At Catalyst Solutions (Health Plan of San Joaquin), I analyzed healthcare claims with SQL to identify denial trends and operational bottlenecks. I investigated complex issues by reviewing adjudication rules, provider contracts, benefit configuration, and eligibility.
I supported claims reprocessing by identifying impacted claims, validating results, and monitoring outcomes after implementation. I also documented business requirements and root causes to support issue resolution and process improvements.
At Infinite Computer Solutions (Gainwell Technologies), I supported QNXT claims configuration and provider contract setup, including fee schedules. I assisted with SQL analysis, configuration validation, and testing changes before production rollout.
Across roles at Kloudhive LLC, Catalyst Solutions, and Cognizant Technologies, I worked on provider data, contract configuration, claims analysis, and appeals. My experience includes QNXT, SQL-based data pulls, benefit mapping, provider directory updates, and claims review.
