BETH L. BODENHEIMER

Mechanicsburg, PA ***** 717-***-**** acg91w@r.postjobfree.com

SUMMARY

Extensive experience in Business Analysis (BA), Customer Service, Claims and Supervisory positions in an Insurance

environment. Expertise in understanding business and customer requirements, translating those into a workable project plan

and implementing the appropriate technical solution. Proven track record of learning and utilizing technical systems from

Microsoft Office Tools, IBM Rational Software, Sharepoint, ReqPro, Clarity, SQL, Internet and many homegrown

Highmark systems. Expert knowledge of: HSA, HRA, FSA, PPO, POS, HMO, Membership, Group, Provider, Capitation,

training, ICD9, HCPCS, HIPAA, development, documentation and web. Outstanding mentoring capabilities.

PROFESSIONAL EXPERIENCE

Highmark, Inc.; Camp Hill, PA

(1990-2014)

Business Technical Analyst (2012 – 2014)

• Analyzed company initiatives and large sized projects for internal/external customers for system

releases. This included determining business needs, requirement documentation, functional testing, defect

resolution, training and obtaining all systems accesses for peers/customers. Primary customer; Independence

Blue Cross (IBC).

• Coordinated testing and issue resolution, successfully implemented changes for Financial, Data

Warehouse

and Health Care Procedure Code areas. Projects included a new capitation system and updating an existing

system to differentiate between Blue Plans. Both included Graphical User Interface (GUI) and Mainframe.

• Go-to BA for system accesses and navigation; security, customer service, claims, testing procedures

and related tools; IBM Rational Tools. Mentored new BAs on all of the above. Documented processes and

procedures.

Technical Business Analyst (2009 – 2012)

Optimum System Claims Adjudication and Reconciliation (OSCAR) Back-end Solutions

• Implemented small to medium system changes in a lead or support role. Analyzed business needs

and documented requirements to provide proposals for future releases. Acted as a liaison between the

customer and developers to identify business processes, systems and product requirements.

• Obtained all security accesses and fielded questions for claims, customer service and testing.

• Supported production by reorganizing weekly processes; history claim errors/balancing and MEDCO

Web Errors. Implemented changes for error resolution which saved .25 of an FTE over a calendar year.

• Completed analysis, defined requirements and wrote test plans/scripts for Customer Requests (CRs)

initiated by BCBSA and other Blue Plans. Tested professional, institutional, and adjustment claims; and

BlueCard claims via the OSCAR (Highmark) and ITS (Inter-Plan Teleprocessing Services) systems.

Partnered with technical staff to test claims, identify business needs and appropriate solutions.

Business Analyst 2 – Health Plan Operations (HPO) (ePlatform) (2006 – 2009)

• Lead BA Web Unit. Coordinated initiatives for Highmark Web Portals: Consumer, Employer,

Producer. Reviewed requirements, lead workgroups, documented and conducted training, to ensure CSRs had

detailed guidelines.

• Managed BA Production: CSR 3rd Party Search – alerted management about weak security surrounding

process;

demonstrated internal Personal Health Information was accessible from outside systems. Initiated project

tightening security, saving company from breaches and legal issues. Web Password Resets – directed training

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and implemented ahead of schedule for inexperienced hourly staff on telephonic technical inquiries.

• Coordinated large initiatives in a supporting role: Web Registration Verification, Personal Health

Registry, Plan Cost Advisor, BlueAccount-HSA/FSA/HRA, Sales to Enrollment, Role-Based Security,

email inquiries.

Beth L. Bodenheimer 717-***-****

Technical Business Analyst II, Dental (Concordia-UCCI) & Vision (Davis) Systems (2003 – 2006)

• Supported/led Commercial/DOD Claims/Web projects. DOD; TDP (TRICARE). DITSCAP/DOD

Certified.

• As new business lead, tested/implemented Web: Xpress Web Claims, My Dental Benefits, My Patients’

Benefits, IVR/Faxback and Dental Claims: batch reporting, history/pending, quality control (QC),

Reporting. Pulled test data/prepared documentation for customers: Wal-Mart, Ford, Verizon. Conducted

HIPAA testing of various outbound files: 837 EDI and 835 RENO.

• Led Image Integration project; elimination of manual toggling between UCCI and IWPM (IBM) claim

images. Extensive testing and training of UCCI staff, coordinating with various areas. Presented to

management.

• Created BA Training Manual, Claims Entry overview, RFP responses to national customers.

• Coordinated business conversions and Orthodontic Accumulation Loads for other Blue plans.

• Estimated history loads and conversions for new business and stayed within budget for all projects.

Supervisor, KHPC, Integrated Point Of Service Claims & Enrollment (2000 - 2003)

• Supervised 9 hourly Claims Reviewers/Medical Review nurses. Directed projects to assure optimal

operating efficiencies and cost effective processing, investigation/resolution of claims issues. Analyzed

workflow and data to recommend operational changes. Oversaw Complaint Coordinator and Act 68

complaints & Appeals. Primary products: Hershey HealthStyle/HealthOne; for Capital Blue Cross (CBC)

and OSCAR.

• Implemented numerous procedural guidelines and training for staff: adjustments, referral

development to eliminate lag, Enrollment, Point of Service, group conversions and Act 68.

• Changed feedback for staff, allowing input for non-production time to better account for monthly

reporting.

• Oversaw new database implementation aging claim monitoring; phone development. Saved .5 FTE,

yearly.

• Coordinated employee training, oversaw Claims’ Enrollment assistance between Highmark, CBC and my

unit. Implemented cross-training for high-priority groups; ITS, PEBTF, Hershey, Mack, Heinz groups

between Claims and Customer Service and met all production goals.

• Analyzed and implemented system changes, such as: Automate Manual Claims Inventory Reports - .30

FTE savings, search capability for on-line procedures on Intranet.

• Revised process to ensure timely payment and adjudication, per Act 68. Updated manuals and flows

required by BCBSA, which resulted in the development of a new database.

Previous positions at Highmark, Inc.

• Business Staff Analyst II, BluePRINT Claims (1998 – 2000)

• Staff Support Staff Analyst II (1995 – 1998)

• Senior Customer Service Representative/Team Lead (1990 – 1995)

Previous positions

• Signs By Stine, Co-owner/operator (1988 – 1995)

• Wendy’s International, all crew positions (1981 – 1988)

Education, Training and Accreditation

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• B.A., Art/Liberal Art, Millersville University - founding member of Phi Sigma Sigma fraternity; VP

• Associate Degree, Commercial Art, Antonelli Institute - Dean’s list

• DITSCAP/DOD Certified, HIAA Accredited, numerous courses geared toward Technical BAs/leaders

Volunteer/Community

• Juvenile Diabetes Research Foundation, United Way Scale of Hope, Special Olympics, Big Sisters,

Health Insurance Claim Advocacy

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