Developmental Specialist with talent for Data based solutions and innovation. Strong knowledge of Claim processing, System functions including Business Release Defect resolution and Benefit testing. Extensive Bluechip experience, systems training, knowledge of Benefit Coding, and Automation creation. Communicative and team-oriented with proficiency in EDW. Proven history of fostering analytical processes and solutions to meet team, individual and management objectives.
Skills
Data processing
Detail Oriented
Training program development
Relationship building
Program performance assessment
Data extraction
Tools customization
Report generation
Project lifecycle
Statistical Analysis
Experience
09/2016 to Current
Developmental SpecialistThe May Institute Inc – Weymouth, MA,
A cornerstone member of the Claims Integrity Mental and Behavioral Health Unit fostering process development, training, continued growth, and critical in the on-going relationship with our Clinical department.
Evaluated client processes, employee performance and training progress to determine additional work-flow and training needs.
Developed complete training programs and led training using expert learning techniques..
Blended business's goals, mission and values with learning development initiatives to deliver high-quality training to employees.
Cross-trained on UAT, EDW, PEAT, CLAP, DISCO, CHESS, Checkers, Sequence, and Promote applications.
Partnered with the CHESS Team to coordinate logistics, script creation and create business success in our Mental and Behavioral Health initiatives and programs.
Performed root cause analysis of data to develop counter-strategy and improve performance.
Managed projects and served as primary liaison between client and multiple internal groups to clarify goals and meet quality standards and deadlines.
Reduced organizational operating costs by streamlining processes.
Manipulated data using pivot tables, pivot charts and macros in Excel.
Reviewed company software and business programs to determine value and assess viability in live environment.
Diminished project gaps to facilitate smooth inventory workflow while reducing task duplication.
Developed and implemented of the Pre-Pay and Resolution Helper process automation tools.
Produced in-depth analyses and proposed solutions to meet complex business needs.
Worked alongside team members and leaders to identify analytical requirements and collect information to meet customer and project demands.
Tested prototypes and final products for quality and compliance with design specifications.
Met with managers, vendors and others to solicit cooperation and resolve problems.
Engineered detailed, comprehensive and well-structured test plans and test cases to identify and correct system errors.
Communicated automation test results to team members and highlighted potential risks.
Managed, troubleshot and improved system and benefit coding.
10/2014 to 09/2016
Senior Claims TechnicianHcc Life Insurance – Houston, TX,
Systems experience in Pricing, benefit, accumulator and in-depth system edits and claim locks resolution.
On-boarding of new Vendors, Business Plans, Customized Groups and Retail Market Organization Policies.
Improved operations by working with team members and customers to find workable solutions.
Integrated new technologies to meet area requirements.
Collected, organized and input information into digital database.
Troubleshot and resolved problems with programs and systems.
Created reports detailing findings and recommendations.
Assisted with post-implementation troubleshooting of new applications and application upgrades.
Utilized knowledge of data modeling and statistical analysis to note trends and draw conclusions.
Developed streamlined task system to provide more effective workflows for both peers and management staff.
02/2012 to 10/2014
Claims ExaminerHealth Care Service Corporation, HCSC – City, STATE,
Bluechip Claim Processing, data processing, benefits analysis.
Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
Analyzed information gathered by investigations and reported findings and recommendations.
Researched medical, dental, behavioral health and vision claims for validity to resolve discrepancies.
Contributed to development, planning and completion of project initiatives.
Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Education and Training
Expected in 05/2008 to to
Bachelors of Science: Health Science Truman State University - Kirksville, MO, GPA:
Expected in 05/2006 to to
High School Diploma: Canton R-V High School - Canton, Missouri, GPA:
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