases
- User Acceptance Testing (UAT)
- Data Profiling
- Gather Project Requirements
- Life, Health & LTC Insurance Industry Experience
- Scrum Methodology
- Compliance Experience
- Mainframe Testing
- Train Users
- Policy Interpretation Skills
Timeline
Lead Operations System Support Analyst
Tata Consultancy Services
04.2018 - Current
Operation System Support Analyst
Transamerica Life Insurance
10.2015 - 04.2018
Long Term Care Claims Trainer
Transamerica Life Insurance
07.2009 - 10.2015
Long Term Care Claims Examiner Lead
Transamerica Life Insurance
08.2006 - 07.2009
Long Term Care Claims Examiner III
Transamerica Life Insurance
05.2003 - 08.2006
Major Medical Claims Examiner
Ascent Management
01.1998 - 05.2003
Medicare Supplement Claims Examiner
Ascent Management
01.1996 - 01.1998
Medical Assistant -
National Education Center
GED -
Diamond Hill Jarvis
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