SUMMARY

Experienced IT professional with extensive years of success in the analysis, design, development, and implementation of large and medium scale information systems in health care, insurance, banking and manufacturing applications. Self-motivated professional with extensive and diverse technological and business knowledge. Possesses solid analytical and multi-tasking abilities including excellent written and oral communications skills. Enthusiastic team player, quick learner with a logical mind set. Demonstrated project management abilities and mentoring skills. Ability to bridge communication gap between business and IT teams. Intelligent, personable, effective mentor and liaison.

Methodologies

System Development Life Cycle SDLC , Systems Analysis and Design, Business Process Analysis and Design, Business and Functional Requirements Development, Gap Analysis, Interviewing, Data Administration, Relational Database Modeling, Project Management.

Technical

Software:

• COBOL, CICS, DB2 SQL, QMF, SPUFI, DB2 utilities, Stored Procedures , VSAM, EZTRIEVE PLUS ,TSO, OS/JCL, MQSeries, IBM Utilities, IDCAMS, FTP, NDM, IMS DB FOCUS, Z/OS, VM/CMS, Windows XP.
• Tools include: FILEAID, EXPEDITOR, ENDEVOR, ABENDAID, INTERTEST, PANVALET.
• Application experience includes Microsoft Office, Lotus Notes, Microsoft Outlook, and Visual Basic.

Professional Experience

Confidential

As a Senior Analyst/Developer and a member of an application development team was responsible for major enhancements to the Dental Network Savings Program. Current product and plan designs did not exploit the recently introduced segmented DPPO networks Dental Network Segmentation Phase 1 on par with key competitors. This project provided Dental with an enhanced product and network capability to compete more effectively by offering an out of network Dental Network Savings benefit. PPO networks were enhanced to utilize third party dental networks along with contracted networks as a non-participating cost containment network wrapper. A reduction in plan and member non-participating claim costs was achieved.

Environment: z/OS, Batch Job JCL/PROCS, DB2 SQL, SPUFI, QMF, Stored Procedures ,

COBOL, CICS, VSAM, EZTRIEVE PLUS, Batch/Online, Systems/Acceptance level testing

Confidential

• As a Senior Analyst/Developer and a member of the Great West Integration application development team. Responsibilities included migrating specific processing related to Great Confidential products to Confidential. This entailed moving the Pharmacy business from the current outsourced relationship with Express Scripts ESI , to the following locations:
• Confidential: claim adjudication, concurrent clinical programs
• Confidential: retrospective and concurrent clinical programs, rebate billing
• Confidential: mail order drug fulfillment
• The development effort required significant modification to many of the current CIGNA pharmacy programs plus the need to create additional programs to support Great West business functionality not currently supported in the CIGNA pharmacy IT environment.

Environment: z/OS, Batch Job JCL/PROCS, DB2 SQL, SPUFI, , COBOL, VSAM, EZTRIEVE PLUS, Batch/Online, Systems/Acceptance level testing

Confidential

• As a Senior Analyst/Developer responsibilities included major enhancements, network segmentation, production support, triage and resolution.
• Enhancement was to have a significant impact on the way Dental claim processing was to be handled. Numerous production programs had to be modified to accommodate additional DB2 tables and significant coding changes were also required.
• Tasked to research and resolve open production Service Request issues. Required interaction and coordination with Dental Claims System business and IT personnel.

Environment: z/OS, Batch Job JCL/PROCS, DB2 SQL, SPUFI , CICS, COBOL, VSAM, EZTRIEVE,

Batch/Online, Systems/Acceptance level testing

Confidential

• Business Analyst position where duties included: Wrote Application Design Specification documents for:
• Payee File Feed and Payee Agent Tables Updates
• Licensing File Feed and Licensing Table Update
• Agent Training File Feed and Training Table Update
• Prepared the detailed testing plans and scenarios to support
• checkout of application readiness for production.

Environment: z/OS, DB2 SQL, SPUFI , CICS, COBOL, VSAM.

Confidential

• As a Senior Analyst/Developer and a member of an application development team was responsible for alignment of EOB's for dental claims with Medical EOB's. Goal was to present a uniform look to the EOB's mailed to members and Providers. This required a major redesign to the look and feel of the dental EOB's. Finished product was to produce significant cost savings due to more efficient mail processing.
• Tasked with the responsibility for designing a methodology of bypassing complex, archaic processing rules and coding in order to provide a new interface file which would be used to print the new EOB's.
• Analysis required verification that no other current application uses of the current EOB data files would be impacted

Environment: z/OS, DB2 SQL, SPUFI, QMF , COBOL, VSAM, EZTRIEVE

Confidential

As a Senior Analyst/Developer and a member of an application development team, task required extensive communication with Webster Dental part of CIGNA's dental business area in order to analyze business requirements, design table structures, coordinate programming, and test criteria. Enhancement critical to improving the speed and accuracy of Dental claim processing.

Environment: z/OS, DB2 SQL, SPUFI, QMF , CICS, COBOL, VSAM, EZTRIEVE.

Confidential

• As a Senior Analyst/Developer and a member of an application development team, tasked with implementing HIPAA Privacy for CSS application Customer Service System interfacing with MRR Member Rights Repository . Effort included analysis, design, coding, testing, and implementation. Technology of application includes PC based application using CICS Client Services interfacing with CICS/DB2 programs.
• PAL Referrals HCIN Eligibility Benefits Applications. Provided primary production and enhancement support. Systems interfaced with MEDUNITE, CED, National Accounts ,Non-National Accounts, Medicom, Cigna Claims, and Proclaim. Application technology included batch and on-line processing against DB2 tables.
• Tasked with business analysis, system design, and program coding and testing in EDI application for

HIPAA transactions:

• HIPAA 270-271 Eligibility Inquiry and Response
• HIPAA 276-277 Claim Status Request and Response
• HIPAA 278 Services Review Request for Authorizations

Environment: z/OS, DB2 SQL, SPUFI, QMF , CICS, COBOL.

Confidential

As a senior application developer, I was a member of the team that designed, programmed, and implemented the CPF/ICMS Wrapper. Application effort incorporated the IBUS middleware application utilizing the Event/Message Mover Service. Application environment included interfacing with the Provider Workbench application using CICS Client Services. Application programs were written in Visual Basic and Cobol with DB2 providing the database services.

Environment: z/OS, DB2 SQL, SPUFI, QMF , CICS, COBOL.

Confidential

• Tasked with performing compliance testing on client data interfacing with major claim paying engines CHP, Medicom and Dentacom . These systems were cross platform DB2, BDAM and VSAM. Thorough evaluation of data would determine if they were Y2K compliant or if there were client specific data integrity errors. Results of analysis to be reported to the business area.
• Utilized DB2 table tools SPUFI and QMF to provide client specific information.

Environment: z/OS, DB2 SQL, SPUFI, QMF , COBOL, VSAM, BDAM.

Confidential

As major point person, utilizing Confidential standards, remediated account level IMS databases known as CMF/CASD. These databases were utilized by claim engines National, Medicom and Dentacom to create extract files for many of Confidential s other major applications. I was responsible for validating the quality of the outsourced programming remediation effort supporting these databases and the extract processes. Additionally, I was primary production support for correcting database access errors and database repair.

Environment: z/OS, CICS, COBOL, IMS, VSAM.