Project Manager
Resume:
Dawn M. Glaser
Blacklick, Ohio 43004
********@*******.**.***
Objective
Secure a full time position of employment working as a project specialist or business analyst in
the Central Ohio area.
Attributes, Skills, Knowledge
Writing Business Requirements Constructing Test Scenarios Testing of Business
Requirements
Data Validation from extracts Troubleshooting and Research Detailed and Solution Oriented
Quality analysis Health Insurance Call and Claim Effective Communication
operations
Six Sigma Methodology Team Player Organized
Fair minded Self-discipline Approachable
Hardworking Dedicated Strong work ethic
Hardware Applications
Desktop, Laptop, Peripherals (printer, scanner, Test Director, Microsoft Word, Excel,
monitor, PowerPoint, Access, Visio, Microsoft Project,
keyboard, mouse, webcams) Microsoft Outlook, Minitab, Citrix, Share-
Operating Systems point, Internet explorer, Norton, Net-Meeting,
Windows XP, Windows Vista Lotus Same-time
Employment history
CIGNA HealthCare April 1998 – April 2009
Experience
Business Project Senior Specialist (CIGNA HealthCare Call and Claim Operations)
Project lead for initiating, planning and execution of small projects or segments of a
larger project
Acting as a Subject Matter Expert for a variety of Call Operations projects
Constructed the business requirements for the Implementation of Claim Business
Outsourcing to an Offshore Vendor
Designed the Business requirements for assigned projects
Constructed the test scenarios, assisted with the testing of the business requirements
Lead the testing of the business requirements, system build testing, training environment
testing and production testing.
Organized weekly calls with each of the responsible resource areas of the project to
discuss project status, delays, open issues, schedule and impact of any changes made and
other follow up items
Business Analysis Specialist (CIGNA HealthCare Claim and Call Operations)
Subject Matter Expert and Root Cause analysis for a variety of projects
Lead small projects, gathering data and defining root cause to make recommendations for
process improvements.
Performed capacity planning; load balancing, daily audit progress of business area tasks
Conducted data validation from system extracts solving for inconsistency among the data
file extract and the information within the claim engines.
Completed system testing during process improvement implementation
Utilized Test Director to document test scenarios, log defects, determined the outcome of
the test based on the desired test results (pass/fail).
Performance Improvement Manager & Quality Lead (CIGNA HealthCare)
Conducted Account and Call audits at the site level as well as organized third party audits
Assisted with the design of the pre-pay queries to decrease the number of overpayments
prior to the claims being posted
Completed Provider contract audits to ensure the hardcopy contract mirrored the claim
processing system. Gathered overpayment/underpayment data from the audits and
worked with the overpayment recover and adjustment teams to recover the monies
overpaid to providers.
Created medical (HCFA) and Hospital (UB92) claim examples and entered claims into
the training environment to be utilized by trainees.
Assisted with the Quality programs current and future processes workflows
Created Technical Coach/Trainer Skills assessments to be utilized throughout CIGNA
service operations to identify training needs within our technical staff.
Provide support to the Overpayment recovery team as a Subject matter expert and
making recommendations for potential overpayment projects along with providing
training to the overpayment team.
Tier III Adjustment and Claim Processor (CIGNA HealthCare)
Processed adjustment claims effectively in accordance with account specific benefits
and/or Health plan protocols.
Worked pended adjustments/claims on a daily basis.
Worked with the overpayment recovery team to process refund returns
Audited account claims to ensure contract accuracy
Entered and processed claims from HCFA and UB92
Processed managed care HMO claims
Maintained production, processing standards and HIPAA guidelines
Education
Course Completion Date
High School Diploma – Napoleon High School June 1987
Medical Specialist – U.S. Army February 1988
Six Sigma Yellow Belt – CIGNA Healthcare September 2003
Front Line Manager Program – CIGNA Healthcare June 2006
Project Management October 2006
Six Sigma Black Belt July 2008
Columbus State - Computer Science Presently Attending
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