Daniel Gamache Email & Phone Number

East Lansing, Mi, Us

Okemos, Michigan, United States

Okemos, Mi

Okemos, Michigan

Columbia, South Carolina Area

Currently working on the TRICARE contracts performing business enhancements through projects and change sheet requests. Business uses a Role based methodology.

Auburn Hills, Mi

Okemos, Mi

Early Retirement From Delta Dental of Michigan, June, 2015ADP II - Certified (2013) New Systems DesignA Primary IT Subject Matter Expert (SME) working on the redesign for the Client, Common, and Benefit Program areas of the ETS Project (Enterprise Technology Solutions). Client - the customer data store housing the administrative information about the client and their sublocations, agent/broker information, claims processing/eligibility/ortho/COB configuration rules, contracts, premium rates, and other data describing the client or the customized product configurations requested.Common – the Carrier’s product data store, product pricing strategies, region pricing maps and fee tables, dental procedure configurations (CDT Reporting, Rating, Toolkits/Benefits), messaging used on EOB/Claims/Toolkits/IVR, banking, calendars, and other data used to support the claims processing and billing efforts.Benefit Program – the products and features purchased by the client. Benefit Features include: benefit levels (coinsurance percentages by benefit category), maximum/deductibles, time limitations and exclusions (claims rules), and waiting periods features. Each benefit feature can be qualified by network, member type, member benefit type, and/or ages.Business Systems SolutionsPrimary IT SME collaborating with the business community to support the market changes, insurance commission regulations, government laws, Federal/State Exchanges (Affordable Care Act). Included designing solutions for: Waiting Period Credits, Carryover Maximums, Graduated Benefits, EHB Benefits, out-of-pocket expenses, and office visit fee's, Conversions to ETS Client, Common, Benefit Program SME for conversion to ETS, for current plans DDMI, DDOH, DDIN and carrier plan affiliates: Delta Dental of Tennessee, Delta Dental of New Mexico. Added new carrier plan affiliates: Delta Dental of North Carolina, Delta Dental of Kentucky, and Delta Dental of Arkansas.

Okemos, Mi

Partners and Affiliates (1994 – 2007 the middle years)With the success of the IDMS claims processing system came additional opportunities to partner with our sister plans. This required traveling for requirements gathering, gap analysis, training, and Implementations. The other Plans included: DDAR, DDOK, DDTN, DDNM, and DDCO. All implementations were met with great success. The experience of working with the other plans is exciting, challenging, and very rewarding. It is always great to find like-minded folks struggling with the same issues and solving them together. What was great about each of these opportunities was every enhancement a partner/affiliate brought to the table, everyone on the system would immediately benefit from that enhancement in their marketplace.

Farmington Hills, Mi

Designing IDMS/R (The Early Years)I started in October of 1986, the first day I was put on the team to assist in designing the new claims processing system on an IDMS/R (Integrated Data Management Systems/Relational Database) environment. The company was moving from CICS. After initiation to the core components of the design effort, I was assigned the Group (client) area for design. Requirements gathering, interviews, work flow documentation, data dictionaries, specification writing, presentations, walk trough’s, all supported by a new methodology: A Data Driven Design. This methodology was being written at the same time, by a consultant. Training documentation and on-site training for the whole company was also involved. Many new features and products were created to enhance the experience in the system. This involved talking with the people in Sales/Marketing, Accounting, Claims processing, Claim Audit, Mailroom, and Group Administration from the hourly staff to the Vice-President of the department. One of the crowning achievements in my career involved listening to the hourly staff, in a social setting where everyone spoke freely, and designing a business solution around the frustrations they pointed out in the system. A composite inquiry involving 3 different schemas united in one view. This one query became the blue print for the IVR and toolkit applications to follow. This system improved the claims drop-to-pay rate exponentially and became a popular around the country allowing DDMI to partner/affiliate with other Delta Plans.

Southfield, Mi

Business Administration

Pre-Business Administration