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BlueCross And BlueShield of Tennessee - Configuration Quality Analyst I-Business Analytics & Relationship Resume Example

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CONFIGURATION QUALITY ANALYST I-BUSINESS ANALYTICS & RELATIONSHIP
Professional Summary

Accomplished quality configuration analyst skilled in the development and ongoing maintenance of my department's quality program and related functions associated with the testing of configuration changes. Exceptional ability to participate in as well as lead meetings in order to ensure collaboration between key areas of responsibility.

Skill Highlights
  • Maintain a thorough understanding of policies and guidelines.
  • Prepare written reports, document issues as well as update tracking databases as discrepancies are found.
  • Run queries to identify possible dollar errors associated with inaccuracies.
  • Project management.
  • Work well with my team in order to satisfy and/or exceed expectations and goals set by management.
  • Collaborate with my team in order to identify opportunities for improvement as well as ways to streamline current processes.
  • Available for other tasks as deemed necessary by my management team.
Accomplishments
  • 14 years of experience working in a client/customer support position.
  • 10 years of experience in the healthcare industry, which has included working with large account in the commercial market with health management products.
  • 6 years working as a liaison between group administrators and brokers as well as collaborating with account executives in order to successfully respond to inquires related to open accounts.
  • 4 years of educational experience in the research methodology of Psychology which included cultural change strategies, population management as presentation skills.
Professional Experience
BlueCross And BlueShield of Tennessee Chattanooga, TN Configuration Quality Analyst I-Business Analytics & Relationship 12/2014 to Current
  • Develops and maintains the department's quality program materials, and continuously evaluates these materials for improvements.
  • Performs audit plan, claims regression test, control evaluation, report drafting and issue remediation.
  • Analyzes and documents test results and finalizes approval of results.
  • Work closely with configuration staff and audit colleagues to identify and assess risk and controls to support adequate audit coverage.
  • Prepares and runs database queries to help identify system issues utilizing SQL, Access and/or Cognos.
  • Management of multiple assignments with critical deadlines.
  • Communicate effectively and professionally with all levels of staff.
BlueCross And BlueShield of Tennessee Chattanooga, TN Benefits Representative-Single Point of Contact 04/2008 to 12/2014
  • Main contact for 30 groups to analyze and problem-solve a wide variety of issues.
  • Exceptional oral and written communication to brokers, group administrators and subscribers/members.
  • Work independently and excel in a team environment.
  • Reflect excellent leadership skills by serving as a backup Team Lead and absorbing additional tasks in the absence of coworkers.
  • Special group project management for 30 groups.
  • Collaborate on the transition period for new accounts with a change management approach to ensure proper set up of benefits as well as membership guidelines.
  • Advanced use of Microsoft products including: Word, Excel, Outlook, PowerPoint Quicken; Word Perfect; Internet/Intranet proficiency; Facets; Caremark; IPD; BlueCard; Genesys Soft Phone; Cognos; Access; CareAdvance Recognized for high productivity, accuracy and quick turnaround.
  • Facilitate training of new employees.
  • Conduct research on groups and be able to demonstrate presentations as needed.
  • Knowledgeable in Facets medical and dental applications.
BlueCross and BlueShield of Tennessee Chattanoooga , TN Consumer Advisor-Major Accounts 02/2006 to 04/2008
  • Exceeded divisional goals in phone accessibility time and accuracy rate for customer service inquiries.
  • Keep superior analytical and technical skills while working with 500 members' group accounts.
  • Maintained a thorough knowledge of HIPAA laws regarding the release of PHI.
  • Addressed calls in a quick and thorough manner while receiving Kudos statements from several members for exceptional service.
  • Trainer for new hires that came thru which resulted in them being successful in the position as well.
Education and Training
Bachelor of Arts: Psychology University of Tennessee, Chattanooga, TN Psychology
Associate of Arts & Associate of Science Degree: Science and Arts Roane State Community College, Harriman, TN Science and Arts
Skills
  • Excellent computer skills with direct experience in MS Office, Word, PowerPoint, Excel and Access.
  • Outstanding written and oral communication skills which include presentation and team facilitation.
  • Proven ability for the management of multiple tasks and priorities.
  • Strong analytical skills with a knowledge in basic statistics.
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Resume Overview

Companies Worked For:

School Attended

  • University of Tennessee
  • Roane State Community College

Job Titles Held:

  • Configuration Quality Analyst I-Business Analytics & Relationship
  • Benefits Representative-Single Point of Contact
  • Consumer Advisor-Major Accounts

Degrees

  • Bachelor of Arts : Psychology
    Associate of Arts & Associate of Science Degree : Science and Arts

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