Jessica Claire
  • , , 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:

Seeking to build my knowledge within UnitedHealthcare as I branch into new challenging areas. Self-motivated Data Analyst offering 10 years of leadership experience across various industries. Methodical with significant experience in data mining and statistical analysis. Excellent problem-solver with history automating processes and driving operational enhancements. Logical Data Analyst skilled in requirement analysis, software development and database management. Self-directed and proactive professional with 5 years of vast experience collecting, cleaning and interpreting data sets. Natural problem-solver possessing strong cross-functional understanding of information technology and business processes.

  • Data quality
  • Business management
  • Microsoft Access
  • Administrative oversight
  • Project management
  • Data gathering
  • Failure analysis
Senior Provider Data Analyst, Project team, 12/2016 to Current
United HealthcareCity, STATE,
  • Works with Network Management team to ensure providers are loaded correctly within the major systems by reviewing and completing cases submitted by Network team in Impact
  • Review contractual and demographic data currently loaded within NDB, FACETS, Nice, and Cosmos
  • Run various reports to assist with review of groups, i.e
  • Danner Tool, NDAR, NPPES, AMAARDI, etc
  • Audit provider contracts to review correct contracts are loaded for reimbursement via Emptoris/CLM and NDB to complete cases submitted by NAM
  • Completes Direct Loads for updates/corrections that can be manually completed
  • Submits automated requests through Titan making needed provider updates within various systems, COSMOS, NDB, etc
  • Submit PhyCon PR’s and RESCU (for Urgent cases) for requests that need an in-depth review or correction
  • Complete Audits of work to ensure request was completed correctly
  • Respond timely to clarifications for the loading team to complete their process
  • Assist team members when and where able to – questions or completion of tasks when assistance is needed
  • Complete Audit review of Rosters for provider group to ensure providers are loaded to all contracts as well as locations
  • Work in unison with provider and/or Network to obtain data needed to complete audit as well as submit case for group correction
  • Back up for “Quarterback Position” which entails managing new Project cases that are assigned to our Project queue, reviewing that all pertinent information is attached, working with Network to gather additional information, and assigning cases to team members to complete
  • Special project with completing NPN provider updates.
Prior Authorization Supervisor, 12/2011 to 12/2016
United HealthcareCity, STATE,
  • Recruits, screens, and selects applicants for Coordinator positions
  • Ducates all staff on revised job processes
  • Nsures proper training of new staff by utilizing the resources available within the team, i.e
  • SOP’s, Job Aids, DES, etc
  • Assign work to staff
  • Anages mentors and supports staff on a daily basis
  • Evelops and mentors SME’s
  • Ssists on M&R line of business
  • Evelops clear goals and objectives for performance management and effectively communicate accountability as well as setting and achieving goals such as Quality and Metrics
  • Reates a culture and atmosphere that will lead to team's overall job satisfaction, identifying and addressing possible work barriers
  • Mplements and evaluates strategies to improve performance including work improvement plans and making final determination on terminations of employment
  • Tilizes management reports for the department to assess performance of entire team, identifying areas of improvement and putting action plan in place
  • Analyze and identify trends with inventory, adjust gaps and allocate staff where needed to ensure inventory is properly covered
  • Review daily inventory and provide case volume to business partners on morning call
  • Acilitate weekly huddle with team to review new processes, patterns of issues or address any questions
  • Complete Monthly 1:1’s to review Audits and Metrics as well as any case issues found
  • Attend various Business Partner calls, i.e
  • Annual Grid review, meetings with the plan to discuss changes/transitions, implementations of new business, manager Weekly meeting, etc
  • Work with RN Staff daily to ensure cases are managed in a timely manner
  • Et up and review employee Annual performance reviews, and goals for the coming year
  • Ork cross-functionally with Management to promote the Coordinator function within the Company
  • Assisted with the Military and Veterans project
Financial Counselor Supervisor, 12/2009 to 12/2011
Ironwood Cancer & Research CenterCity, STATE,
  • Responsible for supervising 16 employees between the Gilbert, Chandler and Mesa offices
  • Oversee productivity with the Financial Counselors which include meeting with patients to review their estimated cost for treatment, reviewing other options of funding such as assistance programs and drug replacement assistance
  • Acquire benefits and authorization for various insurance plans, including Commercial Insurance (E&I), Medicaid (C&S) and Medicare (M&R)
  • Reviewing claims processing and ensuring that claims have processed according to patients benefits and reviewing with patient 1:1
  • Monitoring that employee’s complete log for each date of service in a timely manner
  • Completing regular audits of each employee to make sure they are following proper Policy and Procedure
  • Developing and adjusting Policy and Procedures and implementing changes with staff due to business changes
  • Completing probationary period reviews as well as yearly reviews and offering additional training and mentoring where needed
  • Reviewing and submitting disciplinary write ups
  • Review with Business Office Manager regarding hiring and firing employees
  • Oversee training for all employees as well as conduct training for Business Office employees to ensure proper procedures are being followed
  • Assist in various positions when needed.
Network Relations/Provider Relations Manager, 12/2003 to 12/2009
Foundation Administrative ServicesCity, STATE,
  • Oversaw network relations
  • General oversight and interaction with its 15 affiliated organizations
  • Maintenance and management of provider contracts
  • Auditing claims processing by clients
  • Liaison between provider and client to ensure claims are processed according to contract in place
  • Auditing and maintenance of the statewide provider database
  • Development of local foundation website
  • Project manager for development of the claims system
  • Project manager for development of the provider maintenance system
  • Development and implementation of Policy and Procedure guidelines for systems
  • Development and implementation of trainings on new systems for affiliated organizations and clients of the PPO network
Education and Training
M.H.A: , Expected in
Bellevue University - Bellevue, NE
GPA: 3.5
B.S: Criminal Justice, Expected in
Florida Metropolitan University - Tampa, FL.
GPA: 4.0, Summa Cum Laude
Activities and Honors
Member, National Criminal Justice Association, January 2009 to present
  • Assist CEO with developing proposals and marketing opportunities
  • Development of provider contracting and relations
  • Marketing of PPO Network to potential clients as well as key contact person for current clients
  • Implementation of new client business as well as development of products to disburse to employees of new client
  • Completed all training required for access and review of database, provider search, etc
  • To various clients and sister Foundations, Time Management, Independence Blue Cross, Philadelphia, PA, March 1997
  • Olunteer Experience:
  • Ay 2007 to December 2007, Trauma Intervention Program, Corona, CA

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  • Florida Metropolitan University

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  • Senior Provider Data Analyst, Project team
  • Prior Authorization Supervisor
  • Financial Counselor Supervisor
  • Network Relations/Provider Relations Manager


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