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Claims Processing Analyst Resume

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Richardson, TexaS

SUMMARY:

Over 25 years experience in RPG application development, enhancements, and support and 10 years Integration/Conversion projects experience on the AS/400 platform.

  • An analyst who evaluates the user’s need with sensitivity and respect for the work of prior programmers and effectively presents alternative solutions for the preferred result.
  • An experienced, creative programmer who delivers objectives promptly and on target, with efficient processing, increased productivity, data integrity, and user satisfaction.
  • A dedicated and highly motivated programmer, who learns your systems and takes ownership of projects.
  • Skilled in management of full project life cycle; concept through implementation.
  • Well structured and comfortable functioning in a virtual environment, both independently and in teams.
  • Self - disciplined with to attention to detail, a quick-study, able to prioritize and handle multiple responsibilities.
  • Strong written and oral communication skills.

TECHNICAL SKILLS:

  • Job Control: OCL Procedures and CL Programming (CLP)
  • Language: COBOL RPG II, RPG III, RPG IV, ILE, FREE
  • Arrays: Data Areas; Data Structures, DB2 and SQL Functions
  • DDS:Physical Files, Logical Files, Join Files, Data Dictionaries, DSPF PRTF
  • Screen Design Aid (SDA): Menus, SBFL CTLFL Programming
  • File Transfer Protocol (FTP): Download data to As400 from Excel Spread Sheet
  • Query/400 and Open Query File (OPNQRYF),Hawkeye,Turnover,Aldon,Amigo
  • System Administration:PTFs, System Values, Basic Configuration
  • Security Administration: User Profiles, Authorization Lists, Object Authority
  • Operation: Backup & Restore, Print Management, Job Scheduler
  • SEU RLU DBU STRDBG: Statement processing for data.
  • DB2 and SQL/400 Functions and Store Procedures

Hardware:

  • IBM AS/400 RPGIII,IV,ILE FREE
  • IBM System 36

Software:

  • HealthCare Data Load
  • HealthCare Regression Analysis/testing
  • HealthCare Claim Adjustments
  • Financial (A/P, A/R, C/R, P/R, G/L)
  • Insurance Application
  • Sales (Credit, Order Entry, Scheduling, Invoicing)
  • Inventory Management, Raw Materials through Finished Goods (Forecasting, Purchasing, Material Receipts, Shop Floor; Shipping)
  • Manufacturing and Warehouse Distribution
  • Experience: BPCS, Confidential PARMS, JDE(conversion), Genelco (Insurance)

Desktop:

  • Windows 95/98/NT/XP
  • Emulation Software: Rumba, Client Access, Mocha 5250
  • MS Office: Word, Excel, Access,

PROFESSIONAL EXPERIENCE:

Confidential, Richardson Texas

Claims processing Analyst

Responsibilities:

  • Claims processing Analyst In Reverse and Re-Submit Processing, coming from Daily/Hourly submissions of claims, in the Operational submission issues. Apply data updates to process completion of the submitted jobs.
  • DataLoad of claims from pharmacies to RxClaim application.
  • Triarge Analyst on As400 Platform, solving Data issues, in the areas

Confidential, Merrimack NH/Boston, Ma

Claims processing Analyst

Responsibilities:

  • Project: Applications Decomposition Documentation and related programming/analysis/testing/group meetings with user community. About 50 plus program High level and detail program logic level documentation.
  • At the same time, designed, xls spread sheet report, using query manager, on Iseries AS400. Process on daily basis, receive data, via ODBC driver, from AS400 data base, to xls spread sheet.
  • Setting up refresh button for user, to retrieve most current transaction to view and keep in user’s folder. Programming done in RPGLE,SQL and CLP languages.
  • User testing was performed and implemented to production By Aldon implementer.

Confidential

Claims processing Analyst

Responsibilities:

  • Have completed two Projects successfully implemented in a team environment.
  • Other functions: 24/7 Production support for current applications
  • In a group effort, did two detail level FTC Compliant project in mortgaging area of Interest, price and couple other variables changes to calculate new payments. The project requirements. Came up with more than 20 plus programs, were done in RPG, Sql and Store procedures.
  • Simultaneously did number of small efforts, maintenance, program developments, using RPG all versions, SQL, SQLRPG and Store Procedures.
  • All efforts were user tested prior to production implementation.
  • Jul2007/To Dec2010: Digital Infinity System: In Iseries development environment, Mfg/Inv project (inhouse) remotely on As400 Platform, programming with RPG 2,3 4, ILE,Free (all versions). On going maintenance and enhancements twenty-four seven.

