Claims Analytics Manager Resume
Linthicum, MD
SUMMARY:
- An experienced professional with more than fifteen years of increasing responsibilities in the information technology field.
- Technical expertise with mission critical systems for government, healthcare and retail industries and providing cost - effective technology solutions for small businesses.
- Results-oriented, creative and flexible.
- Brings a diverse technology background with knowledge of strategic alignment issues and organizational matters.
- System Development Life Cycle
- Experience with agile and waterfall methodologies
- Query developer, quality assurance testing and script development
- Previous roles included claims analytics manager, project portfolio management subject matter expert, responsibility for creating business solutions from user requirements utilizing all facets of the system development life cycle
- Analyzed and provided to data retention issues of critical department system
- Experience with applying methodology and business rules to develop useful systems
- Knowledge of decision support systems, knowledge management concepts, strategic planning/development, and technology resource planning
- Product support involving analysis and reporting
TECHNICAL SKILLS:
Productivity software: Microsoft Office 360
Database tools: DB2, Adabas, Access, DbVisualizer, Oracle, IBM Cognos
Operating Systems used: AS/400, MVS 390, Windows 95, 98, 2000, NT, XP, 2010, Windows 8, Windows 10, Unix, z/OS
PROFESSIONAL EXPERIENCE:
Claims Analytics Manager
Confidential, Linthicum, MD
Responsibilities:
- Analyzes claim errors preventing FFP match.
- Works with Medicaid analyst and claims processors to resolve technical issues preventing flow through processing.
- Facilitates monthly meeting with Medicaid contract manager and finance representatives to update the status of outstanding claim matches.
- Communicates with all levels of the organization on matters of financial risk.
- Responsible for developing efficient processes for gathering data for analysis.
- SME for end user testing, responsible for development of test scenarios.
- Develops monthly report reflecting status of at-risk dollars including detailed narratives highlighting irregularities.
Technical Project Manager
Confidential, Reston, VA
Responsibilities:
- Configures system based on organizational requirements
- Supports and provides user
- Resolves system/user issues
- Monitors data quality and maintains user profiles
- Develops management reports to support project resource management and budgeting
- Presents data to CTO to aid in organizational decisions related to labor, time allocation and project costs
- Interacts with CIO leadership to determine reporting requirements
- Partners with Project Managers to resolve issues, conduct meetings and seminars
- Supports Vice President and Director in preparation of special reports, presentations and research projects
Corporate Business Systems Analyst
Confidential, Reston, VA
Responsibilities:
- Configures system based on organizational requirements
- Supports and provides user
- Monitors data quality, maintains user profiles and resolves system issues
- Develops management reports to support project resource management and budgeting
- Presents data to CTO to aid in organizational decisions related to labor, time allocation and project costs
- Interacts with CIO leadership to determine reporting requirements
- Partners with Project Managers to resolve issues, conduct meetings and seminars
- Supports Vice President and Director in preparation of special reports, presentations and research projects
- Auxiliary support of vendor management process assisting team with consulting staff and vendor contracts.
Corporate Business Systems Analyst
Confidential, Reston, VA
Responsibilities:
- Coordinate configuration and implementation of new clients and modifications for all automated member and provider correspondence
- Interact and build relationships with various internal business units as well as external clients
- Project management with responsibilities for meeting facilitation and process improvement
- Help ticket management and support for correspondence and CAS Claims application issues
- Coordinate job scheduling tasks for new batch processes
Business Systems Analyst
Confidential, Linthicum, MD
Responsibilities:
- Supported internal and external users on suite of organizational applications through and problem resolution
- Responsible for leading user acceptance testing (UAT) effort for service center and development of formalized process
- Provided data mapping for extract development and reporting
- Provided backup support for LAN administrator and IT Director
Survey Operations Analyst
Confidential, Columbia, MD
Responsibilities:
- Provided analysis of performance of radio markets and return rate planning
- Planned sample for diary and electronic meter system services
- Utilized understanding of methodology and business rules for both services
- Provided guidance for questions related to data integrity, areas of responsibility
- Participated in implementation of departmental quality management system: document and records control.
IT Programmer Analyst
Confidential, Baltimore, MD
Responsibilities:
- Provided detailed data analysis for Confidential Legislature resulting in appropriations to support drug utilization oversight by staff physicians
- Provided timely and accurate ad hoc reports for Maryland Medicaid Pharmacy Program using FOCUS reporting software and Business Objects
- Analyzed data trends and provided feedback to users
- Reviewed state and federal legislation and provided impact analysis to data
- Utilized Medicaid Management Information Systems (MMIS) application
- Provided auxiliary support for state pharmacy call center
Programmer Analyst (Specialist)
Confidential, Sacramento, CA
Responsibilities:
- Maintained and provided troubleshooting of job abends
- Provided support of IDMS to DB2 conversion
- Production Support Team Lead, providing coverage and solutions for complex issues with batch jobs
Software Engineer
Confidential, West Sacramento, CA
Responsibilities:
- Coordinated development standards for COBOL community of practice
- Provided maintenance of online/batch programs for logistics and transportation team on mainframe system
- Designed and developed web-based application enhancement to reduce labor costs while complying with bioterrorism laws
- Participated in on-call rotation
- Participated in task force to improve technical support processes by developing help desk employee best practices guidelines