Quality Assurance Insurance

Julian Paul Caesar

** **** **.

Windsor, CT ***95-1127

Tel. 860-***-****

Email: ******.******@****.***

SUMMARY

Most of my tenure as an IT professional has been in the

consultant/vendor world. The companies and the departments within

those companies, which I have supported primarily, have been

insurance, annuities and pensions, and manufacturing. IT expertise's

varies from the mainframe to the PC with solid SDLC methodology.

Over time I have compiled an extensive repertoire of business

knowledge and business practices. My personal traits that are carried

over to all my assignments are that I am thorough; grasps knowledge

and concepts quickly; technical, yet business savvy and understand

their relationship; high motivated; goal orientated and a team player

who is a self starter.

AREAS of EXPERTISE

Compliance: with emphasis on IRS, SEC, NASD, ISO, FAA, and Medicare.

Insurance: with emphasis on Life (Term, whole life, and Universal

life), Health, Group, Auto, Home, Annuity (TPA, Variable & Fixed) &

Pensions.

Insurance Processes: with emphasis on rating, commissions &

compensation, claims, administration, valuations, reporting, billing,

rating, commissions & compensation, claims, administration,

valuations, reporting, billing, underwriting, rules, illustrations,

dollar cost averaging, General Ledger, mutual funds.

Insurance Systems: with emphasis on Vantage V-1/ ULA Vantage system,

OMNI, PMS, rating, commissions and benefits, claims, billing, money

collections, proxy, valuation.

Healthcare: with emphasis on eligibility, coordination of benefits,

Medicare vs. corporate, pharmacy and medical Health Insurance,

Pharmacy applications, Pharmacy claim adjudication, ARGUS, HIPAA.

Systems Analyst / Business Analysis / Business Systems Analyst

Core skills include the following processes and actions:

. Gather Business Specifications

. Create Business Specifications, Functional Specifications and

Technical Specifications

. Data Mapping/ Data Integrity/Data Normalization

. Data Conversion

. Flowcharting/ VISIO

. Research/ analysis into subordinate system and feeds

. Feasibility studies on developing more productive processes

. Train and assist teams on project development procedures

. Gap Analysis

. JAD Facilitator

. Documentation & Reporting

. Data Modeling, familiar with IRWIN

. Process Modeling

. Business Intelligence

. Trend Analysis

. Data Warehousing

. Technical and business documentation

. Resource and project management

Programmer / Developer

Core skills include the following processes and actions:

. Utilized SDLC standards and practices

. QA processes were enhanced with the use of Test Director

. Coding techniques involving all version of COBOL, Micro-focus Cobol,

JCL

. Higher Generation languages utilized were; TELON, EZtrieve, SAS,

Spufi, Fileaid, SQL, QMF

. Data Bases; DB2, IMS, Ratabase, Vantage, ADABAS, VSAM, ISAM

. Testing tools were Expediter, Intertest, Animator

. Library tools were Panvalet and Endeavor

. Communication and on-line process used was CICS, MFS, MQ series, BMS,

MFS

. PC tools used were; Word, EXCEL, Power Point, Visio, Access

. General tools TSO/ISPF and CMS

Specialty items; XICS (language of the Pitney Bowes Printer), abendaid

EXPERIENCE (Note 6/85 to Present; IT Consultant)

06/10 - Present CIGNA (Health Insurance, Pharmacy)

Business Analyst

. Part of a major effort to replace current Claims System, primary focus

is pricing on the contracts supported.

. Conversion of CIGNA data to HP/EDS MetaVance system which will be

replacing current system.

. Technical environment - Informatica, Micro Soft suite of tools,

Quality Center, SDLC, CaliberRM

10/07 - 10/09 Mass Mutual Insurance

Independent IT Consultant Systems Analyst/Developer

. General supports to the compensation system for agents

. Design, built, and implemented process to handle ROTH (similar to

401K)

. Design, built, and implemented process for Agent's valuation. Agent

retention based on future earnings from residuals.

. Re-write agent's pension's process to comply with 409 regulations

concerning qualified and non qualified compensation.

. Provided business and system analysis into enhancements and problem

resolution.

. Coded, tested, and implemented projects to support initiatives.

. Supported Vantage system as well as home grown systems, online and

batch.

. Technical environment: TSO/ISPF, CICS, COBOL, JCL, DB2, VSAM,

EZtrieve, and Vantage

10/06 - 9/07 Mainframe Professionals, Independent Consultant

Independent IT Consultant

. Worked with several small to medium businesses with regards to

hardware and software solutions, Business Analyst agenda was adhered

to.

. Train personnel in software or procedures to become more productive.

. Recommended new or updated current software and hardware updates.

