Sr. Analyst
Resume:
Charlotte Goodwin
Franklin, MI *****
***********@*****.***
Administration/ Management: Analyst with over 5 years of experience supporting business solution and analyzing business operations. Striving to utilize my analytical ability and strong organization skills to achieve the goals of your company.
EXPERIENCE:
BlueCross Blue Shield Michigan
BlueCard Plan to Plan Service
Renaissance Center 600 Tower
February 23, 2017 – September 10, 2019
BlueCard Sr. Analyst
• Develop and improve workflows and business processes within area(s) to improve customer service, decrease operational costs and improve overall quality
• Flexlink Subject Matter Expert
• Ability to work independently, written a team environment and with multiple priorities
• Knowledge of Access Database, Microsoft Word/ Excel, SharePoint, Microsoft Outlook, Blue 2, NASCO /3270, Open Span, Navigator, Nterflow tool.
• Ability to work closely with the technical support team in understanding and resolving system issues.
• Consult with Quality Business Leaders for Vendor Work Type Processing
• Evaluate Vendor Quality Assessments and Rebuttals
• Calibrate with Quality Auditors for External Business Partners
• Writing, testing and process improvement for scripting claims
• Creating Job Aids
• Implementation and analysis of new and improved workflows for claims
• Reporting and new products to improve customer service levels and overall quality.
• Provide leadership team with status of projects; issue, communicate and recommend policy decision.
• 54 Adjustment Gatekeeper
• Maintenance Change Request Gatekeeper
• Flex link claim DF create
• 301 Denials- Provider Recoupment
• Conducted huddles to rolled out new processes
• Assist personnel (both internal and external) by answering questions, supplying information and training.
• Represent department and division as requested on work groups and special assignments.
• Develop and maintain an effective working relationship with customers or partners. BlueCard Analyst
BlueCard Plan to Plan Service Department
March 3, 2013
• Consult with Quality Business Leaders for Vendor Work Type Processing
• Evaluate Vendor Quality Assessments and Rebuttals
• Calibrate with Quality Auditors for External Business Partners
• Writing, testing and process improvement for scripting claims
• Creating Job Aids
• Implementation and analysis of new and improved workflows for claims
• Reporting and new products to improve customer service levels and overall quality.
• Provide leadership team with status of projects; issue, communicate and recommend policy decision.
• 54 Adjustment Gatekeeper
• Maintaince Change Request Gatekeeper
• Flex link claim DF create
• 301 Denials
• Attended Provider Fairs
• Conducted huddles to rolled out new processes
• Assist personnel (both internal and external) by answering questions, supplying information and training.
• Represent department and division as requested on work groups and special assignments.
• Develop and maintain an effective working relationship with customers or partners.
• Monitor Blue Card Advocate, mail box
• Monitor BlueCard Ombudsman, mail box
BlueCard Unit Leader
BlueCard Plan to Plan Service Department
March 3, 2009
Assist the Supervisor in managing the work
Prepare work schedules
Prepare daily, weekly, and monthly inventory and performance reports, including WMS efficiency reports, Viper inventory report, Excel inventory spreadsheets, and EOS report
Provide performance feedback to employees
Identify system overflow issues and write-up problem IDs for system investigation/ resolution
Assist is employee development through coaching and on-the-job training
Answer/clarify Full Service Representative claim processing questions
Contact providers and other Blue Cross Blues Shield plans as necessary
Corresponded with providers and other Blue Cross Blue Shield plans via telephone or letter
Process complex priority cases and inquires from the Ombudsmen and Executive Cases for approval/denial, which requires a high level of expertise in pricing. Chairperson/Committee Person – Local 1781 UAW
Southfield, MI 48034
June 2003 – March 2017
• Conflicts Resolution
• Counsels on Attendance, Performance and Quality issues
• Build teamwork principles and goal setting in meetings
• Listen for underlying problems and refer to appropriate professional
• Participate in meetings, focus on problem solving
• Analyze situation to bring about realization and resolution
• Develops leadership skills through attending classes and conferences
• Work with management pro-actively on changes in work process
• Interpret the Union Contract Master Labor Agreement for clarification
• Write grievance (complaints) to progress up the demands for resolution
• Negotiate win/win solution
EDUCATION/Certification: 2 years at Business Management, Wayne State University, UAW Representative, Excellence of Leadership, Lean Six, Black Sigma Blackbelt
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