James Dash Email & Phone Number

Performed system analysis and design for new functionality and enhancements to complex and integrated medical claims processing and payment systems, customer service inquiry applications and medical authorization interface applications. Created technical estimates and specifications for development projects. Led and coordinated developer teams for project development and implementation. Coded, tested and implemented program changes, Oracle SQL changes and TIBCO web services changes for enhancements and problem fixes of applications.• Reduced pended medical authorizations by 25% by enhancing Oracle application that translates and interfaces authorizations from vendor hosted application into a claims processing application in Windows / Oracle environment.• Installed vendor medical policy application on Windows servers utilized by a claims processing application. Provided production support and installed knowledge base upgrades.• Completed TIBCO BusinessWorks application development training and provided production support for related web services applications.• Completed technical analysis, coding, testing and implementation for the development and installation of a new medical claims payment application.• Successfully tested and supported assigned applications for corporate Disaster Recovery exercises for mainframe legacy and server environments.• Provided project analysis and technical support for mainframe legacy claims processing and payment systems, customer service inquiry applications and batch report application.• Provided Subject Matter Expert analysis, guidance and advice in the outsourcing of production support for mainframe legacy applications.

Provided production support and Subject Matter Expert role for telephone Interactive Voice Response customer inquiry application. Performed technical analysis and design, developed technical specifications, coded, tested and implemented new functionality and enhancements to batch reports application. Provided client support and trained end users to run letter generation application.• Increased medical provider satisfaction ratings and customer service effectiveness with enhancements and new functionality features to company’s telephone interactive customer inquiry application. Application’s annual call volumes tripled over 5 year period while maintaining 99.9% accuracy rating on monthly random sample internal audits.• Enabled company to increase recovery of claims overpayments, subrogation and coordination of benefit payments by enhancing batch report application used by client area.• Increased client productivity by automating extract process for questionnaire and letter generation application. Trained client to run letter generation application without IT assistance.

Coded, tested and implemented COBOL and Easytrieve Plus programs for new medical claims and payment systems. Led development project to produce annual Summary Explanation of Benefits document for medical insurance subscribers. Provided 24/7 on-call support for claims processing and payment systems.• Enabled company to implement new claims and payment systems on time and budget without major problems or service interruption to subscribers and medical providers.• Increased company subscriber satisfaction ratings and met state regulatory requirements with implementation of annual Summary Explanation of Benefits document.• Provided company with stable, reliable claims processing and payment production systems consistently meeting or exceeding service level agreements.