. Utilized business intelligent operatives of process modeling and data

modeling to develop a more efficient organization.

. Customize software to business needs.

. Suggested IT and business solutions to accomplish business needs;

general ledger, mailing, reporting

04/06 - 10/06 CIGNA (Health Insurance, Pharmacy)

Quality Assurance Analyst/ Senior Systems Business Analyst

. Developed, created, and implemented a series of test plans critical to

the pharmacy system with regards to a new business entity.

. Process modeling was used to gain knowledge currently ascertained,

then a new company code was introduced. This new code followed the

old process, yet at the same time was unique for reporting.

. Medicare enhancements investigated as to system requirements mandated

by law.

. Utilized Test Director for the logging of defects and the history in

solving them.

. Utilized my technical abilities to investigate CIGNA systems and data.

. Based on project requirements and specifications, created test data

for IT staff.

. Technical environment - DB2, SQL, FILEAID, data comparison utilities,

COBOL, EZtrieve, FOCUS

03/06 - 04/06 Fireman's Fund Insurance (P & C, Auto Insurance

Systems)

Senior Systems Business Analyst

. Key team member doing a feasibility study into developing a more

productive process into fixing current production problems within the

auto system

. Reviewed ratabase code and legacy code with respect to problem.

. Utilized Test Director for the logging of defects as well as their

history,

. Developed and documented methodology with working out problems.

. Trained personnel in auto insurance and ratabase process

07/02 - 11/05 Hartford Insurance Group

(P & C, Auto Insurance Systems- Premium Calculator)

Business Systems Analyst/Developer (programmer)

. Gather business requirements from ISO requirements and interviews.

. Documented requirements to develop business and technical requirements

for rating auto insurance.

. Provide complex analytical support through analysis, interpretation,

and Quality Assurance testing of auto insurance rating to support of a

new premium calculator (rating process).

. Investigate the root cause and affect of the premium and output

differences found in testing.

. Provided technical and business documentation to support differences

found as a result of testing. Subsequent changes were based on these

findings.

. Create, execute, and document testing results.

. Train and assist new team on project development procedures

. Quality Assurance testing, verify results prior to production

implementation

(P & C, Auto Insurance Systems)- State of Texas Auto

Insurance

Business Systems Analyst/Developer (programmer)

. From the business specifications, develop technical specifications for

the State of Texas Auto Insurance

. Used technical requirements to create new programming code to support

Texas rating, policy administration, claims, statutory reporting and

data warehousing,

. Parallel testing was executed as to verify output for Texas; old plan

versus new plan

. System had to be cross-functional, supporting old plan policies while

creating and supporting new plan policies

. Analyze actual results against plan and forecasted results.

. Quality Assurance testing

(P & C, Auto Insurance Systems)- Underwriting Rules/ RUP/

Blaze Advisor

Business Systems Analyst/Developer (programmer)

. Business research into underwriting rules; within business manuals,

programs, and system's documentation

. Developed specifications or coding and execution of rules

. Develop a complex technical solution (test plan) for comparative

testing of the 'old' and the 'new' access of underwriting rules

(parallel).

. Participated in implementing a rules engine with Blaze Advisor for the

purpose to house underwriting rules using the Rational Unified Process

(RUP)

. Developed and tested production JCL job streams to support new process

. Assorted data base extracts were created to obtain auto policies for

positive and negative testing of the underwriting rules under Blaze

04/01 - 07/02 Pratt & Whitney (PWA) - (Manufacturing, shipping, time &

material systems/ SAP)

Business Systems

Analyst/Developer (programmer)

. SAP introduced as the new software to process and control aero

manufacturing data. Business Intelligence using data modeling and

processing modeling was used to establish the current environment and

add a basis for conversion.

. IMS data was analyzed, rationalized, and modeled. This preceded the

loading of the relational data base utilized by SAP.

. SAP process is canned and generic, process modeling was used to

compare and add additional logic

. Worked heavily in managing overseas personnel in the timely

development of new code

. Identified gaps within the new SAP process and current legacy process

. Develop, tested, and implemented interfaces with SAP and the legacy

databases

. Develop and utilize a test plan, full cycle and verify results

. Designed, coded, and tested interface modules bridging SAP with the

mainframe

. Utilization of MQSERIES for communication to the SAP environment on

the mid tier machines

. Provide user enhancement to the legacy system with regards to bar

coding of parts, printing, and reporting

. Technical environment - IMS DB/DC, DB2, SQL, MQSERIES, COBOL370, SAP,

ENDEAVOR, FILEAID

08/98 - 04/01 Pratt & Whitney (PWA) - (Manufacturing, shipping,

time & material systems)

Team Leader/ QA Lead/ Business Systems Analyst

. As a key resource to the Y2K initiative, I help manage a foreign

vendor. My analysis and technical specifications coupled with my

managerial expertise governed work flow in a steady fashion for the

Y2K task.

