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supervisor system analyst 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: - resumesample@example.com - : - -
Professional Summary

I am a seasoned System Analyst with over 19 years of claims processing experience, communication and analytical problem resolution skills; a detail oriented and innovative problem solver who is responsible for ensuring claims adjudication compliance. I’ve displayed impeccable ability to identify complex claims processing errors, and possess the knowledge to resolve those complex errors effectively and efficiently. Should technical system errors arise I am knowledgeable of the various avenues to explore to resolve those technical issues expeditiously. Additionally, I have function in the capacity of claims processing trainer for seven consecutive years; I’ve developed training materials based on my knowledge of claims policies and procedures, and the speed at which employees assimilate new information. Equally important to note, I presently function as a multitasked system analyst in the Claims Operations Department with my primary function as a supervisor. My experience, compounded with my quest for knowledge has equipped me to function effectively in my role. I am an avid learner who embraces and take advantage of the courses that is applicable to my job function that are offered at the company’s University, and any applicable courses offer from external sources. One important character trait that has received high praise from co-workers is my ability to motivate others, and to resolve issues in a timely manner. I am also proficient in Microsoft Office products, Epaces, PowerSTEPP for windows, 3M Grouper, AWD(Automated Work Distributor), and Macess Service Module. I am confident that the theoretical knowledge and practical skills outline make me viable candidate for a position in the analytical field. Managerial Skills – Decision maker, motivator & quick thinker Highly innovative – Offer suggestions and ideas for high productivity Problem solving skills – resolve unnecessary claim pending issues Money management. Time management and structuring for non-profit organization.

Skills
  • Critical Thinking
  • Training and Development
  • Problem-Solving
  • Planning and Coordination
Work History
11/2014 to 04/2022
Supervisor System Analyst City Of Olathe Olathe, KS,
  • The primary responsibility of the supervisor is to coordinate with the manager to ensure the Claims Processing Unit maintains acceptable service levels
  • In addition, the supervisor provides support to the manager and other Metroplus departments’ heads regarding the adjudication of complex, difficult and non-routine claims for multiple lines of business
  • Supervise the day to day workload of the Claims Unit
  • Responsible for the delegation of tasks, monitor progress to ensure the tasks are on track to be completed on time, and in accordance with instructions
  • Responsible for employees’ supervision, performance, and development of assigned personnel in areas of responsibility and accountability
  • Ensure that training manuals are current, and that policies and procedures are applied appropriately
  • Plans, develops and conduct refresher training to maintain proficiency of staff
  • Anticipate, identify, and resolve issues with claims submissions (manual and electronic)
  • Coach staff to assist in self-discovery and help them realize their full potential
  • Delegate task effectively and allocate staff on basis of workload and proficiency
  • Conduct UAT (User Acceptance Testing), and assist with the validation of tested products
  • Ensure new and updated processes are clearly defined and understood, disseminated via simple means and stored on a Shared Platform for quick reference
  • Responsible for creating Claims processing guidance
  • Manage and participate in special projects
  • Initiated a monthly Supervisor’s meeting for all supervisors in the Claims Operations Department, and ensure that order and structure are maintained at all meetings
  • Maintain Production, Attendance logs and Downtime logs for accountability and reporting purposes
  • Ensure employees are in compliance with HIPPA rules, company’s guidelines, local and State rules
  • Generate and interpret production and inventory reports
  • Have written the company’s standard Policy and Procedure for the “Claims Adjudication Process”, and have contributed to the annual updating of The Claims Processing Unit’s Policing and Procedures
  • Provide metrics to upper management of employees’ performance, attendance and punctuality
  • Assist the Finance department with resolving issues related to STOPLOSS
  • Work closely with the Adjustment Unit within the Claims Operations Department to address providers’ disputes and complaints
  • Review resume of
03/2004 to 11/2014
Senior System Analyst Asustek Computer Fremont, CA,
  • My responsibilities were, but not limited to provide system support services, which include system analysis and supervision in the absence of the supervisor
  • I was assigned the task to test new products and changes in current products, and document findings of the same
  • Provide support to other Metroplus departments regarding the adjudication of complex, difficult and non-routine claims for multiple lines of business
  • I was responsible for ensuring that all claims identified as exceeding claim age parameters are handled promptly with the best possible outcome
  • Process non-routine and complex claims for all lines of business
  • Trained new claims examiners and re-trained established examiners on changes and updates relative to claims processing
  • Responsible for the reviewing of a monthly Aged Report and to exhaust all avenues to finalized those claims
  • Shadowed the Claims Examiner Trainer and make recommendation to ensure that employees are prepared to perform to their optimum best
  • Identify the need for re-training session based on recurring errors
  • Ability to identify and find solutions for problems regarding claims processing
  • Takes very keen interest in claims payment disbursement to providers to avoid overpayment of claims, which could result in extensive and bothersome retrieval procedures, and also to ensure that providers are satisfied in order to minimize complaints to arbitration bodies
  • Determined benefits payable based on established criteria, provider contracts and plan provisions
  • Communicate in a clear, concise, understandable manner, and listen attentively to others
  • Knowledge of contractual agreements between MetroPlus and providers, and a strong knowledge of managed care Benefit programs.
03/2002 to 06/2004
Assistant System Analyst Metroplus Health Plan City, STATE,
  • Perform the manual processing of Medicaid claims for all lines of business
  • Including manually data entering the hard copy claims into the PowerStepp processing system
  • Possess the ability to identify, and process electronic submitted claims
  • Process first- and third-party medical insurance claims
  • Analyzed and determined completeness and validity of claims
  • Demonstrated brilliant analytical, error detection and problem solving capabilities with any task assigned relative to claims processing
  • Ability to communicate and coordinate with team members, and external associates to address claims related concerns and issues
  • Reviewed and validate data elements on correspondence for accuracy
  • Maintained all required documentation of claim received and examined
  • Preserved confidentiality of all claims files, claims reports and claims-related issues
  • Adjudicated medical claims
  • Processed all types of pended claims
  • Determined benefits payable based on established criteria, provider contracts and plan provisions
  • Achieve and maintain and overall claims processing accuracy of 98%.
Education
Expected in to to
Associate of Science: Acct
Long Island University - Brooklyn,
GPA:
Expected in to to
Certified Billing and Coding Specialist:
Caliber Training Institute - N.Y., New York
GPA:
Accomplishments
  • Supervised team of [Number] staff members.
  • Achieved [Result] through effectively helping with [Task].
  • Collaborated with team of [Number] in the development of [Project name].
  • Resolved product issue through consumer testing.
  • Documented and resolved [Issue] which led to [Results].
  • Achieved [Result] by completing [Task] with accuracy and efficiency.

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Resume Overview

School Attended

  • Long Island University
  • Caliber Training Institute

Job Titles Held:

  • Supervisor System Analyst
  • Senior System Analyst
  • Assistant System Analyst

Degrees

  • Associate of Science
  • Certified Billing and Coding Specialist

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