SUMMARY:

Highly accomplished Senior Business Analyst with a verifiable track record of managing complex projects and exceeding expectations. Seeking a position with a focus on team leadership, process improvement, and creating effective business solutions.

COMPUTER SKILLS:

Proficient in: Microsoft Office, ICIS, OSCAR, PEGA, and INSINQ

Experience with: SQL, and SAS.

PROFESSIONAL EXPERIENCE:

Confidential, Harrisburg, PA

Business Analyst

Responsibilities:

• Define and document business requirement, system design documents, system specifications, process improvement, quality assurance, system and integration testing and resolution.
• Communicate effectively with all levels of the organization, including senior staff members.

Confidential, Camp Hill, PA

Senior Business Analyst

Responsibilities:

• Tract, trend, forecast and analyze data to identify potential inaccuracies.
• Communicate effectively with all levels of the organization, including senior staff members.
• Coach, consult, motivate, and mentor team members on moderate to complex business/systems processes.
• Develop SQL queries and SAS programs in response to reporting requests sent to the BPS SharePoint site, verify data and criteria.
• Created and maintained Microsoft Access databases.
• Some Cognos experience.

Business Analyst

Confidential

Responsibilities:

• Analyze moderately complex processes to support Health Plan Operations areas by conducting impact analysis and interpreting system documentation.
• Utilize Project Management Techniques as the project lead, on medium to large - sized projects.
• Communicate effectively with all levels of the organization, including senior staff members.
• Determine and define business requirement, functional design, system specifications, process improvement, quality assurance, system and integration testing and resolution.
• Over 6 years experience working with the technical and business areas, gathering requirements, developing requirements documents, test cases and supporting large complex systems and projects.
• Over 6 years experience working with business areas in User Acceptance Testing. Designing test cases, executing test cases and documenting results, responding to the bugs found during UAT, and obtaining sign-off that required business functions are operational.

Team Manager

Confidential

Responsibilities:

• Responsible for ensuring that all operating processes, either partially or fully supported by the section, result in superior levels of satisfaction for internal and external customers. Work with counterparts in ePlatform or related staff to identify and clarify benefit, membership, claims medical management, or other issues that are impacting service of specific client accounts.
• Ensure prompt and accurate resolution of all inquiries to the department.
• Maintain appropriate processes to measure performance and provide feedback and ongoing analyses.

Senior Account Support Representative

Confidential

Responsibilities:

• Responsible for providing technical expertise guidance and direction to Account Support

  Representatives on a variety of issues that impact the day-to-day operations of the Marketing Administration Department. Such activities involve training both formally and informally, lending technical expertise in situations that are more complex in nature.

Account Support Representative

Confidential

Responsibilities:

• Responsible for providing account support activities associated with the implementation and administration of groups.
• Coordinating sales form entry and document production; analyzing/coordinating the implementation of new products, group changes, benefit enhancements, non-standard benefits, and activities related to mandated mass updates.
• Identifying and resolving service issues, rating concerns, benefit clarifications, and access/network issues; coordinating rate quotes and renewals; loading benefits and resolving problems associated with the group file benefits; database maintenance.
• Participate in meetings with internal staff and with customers; coordinating account billing activities; and preparing/coordinating customer specific reports, claims extracts and other reports.
• Responsible for determining the eligibility of the Broker to receive commission, updating the commission system to reflect the proper Broker, lines of business, commission levels and time frames. Make any and all adjustments to the system and oversee the actual commission run to assure that all reports and checks are processed in a timely manner.
• On a monthly basis submit monthly activity report to the PID.

Confidential, Harrisburg, PA

Account Administrator, Associations

Responsibilities:

• Responsible for providing accurate and timely service to both Local and National Control Association accounts by monitoring and maintaining accurate and updated billing and enrollment information compatible with the requirements of each individual and unique account.
• Responsible for answering technical/analytical questions relative to Major Medical claims processing. Performing audits and record keeping of quality and quantity statistics. Calculate analyze and enter work management data on a weekly and monthly basis. Compile various daily, weekly and monthly reports. Support management decisions, monitor and control unit workflow in absence of Supervisor. Performance management. Identifying and training and/or cross training of unit employees. Maintain unit's overall quality and quantity range appropriate to level of examiner's experience level. Communicate updates/changes to unit personnel. Inform Supervisor of processing and personnel needs.
• Being the training unit Technical Assistant, close interaction is imperative with Employee Development and the Major Medical Trainer. Any processing/guideline questions that the trainer may have are filtered through me. I will answer the questions or perform additional necessary research as appropriate.
• Fill in for the Major Medical Trainer if the Trainer is absent, or if the topic that needs to be covered that day is one that is known to be a difficult procedure/guideline for the trainees to comprehend.
• Member of the Major Medical Training Committee, my duties are to review, provide feedback, and either accept or deny all requests for training changes to the Major Medical Training Class as submitted by the Major Medical Trainer.
• Involved in the Major Medical image software update project. I attended meetings provided coding insight and suggestions, and tested the new image software.
• Shared the responsibility to analyze and update the flow charts for coding claims.

Training Assistant

Confidential

Responsibilities:

• Responsible for assisting the Major Medical Trainer before and during classes by auditing the materials used in the training class and providing updated examples.
• Verifying trainee errors, audits and answering coding questions while on 100% audit.
• Backup assistant in 1 training class and the primary assistant in another class.
• Reviewer for the Medical Terminology computer program used in the MM Training class.