• Provide technical delivery support for the delivery of all enhancements (<250hrs) and problem incidents involving HF’s data integration platforms which consist of Informatica, SaS and AWS (S3 and Redshift)• Serve as liaison into all areas of IT for our business partner in the Pharmacy Domain offering integrated solution options to support business processes both internal to HF as well as with our PBM• IT project lead to move the current daily eligibility file to our PBM from a Full File containing 36months of history to a daily incremental file for all lines of business. This project includes providing solutions for eligibility transaction reject management leveraging Pega Universal Workflow, automating the maintenance of a client hierarchy/crosswalk table which maps HF data structure to PBMs CAG data structure• Scrum Master for two data integration agile teams within HF’s IM&A (Information Management & Analytics) Train focused on delivering a new enterprise level ODS (Online Data Store) using AWS as host• IT Lead for data migration efforts during HF’s transition from a homegrown CRM platform (OnContact) to Salesforce.com• Ensure that all team/domain software (business/functional/technical) requirements were managed/reviewed through our HP-ALM application• Partner directly with Enterprise Architecture to review solution options that align to the standards as well as best practices of the organization• Provide Technical/Solution Deliver support and guidance to multiple IT and Business domains in areas of Delegated Vendor Extracts, Payment Portal, Provider Portal, Member Portal and any load/extraction of data to/from Enterprise Data Warehouse

• Leading Project Management & Business Analysis responsibilities in a Customer Relationship Management (CRM) tool replacement initiative which include but is not limited to current state process identification, future state business process design, business rules/requirements, staff augmentation recommendations, training preparation and user acceptance testing.• Responsible for establishing protocols, processes and templates for business analyst responsibilities in a standard SDLC project implementation methodology in an effort to reduce variance and cost in execution.

• Partner with Business functional areas that represent membership/enrollment, provider file operations and billing to gather, analyze, evaluate and translate business needs into Business and Technical Requirements.• Facilitate review meetings of all maintenance and enhancement requests submitted by the above mentioned business functional areas for purposes of review for understanding and prioritization.• Author various Business Intake documents including but not limited to business case documents, business requirement documents, ROIs, current and future state workflows, traceability matrixes, etc.• Acting in a Lead BA/BA Manager role for an enterprise system migration project that will replace Emblem Health’s Consolidated Provider File (CPF), Paperless Credentialing System (PCS), Paperless Recruitment System (PRS) and Provider demographic data stored in the dental and PPO Facility claims systems with a single, vendor based solution that will serve as the central hub for provider demographic data• Lead discussions in the above mentioned project relating to current and future state business process documentation, gap analysis of that current and future state, approach planning of data cleansing and migration from 5 source systems to 1 target and collection of functional and non-functional business requirements

•Responsible for gathering, analyzing, understanding and translating business needs into Business and Technical Requirements.•Effectively manage multiple projects of $250k budget & below through all phases of SDLC at once.•BA/PM role to implement a systemic solution for the proper adjudication and payment of Pre-Admission Testing services processed on both of Horizon BCBSNJ claim engines (QBlue & NASCO) to achieve an annualized, insured MCR savings of $1.75 million. •Lead HCM – Business Solutions Group to collaborate on the creation of a BRD/TRD checklist to compliment an existing Job Aid portfolio for BSAs within the BSG. Drove this initiative from Concept to Delivery of the tool which will assist in standardizing the requirements gathering process and reduce the occurrences of missed orinvalid requirements. •Serve as a resource to BSG Team members in the preparation of QA Reviews, NASCO Workflows, Test Scenario/Test Case creation/execution/review. •Lead Project Business Analyst and IT Lead role on Pharmacy Benefit Management migration project, which is on target to save $140m over the next 3 years. Responsible for BA deliverables being met in a timely matter, resource allocation; provide guidance to PBA team in areas of current state mapping, managing requirements as well as planning business analyst activities. Effectively motivate all IT related teams (Business Analysts, Systems Analyst, Enterprise Architecture, Development and outside vendors) to ensure deliverables are met on time and of good quality.•Played Project Business Analyst role during ICD-9 to ICD-10 migration performing extensive research and documentation of current state work flows; performed Gap/Failure Mode Effect Analysis on current to future state; draft and publish various Business Requirements documents relating to National NASCO Claims and ITS Blue Card processing, Consumer Driven Healthcare (CDH) claims processing and NASCO Claims Edit Handling.

