Quality Assurance Customer Service

PROFESSIONAL SUMMARY:

• Business Analyst with over 20 years of experience, including System Analysis, Configuration, and QA.

• Functional Test Lead experience - instructing, assisting and evaluating onshore and offshore resources

• Experienced Business liaison between End Users and System Developers to translate requirement documents to technical specifications

• Stong experience with CSC PowerMHS software, specializing in the Provider, Claims, and Membership modules.

• Business System Analysis and Configuration experience - work with End Users to analyze current business practice and system setup to identify and implement improvements

• Quality Control tester (manual and automated) of system changes – includes positive and negative testing – experience in creating and running interactive SQL’s to collect and validate data

• Extensive knowledge of Claims Processing – including data entry, group/membership setup,

benefits processing, and provider payments

Industries: Insurance, Education

Platforms: AS400, Mainframe, DB2

Software: DST (PowerMHS), BCBSVT (Legacy), SQL, Query

MS-Office (Word, Excel, Access), Outlook, HP Quality Center (aka TestDirector), Silk Central

EDUCATION/TRAINING:

CIGNA University Fundamentals of Software Testing 12/10

Test Management 12/10

Professional Assertiveness 12/09

Building Relationships to Get Results 12/09

Keane, Inc. Productivity Management - 5/04

Vermont Technical College Introduction to Business Writing - 11/03

Blue Cross/Blue Shield of Vermont Introduction to Leadership – Team Leader & Mentor 11/03

Community College of Vermont Principles of Accounting I

Principles of Accounting II Typing II

AWARDS:

Blue Cross/Blue Shield of Vermont Distinguished Employee – September 2001

PROFESSIONAL EXPERIENCE

CSC (Computer Science Corporation) June 2012 – Present

o Consultant – Functional Test Team Lead - Medicaid

Responsible for Supervising 3 functional area teams - Provider, Recipient and Call Center consisting of 3 leads and 19 testers.

Weekly status reporting for time and work completed

Meet three times a week to review upcoming CSR (Customer Service Requests), calculate estimates for testing, and make assignments

Meet weekly with Test Team Leads to go over procedures and resolve any issues

Work with Test Leads and Testers on questions about requirements, test cases, defects and results

CSC (Computer Science Corporation) May 2011 – June 2012

o Consultant – QA Test Lead - Medicaid

New claim system for NCMMIS is being created on DB2 Mainframe platform. Each section/functionaly is being built and tested as a “Build” and there are also CSR’s which are Customer Service Requests above and beyond the original contracted content.

Build 14.1 – References

CSR’s – Customer Service Requests

• Supervised 10-11 QA testers – reviewed test cases, results, defects and worked with testers on questions/issues

• Met weekly with NC State Representatives to review test results and resolve any issues

• Reported daily to Upper Management and provided bi-weekly reporting to State Representatives

CIGNA Feb 2009 – April 2011

o Consultant – Functional Test Lead

Cost Containment – External Claim Pricing Project

HIPAA 5010 – 835 Outbound/CERR, 837 Outbound/ACCR, PMHS modifications for ICD10 codes Project

• Analyzed Application Designs and Program Specifications to assist with and review Test Plan, Scenarios and Scripts

• Instructed On-shore and Off-shore resources in Test Practices

• Coordinated testing with External Pricing Partners

• Evaluated defects, assisted with resolution and retesting defects, assisted with resolution and retesting

• Evaluated evidence and presented to Business and Project Leaders when testing was complete

CIGNA May 2006 – Feb 2009

o Consultant – Senior Quality Assurance Tester

Custom Benefit Builder Project

ECPP – External Claim Pricing Program Project

Sarbanes-Oxley, ASO Refunds, Lein & Garnishments

Multiple Simple Projects or Production fixes for Claims, Membership, Benefits, EOB/EOPs and wrapper interfaces

• Analyzed Application Designs and Program Specifications to write applicable Test Plan

• Created and executed test scripts in Mercury Test Director – reported defects, assisted with resolution and retested fixes

• Responsible for learning and testing the GLSS (General Ledger Shared Services) process – also responsible for running the mainframe GLSS jobs in the functional and integrated test regions

EDS - Kentucky March 2006 – May 2006

o Consultant – Business Analyst

Benefit Configuration for conversion to new processing system

Research existing benefit edits and audits to determine how to configure the new software system appropriately

Create spreadsheets of existing functionality to use in the configuration of the new system

Blue Cross/Blue Shield of North Carolina May 2005 – Dec 2005

o Consultant - Quality Assurance Tester – (5/05 – 12/05)

Integrated RX testing

Create test cases in Test Director for Benefit Utilization reporting to Medco

Execute test cases for Claims Pre-Edit processing and Benefit Utilization reporting – develop test SQL’s to collect and validate data, document all results, report defects, retest as necessary

Coordinate test data and resolve issues with outside vendor (Medco)

