Nickel Tonkinson

Hixson, TN *****

adrlkt@r.postjobfree.com

+1-423-***-****

Multi-talented Associate Business Analyst with success in process and operational Improvement, emphasis on testing. Recognized for being a critical thinker, able to identify complex issues and analyze and develop process improvements to resolve them. Work Experience

Associate Business Analyst Technical Team Expert BlueCross BlueShield Of Tennessee/Shared Health - Chattanooga, TN May 2017 to December 2019

· Successfully Created, built and tested all workflow configuration and processing guidelines, complying with CMS, Federal and State Medicaid regulations, meeting all time constraints and contractual obligations prior to product launch

· Analyzed and tested function, performance, and design compliance of all current system configurations in order to identify any defects, Improved automation first pass rate by 33%

· Accessed vulnerabilities with process guideline documentation to determine and address quality improvement opportunities, while working with other development and audit teams

· Applied advanced skills as department subject matter expert to resolve complex problems not covered by existing procedures or practices

· Analyzed current business plan, identified inefficiencies in existing processes, and tracked performance following implementation of improvements

· Tracked and evaluated claims history and trends, identified system configuration and Processor errors using Structured Query Language (SQL), MS Access, and Excel, recommended operational improvements and created both Proactive and Adjustment reports to have the errors corrected. Research Expert/Adjuster

BlueCross BlueShield Of Tennessee Inc./VSHP - Chattanooga, TN June 2013 to May 2017

· Acted as BlueCare claims subject matter expert, answering internal and external questions and inquiries

· Adhered to established policies, procedures and compliance for satisfactory audit rating

· Investigated and resolved customer complaints to foster satisfaction

· Analyzed information gathered by investigation of all current and past data to repair defects

· Surpassed standard adherence of 90% to 110%

Medical Claims Examiner

BlueCross BlueShield Of Tennessee Inc./VSHP - Chattanooga, TN March 2011 to June 2013

· Reviewed and follow all procedure guidelines, maintained claims data to process medical professional claims in accurate and timely manner exceeding quality requirement by 10%

· Examined claims forms and other records to determine insurance coverage and claim payout

· Took every opportunity to train and learn procedure steps and guidelines within all VSHP operations departments for knowledge growth and make myself available to assist whenever needed Customer Service Representative

BlueCross BlueShield Of Tennessee/BlueCard Host - Chattanooga, TN October 2008 to March 2011

· Consulted with outside parties to resolve discrepancies and create effective solutions to address customer needs

· Quickly and accurately answered questions by evaluating information and process errors to answered customer questions, suggested effective solutions and resolved issues to increase customer satisfaction

· Exceeded company adherence standards by 7% on consistent basis, handling more than 50 inquiries each day

Mortgage Broker/Loan Officer

Silver State Mortgage - Las Vegas, NV

· Created and maintained professional relationships with both Real Estate Agents as well as those seeking a mortgage loan for home purchase or refinance.

· Attended all continued education courses to maintain valid license

· Coordinated and handled all loan processes – included but not limited to Credit checks, property appraisals, credit improvement, and document signings. Education

Business Analyst Certified - Cornell University in Organizational Management, Leadership

Blue University - Chattanooga, TN

High school diploma or GED

Skills

• Advanced critical thinking

• Operational analysis and improvements

• Business process improvement & Problem resolution

• Configuration testing

• 11.5 yr. experience in Health Insurance Industry

• Develop and Implement policy and procedure

• Team leadership

• Business and Data Analysis

• Business operations expertise

• Proficient in all Microsoft Office and SQL

• Loan Officer Experience

• Microsoft Access

• Business Analysis

• User Acceptance Testing

• Business Requirements

• Requirements Gathering

• Analytics

• CPT coding

• Medical billing

• ICD-10

• Test Cases

• Microsoft SQL Server

• Data Warehouse

Certifications and Licenses

Certified in Business Analytics. 2020

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