Confidential, CA

Claims processing Analyst

Responsibilities:

  • In Iseries development environment, mostly working on Integration projects, Billing cycles, Processing Batched POS transactions, and on going maintenance. Trouble shooting, testing etc. Setting up Billing cycle tables with variable products line codes.RPG III/IV/Ile on As400.Files were being interfaced with JDE software.
  • A leading e-Business services provider. Employed as fulltime, working at a client site in Seattle as RPG code developer in manufacturing environment. Rpg3/4 ile. Project: Developed Master Scheduling System to integrate with Shop Floor System. Set up flow charts, physical file layouts that integrated with current Order Entry module and various other outside applications. Writing various user friendly reports, inquiry programs after doing lot of analysis and testing, and then put in production environment. RPG III/IV/Ile on As400
  • Maintenance is always an ongoing ultimate process. For future use, more information is stored in data base files can later be used for reports and programs and functions. As time went by, new affiliations of companies, required more maintenance and integration. Tools used DBU/Hawkeye
  • Lot of monitoring, testing, changes on daily, monthly basis, due change of functionality.

Confidential, CA

Claims processing Analyst

Responsibilities:

  • Working on an Integration Project for newly acquired business to Genelco Application. Lots of programming, analysis, design, reports etc, in an As400 platform, with RPGILE. Worked closely with group of programmers with this project for utmost coordination with scheduled meetings to report progress of assignments. Tools used DBU, Hawkeye, and Turnover.
  • Maintenance, trouble shooting etc: Due to complexity of the project, integrating to Genelco Application, almost daily dealing with, changes to database files, add new logical files, modify existing programs, writing to interfacing programs, modules etc. File Trigger programs.
  • Testing, documenting programs prior to Live Installation. Monitor nightly scheduled process and programs. Made changes to online display screens and programs modules. Made changes to complete the run of the jobs. Worked very closely with respective users, for signoff on reports, took required notes, noted requirements and gave completion period/testing etc. Reformatting data from various sources, converting to Genelco format database files. Worked after hours, even on Saturdays. RPG III/IV/Ile on As400

Confidential, CA

Claims processing Analyst

Responsibilities:

  • Credit Card Online processing application programming in RPG ILE AS400 environment.
  • This company grew up with from earlier years with various packages and S/36 and AS400 platform with RPG languages - RPG2/3, RPG400 and RPGILE.
  • I have been working these languages as years went on.
  • This constitutes Maintenance requirement for programs, modules, procedure and files and update processes.On going Maintenance of various packages.
  • From home grown applications, Pacific Island and Jde data base files, used to extract data for adhoc reports.
  • Process to create temporary files and programs and modules and later to regular menu/job processing for scheduled functionality (Daily, Monthly etc.).
  • Worked from home on critical issues. On call 24/7.

Confidential, San Francisco, Ca

Claims processing Analyst

Responsibilities:

  • Financial Applications, Assignment description: Conversion of data (AP, AR history, Customers, Vendors) from Confidential and Dyanax packages to JD Edwards, on AS/400 RPGIII/IV environment.

Confidential, Los Angeles, Ca

Claims processing Analyst

Responsibilities:

  • Programmer in BPCS Financials & Manufacturing environment for 9 Months on Y2K project and later ongoing projects in AS/400 RPGIII/IV and ILE.
  • ISDB - Source debug used extensively.
  • Tools used DBU, Hawkeye.

Confidential, Sacramento, Ca

Claims processing Analyst

Responsibilities:

  • For Mortgage Division - Designed, Programmed, Tested and implemented an Auditing System for Loans - 6 Month. London Bridge applications
  • For SBA Loans Division, helped implementing a Loan Servicing Application, Customize, Analyze to produce new reports and processing procedures. Programming done in AS/400 RPGIII/IV/ILE and in some cases in S/36 RPGII environment.

Confidential

Senior Prog/Analyst

Responsibilities:

  • A major Wholesaling, Retailing and Distributing Corporation in Bay Area- (San Francisco Area) in Food, having Petrini's Stores, Costless Stores, New Deals Stores and Three Warehouses; In Santa Rosa, Modesto and Tracy, all in Northern California.

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