Alex Foley Email & Phone Number

o Provide pre and post-sales application demonstrations to external stakeholders to illustrate the value proposition while uncovering clients’ needs to provide solutions that fit their business modelo Ensure business requirements are valid, clear, and concise by asking probing questions to produce an easily understood technical translation through Jira tickets and cross-functional meetings for engineering, quality assurance, and data teams o Participate in various discovery meetings to understand clients’ current state and how Zelis’ online provider directory tool can better align with their businesso Develop creative solutions by utilizing current functionalities in unconventional ways to circumvent custom engineering work, reducing costs for the cliento Provide critical support to project managers by addressing loose ends, answering questions, and following up on requests to clientso Serve as a subject matter expert for new implementations by maintaining up-to-date knowledge of the tool, allowing for 8x YoY growth for Enterprise book of businesso Collaborate with clients to develop configuration documentation that is ultimately the source-of-truth for their solutiono Partner with other areas of the business (product, engineering, data) to determine new solutions that allow for scalabilityo Spearhead initiatives for department enhancements by leading meetings, maintaining project plan documentation, and providing consultation services for adjacent advisory teamso Assist in the professional development of coworkers by providing tools, resources, and training needed to excel

o Assure product quality through the development and execution of manual test scripts while adhering to department's cadence and accuracy guidelineso Support root cause analysis and communicate proposed solutions in an effective and timely manner to key stakeholderso Execute assigned application regression testing on a weekly basiso Participate in weekly refinement sessions with clients to better understand and clarify requirementso Perform bi-weekly and ad-hoc demonstrations of product features originated within Agile sprints to applicable clientso Evaluate and compose bi-weekly knowledge verification questions for team edification and developmento Participate in improvement initiatives by contributing to documentation utilized for client configurations and client implementationso Assist in the hiring and training of newly hired Quality Assurance associates

o Manage vendor and cross-functional business relationships to develop, test, and implement new and upgraded solutions for online provider directory and cost estimator toolo Analyze, review, and resolve issues related to online provider directory and cost calculations o Conduct, organize, and schedule project meetings, document minutes, and drive next stepso Conduct meetings with pertinent stakeholders for the development and refinement of business requirements to implement new, or improve existing, online provider directory functionalities o Assist in the development and implementation of solutions to accommodate federal and state health insurance mandates o Extract, manipulate, and cleanse data utilizing BI tools, produce meaningful reports, and provide actionable analysis with recommendations to leaders, internal partners, and vendors via written and oral presentations and reportso Create and test use case scenarios

o Adjudicate and manage high and low volume claim adjustment recoveries, high dollar claims, and validate DRG-priced facility claims o Promote accountability and adherence by maintaining availability for the Interplan Hotline, field incoming calls from internal/external customers, and ensure follow-up in a timely mannero Train associates on adjudication of claims, recovery inventory, and responding to fellow Blue Cross Blue Shield Association inquirieso Maintain, monitor, and delegate outstanding adjustment request, Blue Cross Blue Shield Association plan inquiry message, adjustment suspense, and plan-to-plan provider follow-up inventorieso Identify efficiencies through assessment and development of workflows for a more unified team objective and outcome

Hingham, Ma

o Utilize various applications to correct erroneously processed professional and facility claimso Initiate and respond to claims correspondence with fellow Blue Cross Blue Shield Association planso Apply fast-paced critical decision-making skills for each interaction with a provider or sister-plano Assist in training newly hired associates

o Provide benefit and eligibility information of members to dental providers nationwideo Maintain a working knowledge of ADA procedure codes and regulations

o Correct information, when necessary, on erroneously scanned claims

Bachelor Of Science - Bs, Management Information Systems, Technology And Management

Associates, Business

Associate Of Arts And Sciences (A.A.S.), Recording Arts Technology/Technician