At Aetna, CVS Health, I conduct RUM reviews in QuickBase, validating procedure and diagnosis codes against QNXT and PMMIS. I also led quarterly reviews of 10,000+ CPT codes to verify coverage, effective dates, and configuration accuracy.
I analyze claims data with SQL, investigate processing gaps before claims adjudication, and use Power BI measures to track denial rates, approval percentages, and turnaround times. I evaluate automation against defined success metrics while applying data-accuracy and HIPAA guardrails.
Previously, at UnitedHealthcare, I analyzed claims trends and discrepancies using SQL, Python, and Excel. I automated reports and validation processes, and matched IQVIA Plantrak records with Symphony Health PayerSource extracts.
At Capgemini, I analyzed customer and market data, developed forecasting models, and created Tableau dashboards. I also used AWS services to build data pipelines supporting market research teams.
