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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

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