Work directly under Medical Director to develop insightful medical dashboards to identify medical trends for global clients in 40 countries.Manage MAXIS global healthcare metrics to assist global clients’ human resource department in population health management via medical cost trends analysis, benefit reconfiguration, and provide potential innovative solutions to mitigate identified cost drivers.Collaborate with MAXIS senior leadership team and legal to procure global wellness solutions to mitigate cost drivers identified in medical dashboard analytics.

Acting Chairman of Healthcare Claims Committee. Involved in all phases of Healthcare Indices life-cycle. Manage 17,000+ Healthcare Claim Indices as industry benchmark to assist insurers set future rates; guide medical providers to forecast future revenue growth; help experts identify origin of healthcare cost trends.Identify gaps in Healthcare Claim Indices development/support process and implement reconciliation steps. Validating integrity of aggregate Health Plan data versus published Healthcare Claims Indices in all regions.Validate claim data from 33 different healthcare carriers including Humana; Blue Cross Blue Shield of Illinois, New Mexico, Oklahoma, Texas; Aetna; Cigna; and Premera.

Serve as the Lead Business Data Analyst in Payment Integrity Unit to ensure payment accuracy, and minimize member & provider abrasion. Reconcile numerous payments variation initiatives involving analysis and impact quantification on Provider & Facility Reimbursement, Member Benefits, Medical Policy, internal systems data vs published rates from CMS sites.Identify Root Cause of Payment / Reimbursement variation through Contract Review, Interpretation and data reconciliation. Cost containment initiatives through data validation and analytic exercises utilizing SAS, Cognos, and MS Access amount in excess of $24 million in savings and annual run rate savings of $13.6 million a year for 2012.Through provider and facility reimbursement analytic, suggests analytic insights to Network Management to model contracts as per quantification findings. Validate IPA's performance to measure level of qualified bonus. Assist actuary in determine cost of adding specific riders on government sponsored plans to ensure higher healthcare quality ratings. Run numerous simulation exercises to see cost of eliminating co-pays and deductibles for specific preventive care services.Serve as SME (subject matter expert) to validate vendor lead over-payment recovery / cost containment initiatives from AIM / OPTUM, and LEK.Facilitate / chair brainstorming sessions involving Underwriting, Benefits, Care & Medical Management, Provider Relations, and Claims departments. Coordinate System changes / fixes with Network Management, Care Management, Benefits, and Business Technical Services to ensure all identified payment / reimbursement issues are resolved.

Responsible for gate keeping of business requirements, meeting all milestones of SDLC. Expertise in Project management, System Design/Analysis, QA auditing, Provider reimbursement reconciliation. Data extraction, integration, and BI report writing.Serve as Senior Business System Analyst who liaises between Business and IT in all phases of SDLC. Audit & draft business requirement documents, conduct QA auditing, set up/audit test cases for UAT, facilitate brainstorming sessions with business and IT personnel, train users and communicate workaround with production support.Lead numerous CMS rate adjustment projects for Claim Operations, claim adjudication simulation projects for Provider Relations, and assist in numerous overpayments projects for Financial Recovery. Audit medical claim files originate from providers to identify discrepancies with what Qcare paid and contracted rates.Reconcile system fix by BTS - Production Support with ad-hoc reports on claims impacted by Medical Policy, Referral, Pre-Auths, and reference file updates.Serve as the Ad-Hoc report writer with BI Cognos Impromtu for BTS - Production Support, BTS - QA, Claims Operations, Provider Relations & Legal departments.Conduct Data Analysis with BI Cognos Impromptu and MS Access on data from various legacy sources and reconcile data against data warehouse.

Serve as a guest lecturer at Avtech Institute of Technology giving lecturers to students on all phases of SDLC for both OLTP & OLAP systems. Mentor students on different methodology paths in developing transaction processing systems versus analytical processing systems. Clarify the differences of data modeling on normalized (transaction based) and de-normalized (analytical based). Emphasize impact of information drill path on data modeling design.Taking numerous Oracle based certification classes and IT service management certification class.

Responsible for Project Management/System Analysis & Development within HR/Risk Management department. Develop customized Risk Management System, Medical System. Expertise in Risk Management–Insurance Claims including Casualty, Bodily Injury, Third-Party Property Damage, Medical–Insurance Claims including ICD9, CPT, R&C calculations. Select accomplishments:Serve as a Project Coordinator who liaises between Business & IT to scope requirements, utilized WBS to identify and track action items, identify Critical Path, weigh & mitigate Risks, facilitate meetings, brainstorm with business & IT staff. Coordinate all phases of SDLC. Translate business models to functional specifications. Conduct system implementation, integration, testing & training.Serve as the Business/System Analyst who interacts with users & coordinate/delegate responsibilities to a team of 6 developers. Consult end users, managers and coordinate all parties to setup critical milestones.Develop/support medical/hospital system which reimburse providers at Qualcare rate. Account member benefits on deductibles, and treatment limitations. Enhance system with mass adjustment capabilities based on user criteria. Serve as the System Architect by setting front-end Oracle Forms Object Libraries consisting of applications objects, codes, Web-Util infrastructure, Java Bean infrastructure; and develop database back-end codes consisting of back-end database Jobs, Triggers, Sequences, Stored Procedures, Functions, Views and Packages for all programmers to follow.Serve as the Database Developer creating & maintaining Schemas, Tables, Triggers, Indexes, Sequences, Stored Procedures, Functions, Views, Packages, Audit Tables and Audit Triggers. Serve as the Lead System Developer for the Risk Management System/Medical System/Equipment Management /Dynamic Import Export Gate SAIC/Break Bulk CFS System utilizing PL/SQL Developer 7.0, Oracle Forms/Reports 10.1, Web-Util, on Oracle 9i/10g database.

Serve as the Lead Programmer / Analyst who liaises between Business and IT setting up meetings, translating business models into functional specifications. Conduct system testing, user training, support & documentation. Lead a group of 2 programmers in Data Model Design, GUI Design, System coding & implementation. Serve as the Lead Programmer/System Analyst in the enhancement of the Intranet New York Reporting System (NRS) 2001 utilizing PowerBuilder 6.5, Sybase System 11 on Windows NT platform.

Served as the Programmer / Analyst meeting End Users translating business needs into functional specifications. Set up conceptual, logical data models, GUI screen shots and functionality for member programmers to follow.Assisted in the creation of Cost to Price System (CTPS) to replace existing spread sheet system with Client –Server system technology utilizing PowerBuilder 6.0 & Oracle 7.3 on Windows NT platform.

Developed Convatec Advertising Expense & Tracking System by utilizing PowerBuilder 4.0a & Sybase System 10.