Supported transitions of business from CCStpa to both BCBSMN (parent company) and to AmeriHealth Administrators (as the result of a sale). Responsible for implementations and testing of client set-ups related to these transitions.• System platform conversions for the two companies: assisted in migration of existing benefits, claims and accumulator testing, and benefit coding validations• Supported AmeriHealth Administrators (AHA) and BCBSMN on claims issues, reconciliation of reports and EOB requests during period of extensive change• Managed Client Center website set-up and termination requests for clients and internal employees; helped resolve claims and membership inquiries throughout transitions • Tested and validated new business runout tools (claims, membership, and provider) in preparation for BCBSMN’s decommissioning of existing systems• Collaborated with external vendors and internal staff to implement multiple projects, including Workday HCM software• Participant of multiple workgroups to analyze testing tools and create and finalize testing documentation (Master Test Plan, Test Case Template, and Test Summary Report)

• Implementation and testing of self-insured clients’ strategic initiatives for business requirements and network arrangements• Risk mitigation; identify solutions to complex issues and communicate outcomes or potential outcomes with stakeholders• Benefit validation for new and existing clients; Validation of accumulator and eligibility files for new and existing clients• Managed team mailboxes for R&Q, Claims, and Customer Service areas (researched and responded to various types of inquiries from external and internal sources)

• Built and maintained client set up information and medical/vision/dental benefits within online tools for new and existing clients• Created and submitted prescription benefits, provided account structure/mapping for eligibility feeds to external pharmacy vendors (e.g., Prime Therapeutics, Express Scripts)• Reviewed/audited new and amended benefit plan designs for Summary Plan Documents• Created and maintained member ID cards, provided ID card mapping for eligibility feeds to external printing vendor• Supported RFP process for benefit capabilities review to identify manual processes• Participated in cross functional new client implementation and renewal meetings, working with Sales Operations, Account Managers, Underwriters, Contract Writers, Brokers, and Vendors• Member of interdepartmental workgroups for process improvements to platform and online tools

• Collaborated with Account Management and clients/agents to clarify medical, dental, vision, and prescription benefits, and obtain written documentation and approvals• Researched multiple reference materials and systems to analyze and code benefits and to resolve claims processing inquiries • Conducted system testing of benefit coding to ensure accuracy• Created Benefit Summary Sheets for Claims and Customer Service• Reviewed/audited new and amended benefit plan designs for Summary Plan Documents • Assisted in the training and auditing of Benefit Analysts

• Trained new and existing employees on area specific skills, procedures, and system components required to perform their job functions for claims and customer service• Audited claims processed by trainees• Developed and maintained system/user documentation and manuals• Observed and coached employees one-on-one in a classroom setting or on the floor in response to specific questions or individual developmental needs• Assumed mentor and role model responsibilities

• Processed medical, dental, and prescription claims on two different system platforms• Reviewed and released high dollar claims• Resolved complex system edits and requested necessary documentation in order to finalize claims• Mentored and provided training to other claims examiners