Senior IMS Lead Contractor, Lead Manager Resume

PROFESSIONAL EXPERIENCE

Confidential

Senior IMS Lead Contractor, Lead Manager

Responsibilities:

Responsible for face to face client relations and escalations.
Responsible to train and manage a full offshore team of 70 people to learn all tasks of IT Operations via Skype, Lync and GoToMeeting.
Responsible for all incoming IT calls, issues and escalations.
Responsible to work IT Helpdesk tickets.
Responsible for user password and trouble shooting.
Responsible for all IT helpdesk related issues
Responsible for all SFTP and PGP Encryption issues, new setups and teaching external partners how to send files.
Responsible for discovering, developing and building automation processes to better service the customer.
Strong Phone skills
Exceptional global communication skills.
Full knowledge base of all Confidential systems
Strong knowledge of EQUIP, Metrics and Measurements(M&M), Agile - Level 2, EQUIP-Agile, QMS overview, QA Agile, Defect Prevention (DP), Software Config mgmt (SCM), QMS overview, Agile - Level 1, Quality assurance and Verification - Test Solution & Consulting

Confidential

Driver

Responsibilities:

Responsible for client relations.
Demonstrated ability to deal peacefully with unforeseen circumstances or delays and use advanced driving techniques to better improve time management and safety
Assured that the vehicle is maintained in excellent condition and is cleaned regularly and In-depth knowledge of vehicle maintenance is applied
Drive V. I. P. to various destinations upon request, with knowledge of various cities and efficient routes
Neat and smart appearance, customer friendly and intellectual individual with desire to exceed expectations.

Confidential

EDI / eCommerce Support Operator - Senior Team Lead

Responsibilities:

Responsible for incoming provider calls and issues.
Responsible for running EDI Call center and HelpDesk
Responsible to work IT Helpdesk tickets.
Responsible for user password and trouble shooting.
Responsible for on call overnight and after hours, IT helpdesk related issues.
Strong knowledge base of security protocols such as secure web mailbox, SFTP, PGP, and HTTPS and NYS DFS laws.
Strong Phone skills. Strong Lynx skills
Strong knowledge with AWS Cloud and Azure (currently enrolled in AWS solutions architect certificate class)
Strong working knowledge of several major Health Care transaction sets (270/271, 276/277, 820, 834, 835, 837I, 837P, 997, 999, 277CA, 277U, HL7).
Understanding of EDI-B2B processes and standards (X12, HIPAA, HL7).
Skilled in reading and interpreting EDI mapping specifications
TSM/IBM Oracle Ultrium2,3,5 and 7 storage knowledge
Experience with CyberArk, ZenDesktop, ZenApp, RDP, SSH, Putty, PowerShell, AVAYA, Foresight, Tidal, WorkDay, ServiceNow, Service Anywhere

Confidential

COB / Claims Adjudicator Specialist - Senior

Responsibilities:

Responsible for adjudicating claims against established criteria and address incoming inquires to ensure that all claims are paid in support of established rules, regulations, performance guarantees and department targets.
Completeknowledge of CMS1500, CMS1450, UB and CMS claims
Fully trained in all claims positions in HeathRules, also created most claims SOP’s for the system while working with other departments to get the processes correctly established.
Responsible for writing and updating Standard Operating Procedures.
Responsible for training, coaching, mentoring new team members.
Highly experienced in Confidential ’s core systems (HealthRules, Power, MACESS, and Siebel applications).
Skilled in Power, Siebel, Core +, RX claim, PowerShell, MIDS GUI Reveal, Princeton, MACESS, MBI, Word, Power Point, Excel, Access (2003 & 2007)

Confidential

Member Services Representative - Specialist

Responsibilities:

Responsible for responding to inquiries and requests from members and other departments regarding eligibility, benefits, claims status, and appeals in accordance with established policies and procedures.
Customer service experience with demonstrated ability to deal with complex situations
Responsible for maintaining the privacy of our members protected health information.
Trained in Complex Accounts, Pharmacy Benefit Management, and the answer line, and in doing so I was able to coach and mentor less experienced team members
Ability to clarify and educate Member Service Representatives on product and plan benefit procedures.
Backed up claims in backlog situations as working as a part time Adjudicator
Customer focused, detail oriented and great time management skills.

Confidential

Assistant Sales Manager

Responsibilities: