Denise Simpson Email & Phone Number

Raleigh-Durham, North Carolina Area

Retired April 7th, 2023BLUECROSS BLUESHIELD OF NORTH CAROLINA, 4615 UNIVERSITY BLVD, DURHAM, NC, 27707 (TELEWORKER)BI Developer/Sr. Data Analyst/Product Analyst, Analytics & Insights (A&I) 2015-CURRENTAs BI Developer on A&I EFF and EXP team, completed several adhoc requests to support Legal Department by providing numerous claims and membership extracts to assist counsel with litigations. Also, involved with the Market Conduct Annual Survey(MCAS) providing data for the Policy Admin submission to DOI. Currently working on FACETS Cotiviti Savings Summary and Detail Report in SQL and Alteryx.As Product Analyst, responsible for tier 1 and 2 support of Financial, Accounting and Underwriting POD (FAU) tasks as well as the Corporate Pharmacy POD. Specific support includes: code enhancements, qa and delivery of assets for the following reports/dashboards/apps: Medication Adherence (MAAD), Provider RX Dashboards, and Ingenio_RX rebate extracts. I previously supported the Membership POD and was responsible for creation and delivery of the Monthly Membership Summary & Detail(MS&D) report consumed by several departments within BCBSNC. Monthly tasks included: compiling and uploading official membership counts to the General Ledger to be used in critical decisions throughout the company. Also worked as Data analyst supporting Client Group Reporting department by generating data extracts and reports for new groups into the monthly automated extract processes. Provides analytic support including data collection, analysis, and delivery to external vendors and Employer Groups, as well as internal clients. Experienced with setting up paths that allow sensitive(PHI) data to be transferred securely using Managed File Transfers(MFT) process. Contributed ideas and guidelines to increase process efficiency by 25%. Demonstrated experience presenting data findings/analysis and making recommendations to leadership staff. Mentored new staff and provided on-boarding assistance as needed.

UNITED HEALTH GROUP , OPTUMHEALTH DATA SOLUTIONS AND BI INTELLIGENCE SERVICES (GOLDEN VALLEY, MN(TELEWORKER IN NC) 2012-PRESENT Sr. Application Reports Developer, Ad Hoc Custom ReportingAs Reports Developer, responsible for requirements gathering, report design, coding, testing, execution and distribution of several Launchpad report requests using SAS. Provides creative custom solutions to customer needs to deliver reports from numerous data sources. These reports enable Senior Account Executives, Account Managers and several other requestors (across UHG and UHC) to forecast trends, prevent stop loss, assist with processing claims and provide various internal status reports. Product focus is Complex Medical Conditions, however, also have experience with multi-client reporting such as STAR(Site Trending Activity Reports) and RRS (Reproductive Resource Services) Enrollment reports. Provides extensive problem solving and analysis by working closely with management, business analysts, and requestors to ensure they receive the data they need in a timely and presentable manner.

Responsible for development and execution of test cases, scenarios and SAS queries to ensure accuracy of Standard Customer Reports(CRDM) (CAR, COVR, CESR, HCCR) for all quarterly/monthly releases. Provides extensive problem solving and analysis by working closely with Business Analysts and Developers to resolve defects or differences in reports, as well as CRDM data. Attended Microstrategy Training (Web for Reporters and Analysts). Have experience using SAS, SAS Enterprise Guide, SQL/DB2, and visio, HP Quality Center.

Responsible for gathering and writing Business Requirements Documents, Requirements Tracebility matrices, and Release notes for projects/products being implemented into the Customer Reporting Datamart. Also, responsible for writing test scenarios, test cases(in SAS) and executing tests to ensure data integrity in Production environment. Have experience using SAS, SAS Enterprise Guide, SQL/DB2, and visio.

Involved in the QA system testing effort for IDSTRAT engine (Evisor Rules for Health Assessment and TRICARE projects). Created test scenarios and SAS programs/proc sql to compare expected results with actual results for numerous business rules. Also involved with testing exisiting production maintenance issues and HSR online application. Have experience using Mercury Test Director, SAS, SAS Enterprise Guide, SQL/DB2.

Created reports for web-based Interactive Client Reporting application providing real-time access to claims and provider information to external accounts. Worked closely with clients, business analysts and team members to deliver solutions aligned with business and IT strategies. Involved in the full system life cycle including analysis, design, development, maintenance and integration of software applications using SAS, SAS Enterprise Guide, SQL/DB2.Developed and implemented Provider Operational Data (POD) web-based application created in SAS Web Report Studio. This application consisted of 24 reports(Claims Adjudication, Processing, CCM and Provider Submission Lead Time) to be utilized by the Provider Finance Group to analyze trends as well as focus on possible Fraud and Abuse areas. Also, developed pertinent SAS Information maps to be used as the datasource for these reports.Automated and implemented WEBMD reports to retrieve SSN, and XZ numbers from ORACLE database using SAS, and Microsoft Access. This project allowed Account Managers to inform employer groups the members that are eligible for incentive awards upon completion of Health Risk Assessment. Converted Financial and Employer Liability weekly and monthly reports from COBOL to SAS. Utilized a COBOL to SAS tool to create SAS INFILE statements from a mainframe COBOL copybook. Reports were automated to produce PDF output vs. hardcopy and created a substantial cost savings by eliminating the steps of printing and postage. Supported Legal department to develop SAS queries to compile claims data pertinent to several litigation cases. These reports identified members with injuries and illnesses related to the intake of certain drugs that were eligible for settlements based on the outcome of the litigaton.

Executed and created regression, new development and maintenance test cases for applications used by the Enterprise Analytics Division. Involved with several research projects for Legal, Underwriting and Actuarial Departments to provide specific information about health care claims data. Also created a Microsoft Access Database to store testcases for the department.

Developed, tested and executed regression and performance test scripts in TSL using WINRUNNER software for a client-server call center application - ETMS (Enterprise Trouble Management System). Provided critical test results for all new software releases implemented into production. Also responsible for WINRUNNER support, PC configuration of test tools, and WINRUNNER training for other System Testers.

As Y2K System Test Lead, provided onging support for 7 system testers with test procedures, environmental setup, peer reviews and problem resolution with remediation team and client. Also tasked with migration of system tested modules into production along with on-call production support. Responsible for reporting progress of team to Keane project manager and

Performed systems analysis and development support for Traffic Call Processing Pricing and Editors systems of MCI Business Markets Division. Involved with Y2000 Conversion projects, new development and maintenance tasks for all quarterly releases, including on-call production support for the Pricing and Editors subsystems.

Provided Quality Assurance Testing support for National LEC Interfacing Systems at the Consumer Division of MCI. Created and executed test plans, test scenarios and data matrices for system and integrated testing phases.

Provided systems analysis and programming support for the Network Capabilites (NETCAP) development of MCI's Business Markets Division. Specific assignments include the 800/900 Number Corporate Accounts, and International Globalization of MCI's Virtual Network (VNET). Also, served as Project Lead for the NETCAP Acceptance Testing team to supervise test planning and execution of development projects. Assigned to the Test Tools group to develop order entry automation of COMS (Circuit Order Management System) using WINRUNNER.

Associate'S Degree, Computer Programming

AAS Computer Programming

Electronic Health Records Specialist (Ehrs) Certification, Medical Insurance Specialist/Medical Biller

Electronic Health Records Specialist

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Feed My Starving Children

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Education record