. Developed a complex Quality Assurance testing procedures to check code

as well as the integrity of sensitive data

. Document systems process and results as produced by the date changing

logic

. Upon the receiving the finish code I managed a testing team of me and

2 other junior members. My responsibilities were for accurate and

timely testing, training subordinates, work assignment to team

members, substantial product information as to data flow and business

processes.

. For Y2K preparation, I was in charged of several systems in which I

analyzed data with regards to dates, Julian, Gregorian, 9s Complement

. Worked under very limited supervision, supported team members in work

assignments and problem solving issues.

. Cross function analysis and testing had to be achieved for

synchronization of results.

. Verify with outsource package as to accuracy

. Prepare technical programming specifications for a foreign vendor

coding

06/96 - 08/98 Aetna - Vantage V-1, OMNI

Project Lead/System Analyst/Developer

. Worked independently and in a team, on the Vantage-V1 system;

. Coordinated internal and external resources for the following tasks;

new fund introduction, annual statements, proxies, product

enhancements, valuation, mailings

. Cross analysis into other similar systems (Omni) vital to the total

book of business

. Created business requirements, and translated said requirements to

technical solutions in a timely fashion

. Researched and ascertain business requirements

. Developed, tested, and implemented technical solutions to support

business initiative

. Provided complex analysis and processes into address standardization

and purification to implemented the 9-position zip code

04/94 - 06/96 Aetna - Vantage V-1

Systems Analyst/Developer

. Based on the business initiative. I was the responsible for creating

a mailing package. The package was sent on the onset of their annuity

or pension contract being migrated from system to system. A business

requirement was my direction and I subsequently converted said

document to a technical requirement, ultimately to code and testing.

A timely schedule was adhered to.

. Provided business analysis of annuity and pension cases prior data

prior to migrating off old Vantage system to the newer V-1 system.

. Data mapping and normalization effort was a significant effort in the

migration effort.

. Supplied business findings as to marketing, technical, and business

functionalities needed to subordinate IT resources.

. Provided analytical support in to data cleansing with regards to

addresses and SSN

07/93 - 04/94 Hartford Insurance Group (P & C, Auto Insurance

Systems)

Senior System Consultant/Developer

. Major underwriting initiative was undertaken for older drivers and

rating, based on actuarial findings older drivers(over 75) were to get

rated as younger drivers due to accident ratio.

. Analyzed current code, changed made, tested and reviewed for

implementation

. Commercial auto rating was revisited as to joint code and commonality

in personal lines

. Minor enhancements were made to auto system

03/92 - 07/93 AETNA Life and Casualty (Annuity and pensions, prior

to V-1/ Billing System)

Team Leader/Systems Analyst/Developer

. Provided complex analysis into the current billing system to create an

upgraded process

. Provide several solutions, documenting the positive and negative

sides, using state of the art technology and cost savings features.

. Project Leader for a rewrite of the Billing System. Lead a team of 3

IT resources and several subordinate business and technical areas in

this successful effort.

. My team analyzed, designed, built, tested, and implemented a Billing

system that decreased manual intervention from 80 hours to less than

2. This project was to lessen the manual intervention of the mailing

of bills but also a disaster recovery aspect with the chance of

possible mailing problem.

. Utilized XICS (language of Pitney Bowes Printers) to produce 2 sided

documents, barcode to utilize postal discounts.

. Programming was modified to select, create files, and report on what

was processed.

06/90 - 03/92 Aetna (Annuity and pension system)

Senior System Consultant/Business Analyst/Designer

. Part of a strategic team to replace an old annuity and pension system.

. As a business analyst, examined current business processes as to

proficiency and accuracy in developing a new system.

. Part of my responsible was examining the current money control and

general ledger accounting, billing, and fund distribution.

. The old Vantage system was interrogated and examined as to it flaws

(i.e. addition of new mutual fund, reporting, and mid tier

processing).

01/90 - 06/90 Hartford Insurance Group (P & C, Auto Insurance

Systems)

Senior System Consultant/Developer

. Provided analytical and system support in applying state/ISO mandated

change to the auto insurance system (administration, rating, claim,

and underwriting)

. Investigate commercial auto procedures and policies as to the possible

use in personal lines

. Based on technical specifications, coding changes were made, tested,

and implemented to the auto system.

06/89 - 12/89 Pratt and Whitney - (manufacturing)

Senior System Consultant/Developer

. Work on a strategic team to develop a business process and technical

solution to develop code for the process of estimating jet engine cost

of components for the United States Air Force.

