Lori C

Elicited and documented business and operational requirements for encounter processing, produced BRDs and traceability matrices, and participated in all project phases to improve claims encounter accuracy.

Supported client management by researching and developing customer-specific resolutions, auditing benefits and contract loads, and issuing client contracts to ensure data quality and reporting compliance.

Assessed and translated customer requirements into solutions, solved moderately complex operational problems, and coached peers while driving process improvements across claims and benefits operations.

Gathered and documented business requirements and traceability matrices for Optum projects, supported prototyping and testing, and coordinated technical tasks to implement validated solutions.

Managed customer projects and coordinated IT support for ERP and supply chain systems, designed and implemented SCM improvements, and drove global project communication across subsidiaries.

Monitored and validated inbound/outbound data exchanges and conversion loads for United States Steel, identified and escalated data issues, and produced documentation and training materials for system transition.

Configured and tested software builds, QA'd build processes and documentation, configured calculations, and uploaded historical data to support reporting functionality.

Developed provider performance improvement and medical cost containment strategies, analyzed claims cost drivers, identified root causes, and authored business requirements for long-term solutions.

Conducted business analysis in SDLC, defined medium-to-high complexity workflows and requirements, and presented resolution options for operations and development requests.

Researched complex system issues, developed business and technical specifications impacting claims, enrollment and compliance, and led regression testing and validation for software changes.

Adjusted improperly paid claims, investigated provider issues, and pursued recoveries via negative balance and refund request processes to reconcile finance accounts.

Analyzed and audited provider and facility claims accounts, located system account issues for correction, and supported reporting and accounts analysis.

Performed claims adjustments and audits for dedicated national accounts, troubleshot system issues, and trained new adjustors while supporting reporting and cleanup efforts.

Handled a dedicated call center account, processed claims and adjustments, trained staff on systems and procedures, and coordinated benefit payments and investigations.

Managed billing, receivables, payroll and accounting via Peachtree, prepared presentations and budgets, administered insurance renewals, and coordinated customer service and collections.

Pursued a business major at Duquesne University.