Randy Pomeroy Email & Phone Number

Philadelphia, PA, US

• Analyzing the existing policies existing policies and procedures and providing the inputs to Executive Management Team to fit into the compass project goals.
• Conducting JAD sessions with different Business Users to develop the business requirements for Claim Processing, Program Integrity, eMedia and Reporting
• Identifying the impacts and training colleagues on new internal policies /procedures changes.
• Performing GAP analysis between Prestige Health Choice and AmeriHealth Caritas for a Data Migration and Conversion.
• Defined scope (requirements) and objective based on user needs and thorough understanding of business processes.
• Worked with stakeholders on process improvement projects designed to improve results. Gatheredand analyzed information and provided recommendations to address and resolve root causes.

Philadelphia, PA, US

• Acted as a Business Analyst in various business operations and helped the organization to achieve cost-effective production with increased quality, efficiency and satisfied customer service, documenting the business.
• Defined scope (requirements) and objective based on user needs and thorough understanding of business processes.
• Worked with stakeholders on process improvement projects designed to improve results. Gathered and analyzed information and provided recommendations to address and resolve root causes.
• Evaluated/researched business problems and their relationship to technology.
• Organized and presented ideas in a convincing and compelling manner.
• Reviewed complex business/systems problems and conveyed information to stakeholders (includes technical teams for translation into solution design).

East Norriton, PA, US

• Responsible for determining testing work effort & testing resources to determine the amount and extent of testing to be performed.
• Reviewed requirements and design specifications to identify gaps and ensure documented project criteria are clear, consistent and testable.
• Drafted and designed Test Strategy document in accordance to Health Partners guidelines.
• Worked as a Lead to assign, oversee and validate results from test team.
• Provided LOE to Project management for each release and code drops.
• Participate in issues resolution and change control process.

Hartford, Connecticut, US

• Primary function was to act as a liaison between IT, Medical Management Department and the Data Analytics teams.
• Annually developed and maintained the Medical Claim Managements Microsoft Project Plan
• Developed, documented and maintained Test Strategy, Test Plan & Testing approach.
• Responsible for determining testing work effort & testing resources to determine the amount and extent of testing to be performed.
• Developed and managed detailed plans for cross functional projects teams and reported the project status
• Reviewed requirements and design specifications to identify gaps and ensure documented project criteria are clear, consistent and testable.

Hartford, Connecticut, US

• Create value in projects by analyzing for areas of improvement, efficiency, and necessity, and also
• applying an appropriate testing model prior to project implementation.
• Acted as a business lead for developing business requirements and related business rules based on the business needs.
• Worked closely with the business partners and SME(s) to define the testing, training, implementation, validation of detailed test plans and support of functional requirements.
• Performed ongoing research, and supported the departmental MS Access database (RuMOR).
• Provided leadership, coaching and mentoring for new members of the team.

Hartford, Connecticut, US

• Monitored daily maintenance within the Aetna Quoting System that the Underwriters, Brokers and Sales team would use to ensure system symmetry
• Ensured balanced flow between Guide and AQC
• Collaborated with Actuaries on State Mandates, Co-Pay, Coinsurance and Deductible Mandates & Plan restricted Mandates
• Coordinated structure changes in conjunction with Actuarial team
• Managed multiple large Rate Filings in MS Excel files for each state and product offering.
• Performed Rate Case Analysis

Hartford, Connecticut, US

Led user acceptance testing, defect reporting and resolution, and checkout testing.Worked to increase the claims auto adjudication rate by 10%Assisted with the translation of business needs into Business Requirements and Functional Specifications documentation within specified timeframesParticipated in all phases of software testing, (UAT, Integration.

Hartford, Connecticut, US

Performed analysis to assess root cause of moderately complex customer issues for reported system defects and control deficiencies found from system audits Conducted interviews, fact-finding, and independent research to design creative, progressive solutions to system issues and managing the issues to closureSupported business area operations/functions by.

Resolved Member/Provider inquiries via phone, letters and Internet i.e. Provided claim status information, interpreted benefit coverage, and processed physician changesWorked to enhance customer satisfaction and retention, while balancing interest of plan, sponsor, and memberMaintained individual productivity and quality standards by comparing weekly.

Recruited, hired, supervised, scheduled, and motivated a staff of 30 employeesTrained service staff to enhance customer service and increased revenue through suggestive sellingPlanned menus, estimated food and beverage costs, and purchased inventoryInvestigated and resolved food/beverage quality and service issues, ensuring customer satisfaction and repeat.

Certificate, Real Estate

Certificate, Health & Life Insurance

Education record