SUMMARY:

• Accomplished, driven Information Analyst with over 10 years of experience as an EDI Coordinator/Specialist and over 9 years of X12 format files with solid experience integrating and managing EDI quality solutions for business clients. Solid understanding of critical operational functions such claims management, multi - state daily transmissions, management of Trading Partner Profiles with minimal exposure to SQL and Business Objects.
• High level of analytical skills a problem solver and focusing on building an effective relationships with customers.
• I am a bilingual Spanish- English professional seeking a challenging position where my experience and abilities can be utilized effectively to further develop and establish a career. Introduction to SQL to become an EDI developer.

TECHNOLOGIES AND SKILLS:

• EDI-HIM-X12-XML
• AS/400
• Windows2013
• FTP
• Notepad ++
• EDI Notepad
• PGP Encryption
• SQL Basic
• ICD 9/10 codes

EMPLOYMENT HISTORY:

Confidential

Sr. EDI Analyst

Responsibilities:

• Effectively achieved 80% reduction for EDI error report and daily maintenance Responsible for the state reporting of 40 plus states, following the IAIABC rules and guidelines.
• Prepared and update the Trading Partner Documents as well as provided content and testing to new jurisdictions and internal users.
• Provide the EDI Acceptance Ratio Report to the Management Team.
• Liaison between our system vendor ISO and Argonaut to ensure error free EDI transactions.
• Successfully completion of Trading Partner Documents for our sister company Rockwood Casualty Insurance Company as well as the testing of the require FROI and SROI transmissions in for Rockwood in 9 states.
• In charge of the training of 50+ employees in the company system as well as quarterly trainings of the EDI changes.
• Support with the testing of the multiple company platforms regarding EDI.
• Constant communication with all the jurisdictions in regards to EDI reporting, upcoming rules and new versions of EDI.
• Daily maintain Confidential (Office of Foreign Assets Control) compliance report, verification of records to avoid positive match.
• Support in the process of WC Compliance Reports.

Confidential

EDI Specialist

Responsibilities:

• Responsible for transmitting COBRA, FSA and Direct Bill files for 100 plus clients via FTP, file format will be received flat, encrypted, etc.
• Assisting the clients with questions regarding the processing report concerning the severity codes, coverage, file format issues etc.

Confidential

Insurance Reporting Specialist

Responsibilities:

• Responsible for the State Reporting of 20 plus states, knowledge of the rules and compliance of each state, daily extractions and submissions of X12 and flat files via FTP, EDI, Disc, encrypted files, paper forms, state websites, etc.
• Revision and corrections of state report errors.
• Assisting Agents on the installation of the program TeamUp for purposes of policy recording.
• Assisted QA Department with the testing of our internet base system.
• In charge of system security, new users, for both our systems.
• Assisted in the digital document process, claims and refund checks printing.
• Communicate with the different Jurisdictions regarding reporting issues.

Confidential

EDI Coordinator

Responsibilities:

• Effectively coordinated EDI functions for 22 different jurisdictions, including the successful completion of Trading Partner Agreements
• Fully responsible for the business’ EDI testing (following IAIABC guides and state laws) and daily extractions and submissions of X12 and flat files through Ingenix system.
• Developed EDI instructional reference book for data management and EDI Coordinator training.
• Assisted Claims Department with claims filings (volumes up to 50 claims daily)
• Responsible to provide data integrity testing for the proprietary insurance application.

Confidential

Claims Assistant

Responsibilities:

• Fully responsible to provide support and assistance to 4 adjusters with up to 6 different jurisdictions, which included communications to the state, communication with attorneys, employers, injured workers and the associated logistics
• Performed administrative duties for the Confidential .
• Completed open enrollment packages and provided new hire orientation.
• Successfully assisted with the translation of the Spanish version of city website.

Confidential

Claims Adjuster

Responsibilities:

• Responsible to investigate up to 200 claims a month to determine compensability.
• Fully responsible to analyze and review claims for accuracy, completeness and eligibility.
• Verified the completion and validity of claim forms and reviewed company records to determine coverage.

Confidential

Risk Manager Assistant

Responsibilities:

• Effectively identified high risk claims to determine high and low cost risk of each employee policy.
• Data entry support for the Sales Administration and Underwriting Department.
• Provided high level of administrative support to two department managers.
• Performed administrative and secretarial duties with wide latitude for exercising discretion and judgment
• Coordinated and managed effectively agendas, traveling arrangements
• Researched, compiled, assimilated, and prepared confidential and sensitive documents, and brief the managers regarding contents.