- Systems Professional with experience in all phases of projects from start to completion.
- Provides testing of various applications, project management and technical support to clients with deep technical background and consistent ability to deliver solutions within defined scope and timelines in healthcare claims (fraud abuse and recovery), property and casualty, finance, and pharma.
- Strong team contributor with highly valued organizational, communication, time management, problem solving and decision making skills.
- Other strengths include ability to multi - task and work independently or within a team.
- SQLSERVER 2008
Senior Business Analyst
- Perform all traditional Business Analysts functions for CCW Provider Domain (Data requirements, Gap Analysis, Data Quality Profiling request, UAT Testing using Teradata, documentation, attended some agile training etc.)
Confidential, West Hartford CT
- Provided support for development environment that successfully replicated a customer’s dimensional database on SQL 2008 containing over 250 tables. Project included data mapping, cleansing and loading
- Developed testing strategy for ORACLE ETL built on Matrix of data integrity check across five phases of case management events.
- Gathered basic knowledge for SSRS and Tableau reporting for client presentation layer.
Confidential, Bloomfield, CT
Senior Technical Support
- Optimize existing code for reduce processing time and delivered data on time with accuracy.
- Technical lead for data Analytics for Data Mining using MS access, enterprise guide, ACL, SQL Server, Oracle TOAD, Quick view and QMF.
- Provided Technical testing for creating self-service leading project for mapping, testing, reviewing process and making suggestions for adjustments and worked with IT creating self-service tool for investigators for increasing productivity and saving time and resources.
- Provided consultations on claims, claims systems and technical as a subject matter expert for claims data.
Confidential, Farmington, CT
- Provided development support to Service Channel for creating CPU, Memory & Disk space graph for critical portal to baseline capacity/planning, developed in SAS/GRAPH weekly reporting to trace backend system activity.
- Preparing measure for HEDIS(NCQA) using claim, eligibility, provider and other data source in SAS/sql,connect,macro, JCL,DB2,QMF,ACCESS using mainframe, Unix and pc.
- Provided production support help how to use ENDEVOR.
- Prepared a claim, eligibility, pharmacy and other test data for new Medicare-D (Prescription Drug) benefits, Clinical Expansion and CBS Financial system for system Testing, Functional Testing, Regression Testing Web testing. Also used Database Manipulation using SQL/server and in QMF and Access for .net and ASP. Created Test plans for Test Director, test cases and performing Functional, Integration (End to End) and Regression Testing. Validated data on Developed test reports. Also analyzed, updated Business requirement and priority list for project.
Confidential, Shelton, CT
- Developed Fund Trade activity ad-hoc Reports in SAS/stat, access, sql. connect gathering data from many different VSAM and Admin systems (ACES, OMNI, VRR, SBA, RPS) for financial reporting (cash value, cash flow, policy and billing group’s statistics) and testing purpose. Areas supported include customer service, financial services and product and business.
- Provided production support to MIS department for report automation in production environment.
Confidential, Middletown, CT
Application Developer II
- For the Financial Support Team, provided benefits data to internal and external customers throughout the country using financial data, claim detail and eligibility data for small, medium and national accounts.
- Designed and developed ad-hoc reports in base SAS and JCL using ISPF, mainframes, Startool, Microsoft Excel and Word to: Unload, policy cancellation or policy holder special requests and provide financial information to policy holders, account managers and service centers Claim history transfer for new business, loading new benefits using prior career data and eligibility data.
- Financial fixes - using claim detail data, financial accumulator data and then overlaying or adding correct benefits members.
- Restructuring of accounts when customer spin-off from parent company implementation of business requirements and writing business specifications and QA testing for reports.
Confidential, Bloomfield, CT
Predictive Modeling Analyst
- Designed and developed ad hoc reports that studied drug usage and effectiveness using base SAS, DB2 SQL, QMF and multiple data and systems sources.
- Reports generated more than $100K in revenue each.
- Tested predictive modeling stop-loss system using SAS/sql, connect, stat.
- Identified problems in calculations, dates and front end data entry screen.
Confidential, Wallingford, CT
Business System Analyst/System Administrator
- SIU Managed national fraud investigation and recovery project using STARS System through systems development life cycle (SDLC).
- Worked with vendor on data mapping Data Warehousing Design patterns (i.e. Star Schema) coordinated STARS enhancement project across multiple sites.
- Used Unix and Sybase in MQ Series client server environment to troubleshoot software, track project progress; develop reports; determine specific business needs and business specs, develop using use cases and execute test plans and move ftp files to server.
- Developed ad hoc reporting in SAS, DB2 SQL and QMF, OLAP, using paid claims information from systems holding Professional, Institutional, Member, Dental, FEP, National, Pharmacy, Medicaid, Employee Fraud data and audit trails.
- Project reduced Anthems fraudulent claims and recovered thousands of dollars.
- Recovered $300,000 of potential claim duplication each quarter prompting rewriting SAS program for hospital and medical-surgical claims using paid claims data warehouse.
- Assisted with workers compensation recovery by writing SQL/server query against data warehouse and SAS program for pharmacy purge claims.
- Received Employee of Month Award for saving $25K per twice-weekly report run.
- Assisted in meeting HIPAA (Health Insurance Probability Accountability Act) compliance requirements by establishing system transaction and security processes.