Operations Analyst Quality Assurance
Resume:
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STACEY JENKINS-JONES
PROFESSIONAL SUMMARY
Senior Operations Analyst with extensive expertise in system design and claims processing, specializing in the configuration and implementation of advanced benefit systems. Over 25 years in the health insurance industry, leveraging skills in data analysis, project management, and quality assurance to enhance operational efficiency and client satisfaction. Committed to driving innovation in claims administration and system integration, ensuring seamless functionality and improved user experiences. EMPLOYMENT HISTORY
CONFIGURATION AND OPERATION CONSULTANT E-BENEFITS Nov 2022 - Present UPMC Workpartners Pittsburgh, Pennsylvania
SENIOR OPERATION ANALYST May 2017 - Nov 2022
UPMC Health Plan Pittsburgh, Pennsylvania
OPERATIONS ANALYST INTERMEDIATE Jan 2009 - May 2017 UPMC Health Plan Pittsburgh, Pennsylvania
Analyze staffing methods to optimize business process flows. Configure and audit new processes on Employee Benefit System. Design system requirements for new client onboarding. Manage projects and conduct monthly client audits. Troubleshoot and resolve client issues in Azure.
Conduct comprehensive analysis of business process flows, optimizing staffing methods and enhancing operational efficiency for UPMC Workpartners.
Configure, test, and implement new processes on Business Solver Employee Benefit System, ensuring seamless integration and functionality.
Manage client Annual Enrollments, executing Plan and Rate changes with precision, leading to improved user satisfaction and reduced errors.
Led data analysis to enhance client satisfaction and presented actionable insights. Managed and optimized MC400 and Gemini databases, ensuring data accuracy and accessibility. Coordinated special projects, delivering on-time results and fostering team collaboration. Mentored and trained staff, building a cohesive and motivated team environment. Tested and implemented system enhancements, improving claims processing efficiency. Analyzed data to identify client satisfaction risks, presenting findings to stakeholders and implementing solutions for improved service delivery.
Led system enhancement testing and project implementations, ensuring seamless integration and optimal performance of claims processing systems.
Mentored and trained staff, fostering a cohesive team environment while providing crucial support to MC400 Users and Operation Analysts.
Developed system requirements and validated enhancements for efficient claims processing. Administered and audited claims systems, ensuring accurate payment and denial outcomes. Led training for analysts on updated policies, enhancing team performance and compliance. Collaborated in team meetings, contributing ideas to boost client satisfaction and teamwork. Reviewed data code sets, recommending business-aligned solutions for system implementations. Developed system requirements for new projects, enhancing existing variables while performing rigorous validation to ensure accuracy in claims processing
BUSINESS ANALYST I Feb 2006 - Jan 2009
UPMC Health Plan Pittsburgh, Pennsylvania
PROVIDER INFORMATION ANALYST II Dec 2000 - Feb 2006 UPMC Health Plan Pittsburgh, Pennsylvania
SENIOR CLAIMS EXAMINER Aug 1999 - Dec 2000
UPMC Health Plan Pittsburgh, Pennsylvania
CLAIMS ADMINISTRATION 1997 - 1999
Highmark Pittsburgh, Pennsylvania
SENIOR BANK TELLER 1992 - 1997
National City Bank Pittsburgh, Pennsylvania
EDUCATION
BACHELOR OF SCIENCE IN BUSINESS ADMINISTRATION - HUMAN RESOURCE MANAGEMENT
Aug 1991 - Dec 1995
California University of Pennsylvania California, Pennsylvania COURSES
CLAIMS ADMINISTRATION TRAINING Aug 1999 - Dec 2000 UPMC Health Plan
SKILLS
Configuration(Experienced), System Design (Experienced), Claims Processing (Expert), Business Analysis (Experienced), Project Management (Skillful), Data Analysis (Skillful), Troubleshooting (Experienced), Training (Experienced), Quality Assurance (Experienced), Healthcare (Experienced), Insurance (Expert), Operational Efficiency(Experienced), Database Management (Experienced), Process Optimization (Expert). Analyzed project needs, relayed insights to development team, enhancing project alignment. Assessed data from processes and surveys, improving decision-making accuracy. Suggested development improvements, aligning projects with client objectives. Designed and executed test scripts, ensuring software reliability. Collaborated with business units to validate applications, identifying service issues. Managed provider info system, ensuring precise billing for healthcare providers. Conducted quality reviews, enhancing provider data accuracy. Supported IT troubleshooting, improving system reliability. Collaborated to maintain accurate records, boosting data integrity. Streamlined processes, enhancing operational efficiency. Trained new employees on claims processing, ensuring compliance with protocols. Resolved complex claim issues, enhancing processing efficiency. Analyzed claims for coverage and liability, reducing errors. Investigated suspicious claims, improving fraud detection. Processed claims under HMO, Medicaid, Medicare policies, ensuring accuracy. Scrutinized claims, medical records, and billing data to determine coverage and liability, ensuring accurate processing and compliance with policies.
Enhanced claims workflow, boosting accuracy and reducing processing time. Implemented data strategies for efficient case management. Optimized procedures, achieving notable cost savings. Surpassed performance targets in claim resolution. Led teller team, enhancing transaction efficiency and client satisfaction. Implemented cash handling procedures, reducing errors and boosting productivity. Mentored junior tellers, elevating team performance and service quality. Strengthened client relationships, fostering trust and loyalty. Collaborated with cross-functional teams, achieving seamless operations. LANGUAGES
English (Native).
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