SUMMARY: To utilize various skills as a Systems Analyst.

PROFESSIONAL EXPERIENCE:

****-**** **** ***** **** Shield of Michigan, Detroit Mi.

Senior Systems/Business Analyst, Application Developer·

Extensive health claims processing experience including 837 and 835 HIPAA transaction processing using the NASCO claims processing systems.

Provider billing and payment processing including support of the providers’ NPI and legacy provider numbers for both Professional and Facility lines of business.

Provided support of the BCBSM FEP (Federal Employee Program) benefits and claims payments.

Analysis and review of FEP eligibility files specific to Coordination of Benefit and Medicare coverages.

Support of all backend reporting for processed claims, including Provider voucher, 835’s and members EOB’s.

Technical Lead and Lead Analyst roles and responsibilities for multiple, concurrently executing projects.

Monitor, track, report and document pre and post implementation data

activities.

Develop and use approved corrective measures when variances are detected during post implementation monitoring.

Extensive test preparations activities including but not limited to creating

and supervising test plans, writing CSRs, creating test data, executing

test cases and preparing presentations to review with business leaders

and Quality Review team members.

Supervising and mentoring the testing duties of supporting testing team members.

Collaborate with cross-functional IT teams, business leaders and IT Vendors to identify and resolve technical and business processing issues.

ENVIRONMENT: MS Project, MS Office Suite, SharePoint, COBOL II, DB2, IMS, SQL, SDLC, Endevor, EOS, PDM, 3270 Attachmate, NASCO.

Project: Migrate Federal Employee Program claims systems from BCBSM Local Systems to National Account Service Company (NASCO) for Electronic and paper claims.

System testing; demonstrating and leading team members with test planning, test conditions, obtaining test data, test case development, test execution, and issue resolution.

Developed business requirements, product configuration, gap analysis & functional design documentation.

Develop and maintain an effective working relationship with customers.

Interfaced directly with business units/business users to identify business requirements.

Provided analysis as needed to assist the business units in understanding the data in order to make well informed decisions via presentations and written reports

Collaborated with cross-functional IT teams.

Project: Migrate BCBSM Local National claims systems from BCBSM Local Systems to National Account Service Company (NASCO) for Electronic and paper claims.

Business Analyst for the Claims Interfaces Development Team.

Technical interface responsible for communications with executive management, business community, developers, multiple support teams, and vendors.

Gather, analyze and document business and technical requirements for the development of UT strategies, test cases, BRDs, RTMs and CSRs.

Developed, tested, maintained and documented multiple testing environments, data strategies, and new tools for Claims processing.

Reviewed and approved Detailed Test Plans and test cases for SIT and UAT.

Performed Risk Analysis, and created job execution reports for business community, developers and testers, and communicated results to all levels of management.

SME for all environment challenges; documented design failures and resolved testing defects.

Participated and contributed to release management meetings and processes.

Communicated and negotiated with all levels of management, business customers, developers and outside vendors from diverse backgrounds in a fast-paced environment.

1993-1994 AAA Insurance, Dearborn Mi.

Application Developer

Analysis and development of systems programs for the High Risk group insurance area.

ENVIRONMENT: COBOL II, DB2, IMS, SQL, SDLC, Endevor,

PANVALET, EOS, 3270 Attachmate, JCL, SYNCSORT, FILEAID.

1986-1993 Chrysler Corp., Centerline Mi.

Application Developer

Analysis, development and support of the Vehicle Transportation systems.

ENVIRONMENT: COBOL II, DB2, IMS, SQL, SDLC,

PANVALET, EOS, 3270 Attachmate, JCL, SYNCSORT, FILEAID.

Education: completed 2 years in Data Processing at the following:

Oakland Community College; various Data Processing and Programming classes.

Henry Ford Community College; COBOL Programming classes.

Contact this candidate