PROFESSIONAL SUMMARY:

• Business Analyst who effectively uses quantitative skills to plan, coordinate, and track the efforts for tasks and resources for systems development and upgrades in specialized areas in order to meet departmental .
• Performs effectively under strong pressure, maintain high standards and bring about effective action through direction, example, and a collaborative team atmosphere.

TECHNICAL SKILLS:

• Visio
• Enterprise Risk Management
• IBM Cognos 10.2.2
• Green Belt Training
• Introduction to LEAN
• Use Cases
• Data Analysis 101
• Leadership Development at BCBSNC
• BCBSNC Business Writing Essentials
• Privacy Coordinator
• SAS Programming, I & II
• SAS Visual Analytics Introduction & Certification Prep
• Confidential SQL Server Introduction
• Linux NOS Essentials
• Healthcare IT Technician
• CompTIA IT Fundamentals Certification course
• Confidential Office Suite Applications, including MS Excel, MS Project, MS Access, PowerPoint
• Apollo/SABRE

PROFESSIONAL EXPERIENCE:

Confidential

Business System Analyst

Responsibilities:

• Interviewed stakeholders regarding requirement gathering, document requirements for the deployment of business solutions.
• Developed and analyzed solutions to business issues, included reviewing and writing of documentation, including functional and technical design requirements
• Wrote and edited program and system documentation, user manuals, and training materials to help end - users in using and operating the system.
• Assisted in overseeing the development of technical design requirements with developers, programmers, and external suppliers before initiating coding.
• Major projects/initiatives: Month End Reporting Automation and Security Module

Confidential

Business System Analyst, IT Department

Responsibilities:

• Determined operational objectives by reviewing business functions; gathering information; evaluating output requirements and formats.
• Performed system testing and regression testing, reviewed, updated and developed testing scripts. Recorded and documented findings to create remediation action plans.
• Designed new computer programs by analyzing requirements; constructing workflow charts and diagrams; studying and testing system capabilities; writing specifications.
• Handled cyber security, checked user accounts permissions.
• Performed audits of Claim process and systems.
• Project manager for Confidential upgrade: System upgrade of Original Software TestBench / TestDrive, assigned to handle project management duties: ensuring all prerequisites were met from current system installs, current service pack, verified all users’ laptops had the correct conversion pack installed, worked with vendor for training and developing training material, scheduled all meetings, tracked and generated all meetings notes & reports. Worked with Original Software System on budget and produce invoice for management review, approval and sign-off.

Confidential

Compliance Consultant

Responsibilities:

• Confidential with existing federal and state laws, regulations and requirements.
• Ensured adherence to Confidential policies and procedures.
• Ensured claim compliance with regulatory requirements and timeframes, with Confidential Association, Confidential, Confidential " Confidential with the Centers for Confidential " Confidential Services and varies TPAs.
• Researched, investigated, and evaluated compliance implementation initiatives and required remediation initiatives.
• Conducted risk assessments and audits to monitor department systems for compliance.
• Redesigned and Managed SharePoint Redesign Project to improve tracking and updating of Job aides, procedures and information

Confidential

Quality Auditor

Responsibilities:

• Performed Focus Audits of system and customer service representative processes.
• Performed SAS70 High Dollar Audits that reviewed Financial Risks and ensured Financial Accuracy and controls.

Confidential

Specialist

Responsibilities:

• Managed complex, highly visible cross-functional projects to ensure compliance with new and existing laws and regulations.
• Tracked Projects progress and generated projects reports using Confidential Office Suite.
• Assisted with deployment of compliance programs through training, audits and assessments, investigations, Confidential examination support and legislative implementations.
• Developed corrective action plans to address gaps and findings from audits to develop and maintain controls.
• Conducted internal audits and compliance reviews in order to mitigate risks related to regulatory audits performed by state regulators and third-party vendors.

Confidential

Business Analyst

Responsibilities:

• Conducted AS IS, gap, and risk Confidential .
• Prepared business cases, business requirements, root cause analysis, and risk assessment controls evaluations on Confidential
• Led InterPlan Program SAS-70 Claims Balancing Project- ensured accurate reporting, explanation of claim systems data, and risk mitigation Confidential walkthrough meetings. Prepared and submit Final SAS-70 report for department.
• InterPlan Programs SME on claim submission using EDI 837 and 835 submission and ensuring Confidential and Confidential compliance requirements and standards.
• Ensured adherence to Confidential policies and practices.

Confidential

Operation Specialist

Responsibilities:

• Handled customer inquiries regarding claims, membership, billing, and other issues.
• Identified quality issues and training needs for InterPlan Programs.
• Designed and implemented training course for new employees. Identified, documented and escalated system and process problems.
• Thoroughly analyzed issues, determined root cause and recommended remediation to business.
• Processed all phases of claims adjustments to reflect appropriate certificate liability.

Confidential

Tech Support

Responsibilities:

• Processed medical claims submitted by providers.
• SME for Confidential claim submission (SF) process to payment (DF). Including error checks, claims suspend errors, along review and adjudication of claims through the Lawson system.

Confidential

Operational Manager

Responsibilities:

• Ticket Counter Supervisor/ Gate Agent Supervisor, Confidential .
• Managed staff of 26 ticket counter agents and 150+ gate agents.
• Managed extensive daily flight operation schedules and Air Traffic Control decisions.
• Reported on safety checks regarding the airplane flight readiness.
• Complaint Resolution Official and Ground Security Representative at RDU Airport