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C a r o l y n

CJ

J a m e s

Business Professional

Profile

Over 30 Years experience in the Business industry. Extensive experience working in roles as a Business Analyst, Data Analyst, Reporting Analyst and Customer Service PROFESSIONAL EXPERIENCE

Self-Employed/Online MS Excel and MS Access Instructor Trainer 02 2023 - CURRENT

• Teach Advance Excel Courses online.

• Teach Beginner to Intermediate MS Access Courses online.

• Curriculum Preparation

• Use of Canva and Zoom.

• Training class prep, set up and registration.

• Media Design

• Advertising

Claims Representative - Call Center

EMERGE (Homeowner Services - Client) 10 2022 - 01 2023

• Responsibilities included taking in-bound calls from homeowner warranty customers to establish claims.

• Provide additional warranty program information.

• Upsells

• Outbound calls to customers and contractors.

Business Analyst

BLUE CROSS AND BLUE SHIELD 10 2021 - 07 2022

• Provided benefit and claims processing information for Medicare Advantage members including commercial contracts for the State of Michigan, Auto and several City contract groups. Various health care contracts evaluated.

• Duties involved verifying eligibility for members and Providers.

• Checked Provider eligibility and practice guidelines using their NPI.

• Handling Pre-Authorization and Referral Data, Explanation of Claim denials and resolution possibilities, contacted 3rd party vendors or doctors/facilities on behalf of members, setting up claims for clinical review and follow-up.

• Medical Terminology utilized.

• Researching and updating healthcare business requirements. Checking for proper billing forms and coding. Checking rejection codes and providing explanations of denials to clients.

• Coordination with other internal departments for clarity. Worked with IT for system updates needed providing feedback and solutions. 313-***-****

ad1dit@r.postjobfree.com

Detroit, MI

EDUCATION

High School Diploma

Northwestern 1984

Business Analyst Certification Training/

BABOK

Global IT

Completed: Dec, 2022

PMI-ACP Certification Training

Global IT

Completed Mar, 2023

Heart Saver Certified

PROFESSIONAL DEVELOPMENT

Compuware Training - Farmington, MI

July 1995

Concentrations: Cobol, IMS, DB2

2

BLUE CROSS AND BLUE SHIELD (Continued)

• Assisted in testing of new healthcare applications, providing feedback for use case analysis.

• Strong use of documentation and resources.

• Communication skills

• Use of IKA, NCompass, Agility, MARX, SharePoint and other BCBSM systems.

• PBM (Xpress Scripts, OptumRX), Knowledge of Formularies and Tiers,

• Step Therapy Rules, Prior Auth

• Other health care applications as required.

• HIPPA Data and Required HIPPA Training.

Enumerator/Census Taker

US CENSUS BUREAU 08 2020 - 10 2020

(Temporary Position - Employed from beginning till end of contract)

• Conducting in-person and over-the-phone interviews with households during the 2020 census period.

• Obtained household demographic and population data via surveys as required by the Federal government.

• Facilitated upload of Census data to the Bureau via electronic device

• Obtained government clearance from the US Dept of Commerce Pronunciation Specialist

APPEN GLOBAL 04 2019 - 06 2019 (PT)

(Temporary Position - Employed from beginning till end of contract)

• Participated in improving the accuracy of the interactive service called Siri. Worked to correct the computer- g e n e r a t e d pronunciation of street names across 7 counties in Michigan.

• Utilized active listening skills, phonetic interpretation.

• Collaborated with a team of local experts to troubleshoot/ improve Siri using Fusion X and Apple Chat

Patient Safety Assistant/

HENRY FORD HEALTH SYSTEM 11 2016 - 12 2020 (PT)

• Close interaction with high-risk patients (suicidal and/or confused). Used conflict resolution skills to avert patient safety issues.

• Use of active observation skills

• Accurate recording of observations

• Collaboration with nurses and doctors

• Utilized medical terminology skills for documentation.

• HIPPA Data and Required HIPPA Training

• Heart Saver Certified

• Medical Terminology

SKILLS

Analysis Skills

Collaboration and Motivation Skills

Delegation Skills Strategic

Planning Abilities

Strong Communication Skills

Ability to remain calm and focused

under pressure

Medical Terminology

Agile, Waterfall, DevOps,

Kanban, SCRUM

User Stories, Unit Testing,

Story Boards

Training after roll-out

SYSTEMS/OPERATIONS

IKA

NCompass

MS Access

MS WORD AND EXCEL

MS POWERPOINT

VISIO

AVAILITY

OUTLOOK

PBMs/XPRESS SCRIPTS

Tableau

VB MS

ACCESS AND EXCEL MACROS

VLOOKUPS

GRAPHS

MS Teams

Zoom

3

Business Analyst/Programmer/

ROBERT HALF TECHNOLOGY 07-201*-**-****

(Client: SEEL)

• Developed an MS Access Database to assign, track, monitor and analyze production of employees.

• Prepared various graph reports for upper management using raw data on a regular basis to determine effectiveness of services and facilitate process improvements.

Business Analyst

ALL THINGS DATA 08 2006 - 06 2014

• Consultant for small business start-ups. Various contracts that required assistance with Database Set-up or Upgrades.

• Established automation of management reports. Provided testing of newly developed web sites

• MS Access, Excel Consulting, ODBC

• Pivot table reports, VLookup, XLookup, Formulas and Functions, Macros

• Database creation and analysis

• Prepared process improvement analysis and documentation Business Analyst/Data Analyst

COMPUWARE CORPORATION 06 1995 - 07 2006

Worked for several major companies as clients of Compuware. Clients included Ford Motor Company, Ford Motor Credit, DMC, BASF and Detroit Public Schools. Varies skills were used based on the client. Sample of duties:

• Risk Management

• COBOL Technical Writing (Business Rule Translation)

• Involved in over 10 major projects throughout complete Life Cycle

• Agile, Waterfall, Devops methodologies utilized.

• Assisted in IT Resource management based on project deliverables.

• Team Lead on several large database implementation projects

• Documentation for user manuals, training materials. Set up user training and provided follow up assistance after roll out

• Provided project status reports, timelines, budget reports, forecast planning and reports

• Monitored progress of projects. Met with project managers to discuss issues, resolution, scope changes, forecasting.

• Used applications and skills: MS Access, MS Excel, Macros, Visual Basic, SQL, VLOOKUP, Reports, Graphs, Presentations with MS PowerPoint, SharePoint, MSMS

AWARDS & ACHIEVEMENTS

Compuware Corporation

• Employee of the Year, 2006

• Received Feature Story in annual report.

Detroit Collegiate Preparatory at Northwestern

• Business Office and Education Club,

Extemporaneous Verbal/Writing Contest

• Received first place award at the

Local, Regional and State level

Placed at Nationals

Blue Cross and Blue Shield of MI

• Innovation Award - 1994

HOBBIES/INTERESTS

Writing

Travel Consulting

Poetry

Public Speaking

Mentoring Youth

Bowling

Sight-Seeing

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