Thomas Rieger Email & Phone Number

Greater Milwaukee Area

Works with Pharmacy and Medical claims to Map and Load to common data structure. Combines PBM, Medispan and CMS data into cohesive data stores.Loads and Analyzes Medicare Part D PDE, MMR and TRR information.Loads and Analyzes PBM claims and eligibility data.Creates forensic measures on data to ensure data quality.Creates pharmacy benchmark data to be used for predictive modeling and forecasting.

Rationalized the pre-merger Anthem and the pre-merger WellPoint technology portfolios. Monitor and Develope strategies for new and emerging technologies.

Determine infrastructure impact implications of new technology while operating within a Project Management Methodology.

Design and implementation of a Health Claims Information System Data Warehouse based on a Star-Schema architecture using Microsoft SQL-Server 7 and Microsoft SQL Server 2000 and Sybase PowerDesigner. The data warehouse includes membership and claims information for use primarily by the actuarial and underwriting departments. Design of the Data Warehouse included the merging and cross-referencing of data from multiple operational data systems into a single coherent data source. Duties also… Show more Design and implementation of a Health Claims Information System Data Warehouse based on a Star-Schema architecture using Microsoft SQL-Server 7 and Microsoft SQL Server 2000 and Sybase PowerDesigner. The data warehouse includes membership and claims information for use primarily by the actuarial and underwriting departments. Design of the Data Warehouse included the merging and cross-referencing of data from multiple operational data systems into a single coherent data source. Duties also included the oversight and Training of Database Administration staff in a largely operational environment. Led the implementation of Pegasys. Pegasys is a rules based engine developed by Pegasystems, Cambridge MA, the purpose of which is to improve claims first pass rate by filtering claims post-entry and prior to adjudication, automatically working certain claim deferrals post-adjudication, and providing workstation functionality and workflow enhancements to claims examiners. This project gave exposure to Sun Solaris, Oracle 9i and IBM MQ. Pegasys went into full production in May, 2004. Currently responsible for day-to-day operational issues and maintenance for this system. Show less

database administration of Microsoft SQL Server versions 4.21 through 6.5 running on Windows NT and also the Oracle 7.2 RDBMS running on a Windows NT Platform. Duties included the creation and maintenance of a Drug Utilization and Review database that was utilized by pharmacy services staff to track both fraud and potential drug interactions. Duties also included database administration of the ADP Human Resources application (based on Peoplesoft’s Peopletools) using Centura SQLBASE on a Novell… Show more database administration of Microsoft SQL Server versions 4.21 through 6.5 running on Windows NT and also the Oracle 7.2 RDBMS running on a Windows NT Platform. Duties included the creation and maintenance of a Drug Utilization and Review database that was utilized by pharmacy services staff to track both fraud and potential drug interactions. Duties also included database administration of the ADP Human Resources application (based on Peoplesoft’s Peopletools) using Centura SQLBASE on a Novell platform. Duties also included the design of a Health Claims Datamart including the creation and maintenance of Star Schemas using S-Designer and Oracle.. Show less

Systems analysis and design; programming to user defined specifications; using client server tools including Powerbuilder, Microsoft Foxpro for Windows, Microsoft Visual BASIC, and Borland Delphi to access a Microsoft SQL Server running on a Windows NT Server and Watcom SQL; using NT server to access a Novell LAN/WAN. Experience connecting to an IBM 3270 mainframe using Irma and Netsoft/3270.

Xbase database design using Microsoft Foxpro, CA-Clipper and Borland dBASE; program design, creation and maintenance primarily for a manufacturing environment; consulting; technical and user support; communications.

Program creation and maintenance using Harris Extended Fortran and Microsoft QuickBASIC 4.5; user and run documentation; mainframe programming; spreadsheet work; utility programming.

Bs, Mathematics And Computer Science, 3.53

Education record