Senior Consultant resume example with 20+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
Professional Summary
  • Hardworking and reliable team player focused on going above and beyond to support team and serve customers. Trained in Compliance Reporting and offering top-notch project lead abilities. Quick learner, seeks out opportunities to go beyond basics, improve processes, and increase customer satisfaction.
  • Successful Senior Consultant equipped to address complex challenges with analytical and forward-thinking approach. Delivers remarkable business results through expert handling of necessary updates, developments, and process scaling. Always ready to tackle challenging obstacles and transform operations.

    Hardworking and Reliable

    Data Mining Experience

    Project Lead Experience

    Analytical Thinking

    Problem Solving

    Compliance Reporting Experience

Work History
Senior Consultant, 07/2011 to Current
Manhattan AssociatesAtlanta, GA,

Started as a Consultant working on several APCD's. My first year, covered and closed for the Project Lead of P8371 during a 6 week period to update various documents including SharePoint, logging issues, work with ADS, mentor and answer questions, hand out work, and complete peer reviews to keep the project going and to complete by the deadline.

I was a Primary for several APCD's, worked on completing APCD projects, submitted files to the state and doing many peer reviews including assisting Project Leads with variances to meet our deadlines.

I was promoted to a Senior Consultant in 2015 -

I am currently Primary for 5 APCD's (CO,CT, NH, KS and RI)

I have assisted several Project Leads with APCD's (UT_APCD, CO_APCD, CT_APCD) completing variances, submitting reports.

Currently this year, Worked on testing files from the ground up for Teradata for RI and CT, running hundreds of projects, working on difficult logic, working on CQ Validations in addition to keeping up with our normal everyday APCD work to meet our deadlines

Here are some larger projects I worked on over the years:

NY HCRA Project on the ACAS side, attending daily calls, working on logic and ACL work for Provider Trigger Files, Provider Flag Files, Customer Ops, Report 8, Exclusions, Medicare, Drilldown etc. Completing yearly ACL projects and reporting issues found in data.

Next Gen - Worked on creating Eligibility/Medical projects from the ground up, creating/building logic to compare to HRP/Standard file etc. Had to review multiple files to make sure issues were fixed.

Took the lead on new Quality Audit being done for APCD's, complete 8-10 reviews each month and answer questions. Responsible to make sure reviews are completed every 15th of the month.

UT_APCD, UT over 100K, UT 3M Totals Project which included appending over 35 files together and creating difficult logic, UT Dupe Project, UT Milliman Total Counts/Dollars

Was tasked with working with Internal Audit for the State of NY (ER Non Par Provider Balance Bill) claim review for Casey Lee’s area, completed extensive research on over 500 reviews successfully


Quality Analyst/Consultant/Project Lead, 09/1995 to 07/2011
Change Healthcare Inc.Pittsburgh, PA,

Took the lead on the HMO System converting to the USHC system. Trained

several new Quality Analysts on this new System. Worked on customer service Audit.

• Completed several projects to improve HMO accuracy for Internal Audit and the

Mount Sinai Project working with our business partners receiving the Service

Excellence Award

• Worked on maintaining and updating Access Database for rebuttal handling

• Worked with Application Developers to create the Claim Quality Assurance

application for quality rebuttals.

• Senior Quality Analyst and Team Leader handling, workflow, rebuttals, reporting

and performance. Various Projects completed NY DOI, HCRA, DRG, HEDIS, and

Medical Claim Ratio. Worked with Policy to report and fix unclear issues.

• Worked with the contracting area to report and clarify unclear contracts and rates

which included reporting possible projects to our overpayment recovery area

• HMO System Manager handling segmentation for Quality Reporting. Reporting

system problems for HMO and Auto Adjudication working with our segment partners to

fix and test the problems to improve quality

• Supported the HCRA audit including 12 Presentations for the Monthly Dashboard

and trending calls with our business partners

• Took the lead for Regional Business Stratified Audit; this includes working with the

Segments during the Validation process

• Completed Adhoc Reporting MCM Solutions class in 2007. Requesting reports for

specialized audits.

• Took the lead on a 45-day CQA testing for ACAS working directly with the

programmer for a successful rollout holding numerous presentations with our business


• Lead and Managed large amount of testers for Major upgrade for CQA Tool

Enhancement and CQA Dual Role


Claim Processing Specialist, 07/1993 to 09/1995
CVS Aetna -Commercial/Medicare ClaimsCity, STATE,

Processed high dollar hospital claims for HMO Commercial and Medicare in a highly productive environment

High School Diploma: , Expected in 06/1986
Wilson Area High School - Easton, PA

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Resume Overview

School Attended

  • Wilson Area High School

Job Titles Held:

  • Senior Consultant
  • Quality Analyst/Consultant/Project Lead
  • Claim Processing Specialist


  • High School Diploma

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