SUMMARY:

• Highly motivated individual with an extensive testing/claims background, administrative support, presentation and research.
• Specialized in implementation development in a team environment as well as analyzing, configuration and researching daily operations to ensure first call resolution and customer satisfaction.

PROFESSIONAL EXPERIENCE:

Confidential

QA Tester/Sr. Claims/Provider Configuration

Responsibilities:

• Developed use cases, and traceability matrices to better assist software development.
• Developed training material for understanding the newly developed application.
• Wrote technical documentation for root cause analysis on customer support issues.
• Part of the team assisting in documentation such as proposal writing, evaluation criteria, proposal approval, design document, project plan, project scheduling and project report.
• Prepared and presented monthly collection reports.
• Involved in training and quality of the overall workflow process.
• Creating and analyzing numerous clients’ reports for various financial requirements
• Led both internal peer review and external reviews of use case specifications and in the process clarifying the critical requirements.
• Met with business teams as well as test teams to review the requirements as outlined in the use cases.
• Experienced in developing test plans, test conditions and test cases to be used in testing based on business requirements using Quality center.
• Created and maintained the Requirement Traceability Matrix between the requirements and other products such as design documents and test plans.
• Familiar with User acceptance testing (UAT), System testing, Integration testing and Regression Testing.
• Developed use cases, and traceability matrices to better assist software development.
• Developed training material for understanding the newly developed application.
• Wrote technical documentation for root cause analysis on customer support issues.
• Part of the team assisting in documentation such as proposal writing, evaluation criteria, proposal approval, design document, project plan, project scheduling and project report.
• Prepared and presented monthly collection reports.
• Involved in training and quality of the overall workflow process.
• Creating and analyzing numerous clients’ reports for various financial requirements
• Led both internal peer review and external reviews of use case specifications and in the process clarifying the critical requirements.
• Met with business teams as well as test teams to review the requirements as outlined in the use cases.
• Experienced in developing test plans, test conditions and test cases to be used in testing based on business requirements using Quality center.
• Created and maintained the Requirement Traceability Matrix between the requirements and other products such as design documents and test plans.
• Familiar with User acceptance testing (UAT), System testing, Integration testing and Regression Testing.
• Working with HL7 (a standards - based representation of patient data, financial data, medical results, and/or orders) Analysts, integration and other department members in testing HL7 interfaces requirements, technical HL7 specifications, and XML configurations.  
• Communicating with all levels of the organization, both written and verbally, in a clear and concise manner and delivering informative, well-organized project updates.
• Managing multiple projects concurrently, monitoring the status of projects containing multiple resources and escalating issues when appropriate.
• Participating in continued support of integrated application systems and troubleshooting and optimizing any functional issues that may arise.

Confidential, Atlanta, GA

Membership Specialist

• Load applications on members and groups, research/analyze problems
• Track errors and audit trends for audit results, providing feedback to management and associates
• Examined, evaluated the accuracy of claim transactions regulations and company guidelines
• Drafted and sent informational correspondences to customers
• Continuously improve customer relations by explaining policy issues and investigating concerns
• Employer access group maintenance
• Group setup, add/remove users, and modify group information
• Database maintenance for new and cancelled groups
• Installation of benefit changes, rates, calculations of Life, STD, LTD
• Review and approve new sold case materials
• Knowledge of medical terminology, coded and processed medical and hospital billing charges

Lead Specialist III

• Up sale life insurance policies
• Load applications on members and groups, research/analyze problems
• Track errors and audit trends for audit results, providing feedback to management and associates
• Examined the accuracy, appropriateness of claim transactions with regulations and company guidelines
• Group setups, add/remove users, and modify group information
• Installation of benefit changes, rates, calculations of Life, STD, LTD
• Knowledge of medical terminology, coded and processed medical and hospital billing charges
• Assisted in facilitating training seminars with physicians offices on insurance products
• Gather information to create monthly and quarterly reports