Lead analyst on multiple projects, including complex build for new Medicare plan, with overall responsibility over research into federal plan guidelines, analysis of system ability to operate on said guidelines, and liaising with leaders across the organization to ensure an on-time and accurate system setup. Perform application testing and troubleshooting of own work and the work of other analysts of varying levels within the system. Formulate strategies and solutions for system shortfalls or errors that are discovered through research and testing. Provide guidance for analysts of all levels on the team.

Investigated claim payment issues to ensure correct reconciliation between our system and Utah State Medicaid. Assisted in building and testing check run (claims payment) and batch processing (large volume) functions. Developed workflow from the ground up to facilitate a refund process in a new claims payment system. Collaborated with other users to create a process for claims adjustment between new and legacy systems. Wrote technical user guides for multiple workflows and processes, which included creating a Visio workflow for end-user training. Successfully resolved issues that resulted in the recoupment of hundreds of thousands of dollars by the organization.

Investigated and analyzed raw data files to determine the cause of claim load errors. Served as liaison between our department and the Utah Health Information Network (UHIN) at monthly meetings across the state. Communicated technical reasons for problems/issues with claim submissions in layman’s terms to outside organizations to allow them to correct claim submission files.

Quickly learned the coverage details for multiple benefit plans offered by the company, including both commercial and Medicaid policies. Helped establish baseline expectations for claims production by maximizing the efficiency of using multiple application windows. Assisted with the training of new customer service representatives on the claims processing system (IDX). Processed medical claims in accordance with company, State, and Federal guidelines.