Description
Familiarity with source control concepts (checking in code, branching, checking out) * Experience writing scripts for automation processes. * Experience with mainframe applications * Experience with IBM technology suites * Experience with SQL, JAVA, Phython and C# programming languages. * Successfully implemented and deployed (systems upgrades, code changes, claim adjudication, application changes) releases across all 5 (IL, NM, OK, MT and TX) enterprise plans. Supervisor, Recovery & Refund Management - SSO Claim Recovery 2012 - 2013 Overseen the day to day operations of the R&RM team to include Refunds, Recovery and FSS Maintenance. Monitor claim related items for SSO. i.e., Blue-chip, IMAGE and ECM. * Provided support, coaching, training and other resources as needed for employees to fulfill their assigned responsibilities and goals. Includes continuous development and team rapport. Identify Opportunities for employee and operational improvements. * Tracked and monitor employee performance (production & quality) against established standard, providing feedback on a weekly/monthly basis. Develop means to measure and track all job duties within span of control. Provide guidance for performance improvement. Conduct evaluations as required. * Monitored and track all inventory, mailboxes and lockboxes to ensure timely processing according to established priorities and guidelines. * Responded to and resolve complex inquiries (internal and external), employee issues and problems. * Monitored, track and approve attendance payroll. * Extensive Knowledge of the union contract, HR and departmental guidelines and standards. * Monitored collection activity and process write offs * Monitored unidentified activity and review write offs when received from Finance on a quarterly basis. * Provided documentation and review for various FSS audits. Met with auditors and provide workflow walkthroughs. Review MAR documentation and assist with updates as required. * Initiated and managed Clarity quality and controls for the department. Supervisor, Subscriber Services (Indexing, Trans Routing, Scanning and Mailroom Operations) 2011 - 2012 Responsible for daily supervision of 19 subordinates, which includes coaching, developing, education and directing activities of employees supervised. Plan work assignments in order to obtain optimum utilization of employees' time and skills. Develop and monitor operating procedures, controls and support functions for the department. Follow-up on work assignments to assure compliance with schedules are met. * Resolve exceptions and problems that have been diverted from normal work flow. * Implement programs for training and cross training of all employees within work area. * Responsible for employee production and quality performance standards, production statistics and the operating controls. As well as Clarity controls and updates * Testing and coordinating Image Plus enhancements, Captiva and ECM version Releases and Mainframe Systems. * Created training manuals and work flows for department and division. * Maintain or develop statistical information necessary for preparation of reports or maintenance of operating controls. * Maintain relationship with internal/external departments and agencies to discuss issues. * Monitor performance and ensure internal, state and federal standards are met or exceeded. * Support divisional corporate goals in meeting Blue Card Index scores monthly and following BCBSA ITS policies. * Provide ITS education and support from a technical and inquiry perspective to internal/external customers including creating and distribution of training material. * Proactively look for improvements in processes for the division. * Participate in work groups and committees. i.e., CORE, ITG/CPE. * Create test claims, review internal test results, and interface with Data Processing on system problems research problem files, and initiate corrective action. * Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested. Project Analyst - Enterprise Content Management 2007 - 2011 Coordinate establishment of information priorities across the EISM organization. Develop and manage the relationship between the information technology group and internal/external clients having complex, relatively unstable business and technical environments. Develop and maintain project plans, issue logs, minutes, charters, requirement documents, and other project documentation. Establish and maintains processes and mechanisms to ensure successful completion of projects, schedules and coordinates project team meetings, including developing and distributing agendas, documentation and dissemination of results, responsible for analyzing/coordinating requirements, defining project scope, translating business requirements into use cases, activity or flow diagrams, and participating in project management activities performing business research to identify gaps between current state and future vision conducting interviews with customers and enterprise experts maintaining project documentation and working closely with the IT team, Interview SME's, vendor partners, and end users to interpret and document functional and nonfunctional requirements. Managed training activities for the division, developed and maintained training materials coordinate and lead training sessions interfacing with internal/external departments, clients, and ITG. * Document requirements, trace to test cases, logical design and end user documentation * Formulate best practice business processes utilizing cases and modeling tools. * Release management for all projects deployed as well as for various programs, products, infrastructure, and enhancements. * QA testing with full system development lifecycle experience, including designing, developing and implementing test plans, test cases and test processes fueling swift corrective actions, significant cost savings and fault-free audits. * Utilize a various software tools (IBM Rationals, Requisite Pro, Clear Case, QTP and Clear Quest) * Perform system analysis, ad Hoc testing, claims and image plus testing, and project management duties * Maintain system functionalities and enhancements * Testing various systems across the enterprise, created and documented processes and procedures * Monitor technical system integrity and insure regulatory compliance * Proactively communicate and collaborate with external/ internal customers and project team members * Analyze information needs, functional/business requirements and produce deliverables * Interface between internal/external customers and software development teams for requirement assurance * Develop requirement specifications according to standard templates, corporate processes and guidelines * Collaborate with developers and subject matter expects (SME), establish technical vision * Analyze trade-offs between usability and performance needs * Conduct and implement various testing methodologies, business release implementation for all projects. * Developed and loaded contract and benefit booklets for Enterprise using ECM and Blue Enterprise Search Technology * Project Planning and Controlling, facilitate training, designed surveys, advise/assist all levels of management Customer Advocate 2006 - 2007 Analyzed, resolved, expedited and coordinated inquiry processing, worked on highly complex problems requiring judgment in the selection of the method and technique for issues resolution. * Insured customer satisfaction, issue resolution and process improvements * Served as primary contact for customers and intake inquiries * Expedite all escalated complaints and execute timely and sound decisions * Demonstrated commitment to providing superior customer service * Claims Adjudication and testing new enhancements for FSU's. * Identified problems, offered solutions and/or courses of action based on available resources * Consistently met and exceeded customer expectations * Adjudicated customer request, concerns, complaints, and issues * Proficient in Blue Chip, Mainframe, MAC I Matrices, RTB, BAM, PREMIER, BlueSTAR, Accums and Bluesource
Accomplishments
Highlights:
Keywords