01/88 - 06/89 Life and Casualty (Annuity and pensions, prior to V-

1)

System Consultant/Developer

. Upgraded the money collection system from 80 byte cards to an online

and batch process

. On-line programming used TELON to create CICS (on-line and background

transactions)

. Responsible for modifying Panoshophic TELON code to initiate

background tasks and return results to the on-line environment

. Internal balancing, dollar and transaction count. The system was

responsible for approximately 10,000 transactions per day handling

approximate $1 million dollars in investments

. Modified the current batch system to accept the replacement files over

the batch cards

. Set up re-org, back out, disaster recovery procedures

05/87 - 12/87 State of Connecticut, Department of Income

Maintenance

System Consultant/Developer

. Designed, wrote, tested, and implemented an automatic process to pay

monthly housing rents and deduct it from the recipients' total monthly

allotment

12/86 - 04/87 Hartford Insurance Group (P & C, Auto Insurance

Systems/ AARP)

System Consultant/Developer

. Contributed with the analysis on the AARP business. Attended meetings

and compared the findings of these meetings with the requirements of

The Hartford.

. Standardize and normalization of data with COMNET for matching and the

elimination of redundant and duplicate record.

. Ad hoc reporting for the Auto System to support marketing with

emphasis on AARP related policies

. Create marketing tapes for outside vendor processing

. Technical environment - IMS, VSAM, COBOL, JCL

12/85 - 11/86 AETNA Life and Casualty - (Life, Health, & Annuity

Insurance Systems)

PROGRAMMER

. Provided analysis and programming support for the individual life.

. Supported the ULA Vantage system; with its conversion to the V1

product with emphasis on the universal life product.

. Technical environment: TSO/ISPF, CICS, COBOL, JCL, VSAM and Vantage

I/O.

6/85 - 11/85 State of Connecticut, Department of Income

Maintenance

Consultant/Developer

. Coded and implemented state mandated enhancements to the welfare

system

. Technical environment: COBOL CICS, TSO/ISPF, VSAM EASYTRIEVE.

Preceding 6/85 I was employed by the following companies as a Programmer

4/83 - 6/85 Hartford Insurance Group (Group Life & Health Insurance

Systems)

4/81 - 3/83 Travelers (Life, Annuity & Health Insurance Systems)

1/80 - 4/81 POLICY MANAGEMENT SYSTEMS (PMS) (P & C, Auto Insurance Systems)

EDUCATION B.A. Psychology, Central Connecticut State

College, 1974

Business Programming, CPI, 1979

University of Hartford, 1975 MBA courses

Hartford College for Women, 2000, Small Business Administration

Classes

Assorted formal technical classes in C, PowerBuilder, SAP ABAP,

Delphi, Oracle, Erwin, DB2, MySQL, IMS DB/DC, Micro Focus

Cobol and Animator, COBOL 390, Fileaid, and Technical

Writing

TECHNICAL SKILLS, LANGUAGES, TOOLS

Create Technical Specifications Production Problem Analysis

System Analysis

Data Analysis & Mapping Project Life Cycle (SDLC)

Program & Data Conversion

COBOL COBOL II COBOL 390

JCL IMS DB/DC MFS

CICS (command & macro) DB2 SPUFI

QMF FILEAID ENDEAVOR

PANVALET EZTRIEVE VSAM

EXPEDITER INTERTEST BMS

MQ SERIES SQL RATABASE

TELON XICS VANTAGE DATA BASE

VANTAGE I/O TSO/ISPF CMS

Proto typing ABENDAID

Documentation

WORD EXCEL ACCESS

Flowcharting/VISIO MICRO FOCUS COBOL

ANIMATOR

SAS

TECHNICAL SKILLS Familiar but not current

BAL POWERBUILDER OOA

OMNI FOCUS

BUSINESS SKILLS & TOOLS

Gather Business Specifications Business Analysis

Parallel Testing

Develop testing procedures Annuity and Pensions Systems

Commercial Lines Systems

Manufacturing Systems State & Federal Systems

Medicare, pharmacy and medical

Auto Insurance Systems Homeowner Systems HIPAA

rules and spec

IRS rules and specs SEC rules and spec FAA

rules and spec

Training Kintana (Mercury tool)

Life Insurance Systems Auto Insurance Claims Health

Insurance

Administration Vantage systems Semi & Annual

Report

Valuations Proxy Unitization

Pharmacy claim adjudication Argus Pharmacy

applications

Test Director Health Insurance Application Data

Warehouse

Data modeling/normalization Process Modeling JAD

Business Intelligence NASD

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