·Responsible for conducting research and analysis for end user community with the goal of recommending and implementing new IT processes/solutions to resolve issues and improve operational performance.·Provide analytical support and act as a liaison between IT and Business Owners regarding new system enhancements.·Managed the successful implementation of the HCS Work At Home program from the IT perspective which included the implementation of a VOIP telephone system.·Played Business Analyst/Project Manager role during the successful implementation of a Data Security project which proved to strengthen the security surrounding the Oracle Database Tables that feed the Horizon Casualty Services front end applications with sensitive claimant data.·Performed Business Analyst / Project Manager tasks including research analysis, Proof of Concept testing, UAT Testing, etc. during the implementation of new Web-based, Service Desk Management tool. This tool proves to aid the Horizon Casualty IT Operations staff in modeling Information Technology Infrastructure Library (ITIL) process and concepts which focus on ensuring that the End-User community has access to the appropriate services to support the business functions.·Provide end user support for all hardware and software issues which include but is not limited to desktop support, applications support, HCS Telephone system issues as well as laptop / desktop deployment.·Key contributor in the managing of 2 successful Disaster Recovery exercises by organizing and maintaining the exercise timeline, developing all project plan, plan overview and post mortem documentation.·Provide End-User support across all systems and proprietary applications including Desktop Support, Troubleshooting front and back end applications, telephone system support, installations, hardware deployment, etc.

•Responsible for the data integrity of electronic enrollment files received from existing and new accounts. •Responsible for the implementation of electronic accounts to Horizon’s National account platform (NASCO). This includes data mapping and encryption, transaction generation and consistency of data as it relates to HIPAA compliance with 834, proprietary and STEP file formats. •Initiate and participate in UAT for enhancements to enrollment functions offered on Horizon’s internet portal. (HCBO). •Support the Electronic Enrollment Team with NASCO related inquiries and processes. Help in analyzing specific NASCO problems which may require additional resources (Model Office, NASCO Atlanta, IBM, etc).•Aided in the creation of the Enrollment Centralized Database which captures all request submitted into the Enrollment area to be used for trend analysis. Such could include Enrollment Inquiries, Electronic File Submissions and Electronic Enrollment Implementations.

•Manage project lifecycle for the development, testing & implementation of client connectivity. This includes estimating, creating & maintaining project plans as well lead contact for client communications.•Database Configuration Manager – Responsibilities include issue identification, route cause analysis, remediation recommendations as well as prevention process implementation for customer routing architecture within NYCE’s CONNEX database.•Responsible for overall configuration and analysis of NYCE’s core services through the use of CRM software (i.e. eFunds Advantage). This includes, but is not limited to data mapping & encryption, transaction integration to back-end systems & standardization and consistency of data as well as ISO standards compliance.

•Served as the primary interface between clients (Financial Institutions) and the NYCE Corporation for single point of service.•Acted as the client’s liaison & advocate in communicating business requirements in-house.•Supported clients in the daily maintenance of their electronic interface to NYCE as well as through change (new services, implementations, etc.) and problem resolution.

•Created file formats to feed an Oracle based marketing application using excel & proprietary formats. •Managed monthly, quarterly & annual reporting for Partner Company.•Implemented and oversaw data requirements for billing departments. This included data identification and fulfillment for expired segment review. These reports enabled cost saving decisions.•Team member responsible for creating the graphical user interface based reporting tool for marketers within Time Warner. To assist in development decisions, employed analysis using SAS to provide insight into subscription trends by demographic and geographic regions.•Team member in the development of a data management tool for help desk. This application included script creation capabilities which facilitated entering large requests timely to meet all service level agreements.