Calculation Set Reduction and PORG Decoupling Testing

ID Card Rewrite testing

Create and execute test cases in Test Director – modify data in PowerMHS, key claims into PowerMHS, modify and adjudicate claims, develop test SQL’s to collect and validate data, document all results, report defects, retest as necessary

Blue Cross/Blue Shield of Vermont Oct 1993 – May 2005

o Group Implementation Specialist – (12/04 – 5/05)

Benefit setup and Maintenance

• Developed and implemented new benefit setups in Legacy and PowerMHS systems to assure correct claims payments

•

• Blue Cross/Blue Shield of Vermont con’t

• Maintained benefit setups and modified as necessary per any Medical Requirements changes

• Cross-trained team members on all benefit setup and maintenance functions

Group setup and maintenance

• Researched and configured system changes for membership/group related functions for PowerMHS 5.0.7 upgrade - worked with Business Users to identify requirements and then acted as liaison with Developers to create technical specifications for said requirements

• Loaded new group information into Legacy and PowerMHS as new business was sold

• Modified current group files for benefit or demographic changes as necessary

o Configuration Analyst – (5/03 – 12/04)

Project Team Lead on Corporate Adaptive Maintenance Projects – research/document/configuration/quality assurance testing of all components related to these updates – assign tasks to 2 other team members and monitor their progress - develop test SQL’s to collect and validate data – document all procedures and results

CPT/HCPC yearly update

ICD-9 yearly update

Research and configure system changes for company wide projects – work with Business Users to identify requirements and coordinate with Developers to create specifications for said requirements

Quality assurance testing on all functionality relating to changes - develop test SQL’s to collect and validate data – document all procedures and results

PowerMHS releases

Membership Backbridge

Set up and maintain benefits in the Legacy system

Research and resolve claims processing issues – do quality assurance testing on all functionality relating to changes

o Quality Control Analyst – (5/02 – 5/03)

Researched and resolved claims processing issues – worked with Business Users to identify requirements and then acted as liaison with Developers to create technical specifications for said requirements

Performed quality assurance testing on all functionality relating to changes.

Developed test SQL’s to collect and validate data – document all procedures and results.

Set up and maintain benefits in the Legacy system.

Blue Cross/Blue Shield of Vermont con’t

Assisted in any Provider Configuration Setup – do quality assurance testing on all functionality relating to changes.

Participated in Projects as assigned.

o System Unification Project Team Member – (4/00 – 5/02)

Researched and analyzed PowerMHS Provider modules for accurate claim and capitation payments.

Worked with Business Users to identify and document all requirements.

Reviewed requirements with Developers to create technical specifications.

Assigned tasks to 2 other team members and monitored their progress

Performed quality assurance testing on all functionality relating to the new configuration.

Develop test SQL’s to collect and validate data – document all procedures and results

Participated in presentations to Executive Staff.

Creation of Requirement Documents, Technical Specifications and Configuration Specifications as required.

Work in a Team oriented atmosphere to identify overlaps in processing

Quality assurance testing of manually set up screens and programmatically set up screens

o Provider Reimbursement Analyst – Medicaid – (12/97 – 4/00)

Set-up and maintain Provider Contact Lines for the Medicaid line of business

Setup and maintain Provider Pricing methodologies for the Medicaid line of business

Work with Quality Control to setup any special benefit requirements for the Medicaid line of business

Work with the Medicaid processing Department to research and resolve any pricing or payment issues

o Senior Claims Processor – (11/96 – 12/97)

Supervise Major Medical and Medicomp Claims Processors

Perform quality checks on all supervised employees

Code and key Major Medical and Medicomp claims submitted by Providers and Subscribers

o Suspense Resolution Analyst – (8/94 – 11/96)

Research and resolve issues causing claims to suspend in the system

Code and key Major Medical Insurance claims submitted by Providers and Subscribers

o Claims Processor – (10/93 – 8/94)

Code and key Major Medical Insurance claims submitted by Providers and Subscribers

Community College of Vermont Oct 1984 – May 1992

o Clerk – (10/91 – 5/92) (Part-time position)

Assigned to Accounts Payable, Registrar’ and Financial Aid Departments to perform duties as assigned; data entry, filing, research projects, account reconciliations, etc.

o Accounting Specialist III – (10/87 – 7/91)

Process all computerized student billing

Coding of student registration forms

Reconciliation of Accounts Receivable accounts to the General Ledger

Phone interaction with students – setting up payment plans

Back-up for the Accounts Receivable Supervisor

Community College of Vermont con’t

o Accounting Clerk – (12/85 – 10/87)

Responsible for the Accounts Payable Department

Processed purchase orders, invoices, and issuing checks

Reconciling 5 Imprest checking accounts which were used in site offices throughout the state

General journal entries

Supervision of another clerk half days

Monthly/yearly reconciliations of accounts to the General Ledger

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