CANDICE HOLLOWAY

**** ***** ****** ****** *****: 919-***-****

Goldsboro, NC 27530 Email: ac2p3n@r.postjobfree.com

Executive Director/Senior Business Analyst

Highly regarded business analyst with more than three years of direct supervisory experience in business process improvement and visionary leadership. Excellent business acumen demonstrated through management and development of high-functioning programs. Outstanding written, verbal and interpersonal communication skills with a history of developing strong and long-lasting alliances that contribute to business success.

Areas of Expertise

Change Management

Benefit Coordination

Strategic Planning/Analysis

Vendor Relations

Lawson

Cross-Functional Team Collaboration

PHI and HIPAA regulations

Risk Analysis

Training new-hires

Business Analysis

Process Improvement

Communication Skills

Manages high dollar claims over 10K

Professional Experience

Blue Cross of NC vendor recovery analyst financial recovery department Jan 2012- present

Audits third-party vendors to determine if over-payments found by data mining are correct.

Acts as a liaison between the company and third party vendors.

Recommends process improvements and changes to procedures to senior management.

Develops risk analysis for over-payments made on paid claims.

Develops procedures to validate and quality check claim over-payments.

Works closely with upper management to stay within proposed budget limits set for the team quarterly.

Monitor new hires work to make sure that they adhere to company policy, procedures, and team goals.

Trains and coaches peers.

Addresses performance issues to validate claims and provide appropriate feedback to the business analyst.

BLUE CROSS of NC Operations Specialist – State PPO Projects Team March 2007 – Jan. 2012

Conducted data analysis on queries that are processed daily and provide feedback to the appropriate areas.

Completed special projects assigned via Queries mailbox or from team lead, which involved data collection/reporting the project’s outcome.

Notified management of system issues, necessary policy changes, and workflow issues.

Served as a SME/ liaison for daily queries maintained and report any issues for automation production.

Reported on inventory spikes or dives in query or special project workflow.

Processed electronic, paper, and suspended claims transactions in daily/monthly assignments.

Processed internal and external claim adjustments to complete/correct prior claim transactions. Request refunds for overpayments, reverses claims denied in error, processes voucher/pay member deductions, prior deductible credit, non-monetary internal adjustments, and recovered monies.

Provided input for Claims Business Rules Governance Team to make sure that the processes used to complete hold codes, queries, and or job aids have the correct wording to assist examiner in processing.

Blue Cross of NC Claims Professional – State Health Plan June 2006 – March 2007

Adjusted, researched and entered data into processing systems, fixing any missing or incorrect information on imaged or paper claim forms.

Identified and analyzed system suspend/processing problems, including documentation of the issue, identification of potential solutions, referral to appropriate technical staff, and follow-up to ensure resolution.

Provided technical assistance for State PPO front-end processors.

KELLY SERVICES Contractor for Blue Cross of NC June 2005 – June 2006

Entered data, collected, analyzed and reported data.

Communicated with customers, providers, pharmacies, and other departments in the Plan to resolve ongoing problems with claim submission and to improve the claims process.

Kept records of system downtime, desk count, flow sheets, and daily work measurement sheet. Rerouted claims to other sections, as appropriate.

FEDEX GROUND Administrative Data Entry Clerk Feb. 2003 – March 2006

Developed strong communication skills between staff, contractors, and customers.

Oversaw cash handling procedures, nightly audits, and deposits.

Data entry, copying, faxing, web-information retrieval, and answering multi-line phones.

Education & Training

Master of Science, Health Administration and Business Administration (Dual Degree),

Pfeiffer University, Misenheimer, NC

Bachelor of Science, Business Administration with concentration in Management and Organizational Development, Mount Olive College, Mount Olive, NC

International Exchange Student, Germany and France

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