Mariah E

I’m a healthcare payer systems analyst with 9+ years of experience supporting Medicare, Medicaid, and managed care operations in Facets and QNXT. I focus on how eligibility, benefit plans, and coverage rules drive claims adjudication outcomes—shaping provider pricing, claim validations, denials, and remittance advice.

I’m at my best when I translate complex payer requirements into clear, actionable artifacts. I gather and document requirements through stakeholder workshops and process mapping, producing BRDs, workflow diagrams, wireframes, and data mapping documentation that teams can execute and validate.

As a Senior Appeals Analyst for Claims, Eligibility & Systems Analysis at Centene (Feb 2021 – Present), I analyze Medicare, Medicaid, and managed care claims at the claim-header and line level in Facets and QNXT. I investigate eligibility-related production issues with root-cause analysis, coordinate with data/ETL teams to resolve upstream data problems, and use SQL for root-cause analysis, data validation, and troubleshooting—supporting UAT and production release readiness, plus audit-ready case narratives.

Before that, I worked as a Medicaid Claims Analyst at Anthem (Aug 2017 – Feb 2021), reviewing and adjusting high-volume Medicaid and Medicare claims using manual and automated adjudication methods. I analyzed eligibility, provider, benefit, remittance, and payment data to identify discrepancies and recommend corrective action, produced reporting for operational prioritization, and improved claims-processing efficiency by 20%. Earlier, as a Client Service Representative at UnitedHealthcare (Nov 2016 – Sep 2017), I resolved complex member and client inquiries across managed care systems while maintaining clear documentation and strong performance.