Jane A. Pagliai

*** * ****** **, ***** Lake Beach, IL 60073 Phone: 847-***-**** Email: adw191@r.postjobfree.com QUALIFICATIONS SUMMARY

IT professional with experience as Business Analyst, Systems Analyst, and Technical/Customer Support in the medical, dental, pharmaceutical claims, and case management procedures. Programming experience based in object-oriented programming languages including CA’s Cleverpath Business Rules Expert, Visual Basic 6, VB.NET, extensive use of SQL and the relational databases of IBM DB2 and SQL Server. As an analyst, I have experience in both participating and leading teams (including cross-functional groups). I am willing to travel when needed.

PROFESSIONAL EXPERIENCE

CVS Health, Pike Blue Bell, PA

Mgr,Business Analyst 3/2023-Current

● Data migration of Aetna eligibility files to the Pharmacy Benefit Managing for Medicare/Marketplace.

● Knowledge of HIPPA 834 and NextGen.

● New hire acclimation and application access

● Develop Business Requirements documents for new and enhancing development of NextGen eligibility

● Use case development for the QA of Medicare, Medicaid and Marketplace plans in several states.

● Data migration from client legacy systems into the Aldera platform

● Experience working within an Agile environment, creating user stories, epics and technical/functional requirements.

● Experience with Sharepoint for the management of all Agile stages of a project.

● Data analysis through Tableu and proprietary files

● Business requirements gathering and Technical Requirements for product fixes and new development AbbVie Mettawa, IL

Business Consultant Unique 06/2022-07/2022

• Manage projects across Therapeutic Areas for Global Affairs digital content regarding the status, benefits, costs, and risks of new requests and current projects.

• Develop comprehensive project estimates and timelines by collecting feedback from all impacted stakeholders.

• Manage a diverse workload while maximizing productivity and innovation.

• Work across IT and business functions to negotiate and secure the availability of resources to meet the demands of the therapeutic areas.

Common Ground Healthcare COOP, Brookfield, WI

Sr. Business Analyst 2/2022-4/2022

Participate in new product launch meetings and configuration/support of the claim payment system (Aldera)

● Analyze and document system shortcomings and recommend system enhancements to improve adjudication results.

● Knowledge of HIPPA 834, 835 and 837 file layouts as well as CMS1500, UB04, and ADA claim forms.

● Prepare technical specifications for system enhancements Aldera claim payment system.

● Participate and make recommendations on new products and review the Aldera platform to determine how the system can be utilized.

● Integration with pharmacy vendor MOOP files and mitigating discrepancies.

● Handling ADHOC SQL requests from internal departments

● Requirements gathering for new product development, creating user stories, epics and technical/functional requirements

● Project tracking in Jira and Sharepoint

● Serve as product owner of the Aldera system

Aldera/Evolent Health, Lisle, IL

Sr. Technical Solutions Consultant 7/2014 – 10/2019 Provide support between development and client users of the Aldera claim platform.

● Analyze and document system shortcomings and recommend system enhancements to improve adjudication results for several clients using the Aldera platform.

● Knowledge of HIPPA 820, 834, 835 and 837 files.

● Client specific training either through conference calls or on-site client visits, representing Adera as a product.

● Review client reported issues to determine root cause and implement appropriate changes

● Experience in supporting private insurers, Medicare, Medicaid and Affordable Care Act plans in several states.

● Setting up provider and state fee schedules within the claim system environment. Implementing pharmacy MOOP file exchanges and mitigating discrepancies.

● Data migration from client legacy systems into the Aldera platform

● Experience working within an Agile environment, creating user stories, epics and technical/functional requirements.

● Experience with Salesforce, Jira, Confluence and Sharepoint f or tracking of projects and documentation

● ADHOC queries for internal, external and data analysis

● Business requirements gathering and Technical Requirements for product fixes and new enhancement

● Moderate experience with MS Office in data collection, data export and reporting SecureEDI, Chicago, IL

Business Analyst-Application Specialist 10/2010 –7/2014 Claim system implementation & migration including claim data conversion from legacy systems.

● Analyze and document system shortcomings and recommend system enhancements to improve adjudication results.

● Knowledge of HIPPA 834, 835 and 837 file layouts as well as CMS1500, UB04, and ADA claim forms.

● Prepare technical specifications for system enhancements, custom client needs and in-house system development.

● Data migration from client legacy systems into the Aldera platform TRUSTMARK SERVICES COMPANY, Lake Forest, IL

IT Systems Analyst – Global360 Workflow Management System 1/2007 – 1/2010

● Maintained VB6 programming for the Workflow application, ensuring the proper routing and prioritization of claim transactions.

● Developed and maintained web-based reporting applications using DB2, SQL Server 2005 and Crystal Reports.

● Provided technical support in person and on the phone for all claim division applications.

● Developed and maintained ancillary VB and VB.NET applications (GUI and non-GUI) used for the loading, unloading, and manipulation of EDl and paper claim data.

● Researched and made purchasing recommendations to management regarding third party vendors for print-to-image

● Implementing pharmacy claim pricing using AWP calculations. TRUSTMARK SERVICES COMPANY, Lake Forest, IL

IT Systems Analyst/Business Analyst – Expert System 1/1999 – 12/2006

● Designed and coded an Expert System (Business Rules Expert/Decision Application) using Aion Cleverpath BRE software.

● Lead project teams to gather and define business requirements and create use case diagrams for the proposed system.

● Defined and managed project goals across multiple business areas, including external vendors.

● Designed and implemented a project to create Average Wholesale Pricing for pharmaceutical claim processing.

● Performed Cost/Benefit Analysis and ROI calculations on all assigned projects.

● Created test plans for Model Office testing and post-implementation validation.

● Attended training to achieve the certification of Trustmark Authorized Project Manager. TRUSTMARK SERVICES COMPANY, Lake Forest, IL

Administrative Assistant 12/1996 – 12/1998

● Completed special programming projects as assigned which utilized SAS, Lotus, Foxpro, and Microsoft Office products.

● Uploaded files from regional general agents and download data from proprietary systems for distribution among the divisional areas and for use in reports.

● Maintained system security profiles.

● Data migration from random Agent enrollment data into machine readable files consumable by the mainframe TRUSTMARK SERVICES COMPANY, Lake Forest, IL

Claimfacts Analyst I, II, and III 01/1993 – 12/1996 TRUSTMARK SERVICES COMPANY, Lake Forest, IL

Reinsurance Specialist 10/1991 – 12/1992

BUELL INSURANCE AGENCY Libertyville, IL

Bookkeeper-Collections 06/1985 – 05/1991

EDUCATION

Bachelor of Science Information Technology

University of Phoenix received 11/26/2006

Certifications

FMLI (Life Management Institute)

HIAA/AHIP (Health Insurance Association)

ICA (International Claims Association)

AIA (AHIP Insurance Agency Management)

VB.NET (Microsoft)

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