TERRY KRAMER

Southington, CT 860-***-****

addwue@r.postjobfree.com www.linkedin.com/in/terry-kramerCT BUSINESS ANALYST, BUSINESS SYSTEMS ANALYST

A Business / Business Systems Analyst professional with extensive experience within the healthcare insurance field. Successful projects include new business integration, development of new applications, maintenance and enhancements to existing applications, and development of new EDI transactions. Solid skills for capturing and documenting business requirements, translating business requirements into technical specifications, and a unique ability to focus on business outcomes (Increase Customer Satisfaction, Reduced Cycle Time, Increased Productivity, Improved Quality, Expense Reduction). Experienced with multiple SDLC methodologies (Waterfall, Agile). Solid individual contributor and team collaborator, with a high commitment to internal & external customer service.

• Business & Functional Analysis • Project Documentation • Process Improvement

• Communication • Meeting Facilitation • Customer Focused

• Agile • Waterfall • Capacity Planning

• Results Oriented • Quality Focused • Relationship Management

• Cross-Functional • Mentor / Leadership • Six Sigma

• Reporting Tools • MS Office Suite • Training

PROFESSIONAL EXPERIENCE

UNITED HEALTH GROUP, Hartford, CT 11/2002 – 11/2019 Director, Prior Authorization Change Management (4/2017 – 11/2019) Led a team of business analysts supporting the maintenance of rules within UHC’s prior authorization system, for all lines of business and all medical products; resource-balanced 12 team members to support standard work, new business and project support work; performed business analyst tasks as needed to support customers and team.

• Improved quality customer relations and reduce cycle time to implement prior authorization changes by mentoring and supporting 17 team members.

• Increased productivity and turned around marginal performance by mentoring, implementing performance metrics and developing team members.

• Obtained approval for 41% capacity growth to meet demand by designing, developing and implementing a resource balancing tool.

• Implemented “more with less” thinking by improving quality, teamwork and relationships.

• Streamlined processes which improved productivity, teamwork and relationships.

• Supported state/federal mandates and customer specific requirements maintaining clinical rules configuration within the prior authorization application.

• Ensured accuracy with business requirements by partnering with medical directors and other business partners.

• As an individual contributor, developed requirements, capabilities/features/user stories, rules configuration and production support as needed to meet expectations and needs of our business partners.

• Created process efficiencies and quality improvements while taking in new scope of work into the team by implementing new processes, resulting in being nominated for a Collaboration Award. IT Functional Architect (Individual Contributor & Manager) (6/2007 – 4/2017) The team of 7 Functional Architects were subject matter experts and supported 7 claim applications and supported internal project teams, business partners, as well as external customers. The team was also assigned to projects as Business Systems Analysts or Project Leads, when resources were needed.

• Contributed to the success of project/programs ensuring quality end results by supporting project teams through the implementation of projects as a Subject Matter Expert, Business Systems Analyst, or Project Lead.

• Participated in SDLC (Agile & Waterfall) for successful implementation of projects.

• Ensured consistency of processes by creating and maintaining process & procedure documentation.

• Achieved high quality results and high-performance by mentoring and supporting team members, other system analysts, and business partners.

• Facilitated World Class Service being a single-point-of-contact for all questions and issues from analysts, developers and business partners & end users.

• Ensured quality specifications by performing reviews and providing sign off on system specifications and test plans.

• Drove strategic design solutions, partnering with business and leadership.

• Improved quality and created efficiencies collaborating with other teams to create Subject Matter Expert processes for other claim platforms.

Business Project Director (2/2004 – 6/2007)

Led a team of business analysts who were responsible for the development of business requirements for operations processes & IT enhancements to support new business; took on project management role for some projects.

• Successfully integrated 4 new alliance and acquisition businesses through business process changes and documentation of business requirements for IT enhancements.

• Developed quality business requirements and processes partnering with the alliance and acquisition business teams.

• Ensured success of IT enhancements performing project management tasks through implementation.

• Increased productivity by mentoring, supporting and developing team members.

• Contributed to successful program implementation by coordinating planning and development of IT enhancements across IT teams and other business partners.

• Facilitated successful conference calls with over 50 attendees by providing an agenda, being prepared, staying on topic.

IT Team Lead, Application Planning/Account Management (11/2002 – 2/2004) Reviewed incoming project requests; accountable for identifying impacted applications and collaborated with application leads to develop estimates and assumptions; coordinated the scheduling of project implementations across applications; followed projects from intake to post-implementation.

• Effectively developed estimating and planning for 7 claim applications, in addition to collaborating with other applications and business liaisons for cross-application planning.

• Provided efficiencies being the point of contact for claim applications’ development team for escalations.

• Improved quality of project estimating by developing internal capacity planning tools which were used to balance with organization’s planning tools.

• Provide the capability of project reports by developing canned and ad-hoc reports in Access for management, development teams and business partners.

• Contributed to continuous process improvements by participating in multiple process-improvement teams. AETNA, Middletown, CT 5/2002 – 11/2002

Quality Assurance Team Lead

Led a team of Quality Assurance Analysts supporting the enhancements to an Oracle Database; collaborated with the IT Team for projects.

• Documented and executed test scenarios and plans based on business requirements and functional specifications.

• Reviewed team members’ test plans & scenarios to ensure completeness and project success.

• Provided 24-hour support of application during implementation and post-implementation. UNITED HEALTH GROUP, Hartford, CT 3/1990 – 5/2002

Manager Information Systems (7/1998 – 11/2002)

Led a team of business analysts and developers supporting the development of a customer service application; maintained the application in support of source application changes and changed business needs; provided production support to end users.

• Achieved high quality results and high-performance by mentoring and supporting team members.

• Performed analysis to document business requirements and document functional specifications to meet business needs and translate to developer programming.

• Created test scenarios and test plans to test enhancements to ensure quality end product.

• Developed a customer service application (using Rapid-Application-Development) and successfully implemented & trained within expected timeframe and cost.

• Implemented processes & service level agreement (SLA) to our customers and end users for production support.

• Successfully integrated new platforms into the customer service application, due to business merger. Business Analyst Consultant (3/1990 – 7/1998)

Supported multiple business processes including (medical) claims processing, customer service, quality assurance, accounting, training, technical support and business analysis for IT enhancements.

• Analyzed and accurately processed medical claims for reimbursement to meet contractual service level agreements with customers.

• Provided customer service (as a lead representative) for large, global customer, contributing to customer satisfaction.

• Performed end-user testing for a customer service application to ensure quality and that it met the needs of the end user.

• Created training documentation and performed training on regulation changes and IT enhancements to over 300 people to enable standard productivity and to ensure quality support to our customers.

• Provided operational and technical support to 13 telecommuters to enable them to meet their productive goals.

• Piloted accounting software and assisted in the successful implementation to production, resulting in higher performance and faster turn-around on accounting transactions.

• Accountable translating business needs into business requirements for IT enhancements of a customer service tool to ensure business needs are accounted for.

EDUCATION

• Central Connecticut State University, MIS (Management, Information Systems)

• Electronic Computer Processing Institute, Certificate in Office Management

• Academy of Our Lady of Mercy (Lauralton Hall) – General Diploma (High School) CERTIFICATIONS

• SQL (course to be completed 6/2020)

• Power BI

• Tableau 10

• Six Sigma

• Agile Methodology

• Accredited from United Leadership Academy (ULA)

• Certificate for the Emerging Leaders Program

• Culture Ambassador

• Group Fitness Instructor

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