Career OverviewI am looking forward to becoming part of a team that offers potential growth, stability and advancement opportunities. Work ExperiencePDM - Network Data Specialist II,2014-CurrentTata Consultancy Services Miami,FL,Completes the setup and maintenance of new provider information to effectively administer the operational requirements of current and new business.Completes research and suggests resolutions for more complex quality issues, and applies expanded knowledge of state-specific provider data requirements to mentor entry level team members and ensure effective administration of core business requirements.Completes Provider Data Management tasks which include but are not limited to establishing new participating provider records, processes provider roster terminations, adding network and capitation rows, and corrects data quality issues.Applies expanded knowledge of state-specific provider data requirements to mentor entry level team members and ensure effective administration of core business requirements.Works with management and team members in the provider configuration and implementation of all approved market specific or global projects to include existing market expansion, new market or business activities, acquisition activities and system design initiatives.Conducts research and analysis of complex provider data quality issues and acts to resolve them in a timely fashion.Observes trends in provider data quality issues and makes proactive suggestions for proactive resolution.Communicates with provider organizations to request and validate provider information and facilitate proactive resolution of issues.Actively maintains a positive customer relationship with the health plan staff, sharing feedback with management and identifying process improvements.Serves as a mentor for entry level team members as needed trains new Specialists and temporary associates.Meets or exceeds individual and department productivity metrics, quality, and timeliness standards as defined by department guidelines.Performs other duties as assigned or requested.Provider Services Unit,03 2012-2014Amerigroup Corp City,STATE,Under general direction, provides assistance to members, providers, or others inquiring about eligibility, claims issues, and product information or experiencing customer service problems.Determines callers needs and provides the pertinent information or researches and resolves their issue appropriately.At times, may be required to assist junior representatives on escalated issues.Provides telephonic assistance to members, providers, billing agencies and or prospective members for assigned products.Assists with benefit and eligibility explanation, claim issues, network changes, customer service issues and or terminations.Prepares correspondence, maintains phone and contact logs, and documents call details as appropriate.Identifies trends and root causes of call inquiries or issues, and recommends improvements to internal processes and training to department leadership.Understands and accurately interprets product benefits, applicable state and federal guidelines regulations, and department policies.Assesses caller s needs, makes appropriate recommendations or action, and aims for first call resolution.Resolves complex or escalated issues of callers by thoroughly researching cause of error.Customer Care Rep,03 2010-03 2012Amerigroup Corp City,STATE,Responsible for responding to either inbound inquiries or outreach calls from to potential and existing Amerigroup members and providers.Responsibilities include providing accurate information education resolution about eligibility status, benefit coverage, provider network, credentialing status, authorization referral status, demographic changes and all other non-claim issues.Function as an information source through telephonic assistance to members, providers, billing agencies, and various company department staff.Provide pleasant customer experience through superior customer service methods, problem solving and real-time issue resolution.Interact with provider community and various departments to resolve issues involving the membership and credentialing status.Explain benefits, eligibility status, enrollment processing procedures and status of authorizations and referrals to callers.Assist with activities to ensure membership s continuity of care.Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls), complete health assessments for plan case management (Early Case Findings and Healthy Beginnings) and conduct membership surveys.Process complaints, following established guidelines.Maintain knowledge of state guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance. Educational BackgroundHigh School Diploma ,Expected in1995-Midlothian High School-Richmond,VAGPA Status-Accredit for Business Computer Applications, Office Administration and Basic Advance Accounting. SkillsTechnical skills in Business Computer Applications with Basic and Advanced Accounting techniques. Skills in Word Processing, Microsoft Office Excel, Spreadsheets, Data Entry, Word Optimization Search Engines Optimization, Microsoft Internet Explorer, MACESS, FACETS and EDINET.  SEP  This is a W2 contract in Minneapolis, MN 55402.Bank is looking for a successful Data Analyst to support our Enterprise Data Governance (EDG) and Data Privacy and Protection (DPP) initiatives. This role will collaborate with the business line and technology groups. Primary responsibilities include Effectively work in matrixed team of Data Analysts, Project Managers and Business Analysts in support of a specific business andor regulatory need. Research and build a detailed understanding of the problem and related data assets in order to code the data processing and analysis. Light development coding Ensure that the data used follows the compliance, access management and control policies of the company while meeting the data governance requirements of the business. Work with technical groups to support the collection, integration, and retention of the data sources. Apply data visualization and summarization techniques to the analytical results. Interpret and communicate the results in a manner that is understood by the business. Basic Qualifications Bachelor s or masters degree in mathematics, Engineering, Computer Science, or equivalent work experience. 5 years related technical experience and 3 years analytical experience in the BankingFinancial industry or similar highly regulated industry. Preferred SkillsExperience Proficiency with SQL SAS (mid to expert level) Intermediate knowledge of application coding and development lifecycle. Analytical (e.g., comfortable with data) and can combine an understanding of business objectives, customer needs, and data required to deliver customer experience and business results. Intermediate knowledge of data governance, data management, data architecture, data modelling concepts and data governance tooling and the complexities of data in a large financial andor highly regulated institution. Willingness to continuously develop and acquire new technical skills, learn new tools programming languages and Big Data techniques. Proven ability to adjust quickly to shifting priorities, multiple demands, ambiguity, and rapid change. Effective oral and written communication with the ability for analyzing, slicing, and dicing data while deriving significant insights. Natural curiosity and self-directed ability to seek out information and meet goalsdeadlines. Agile experience Very comfortable following Agile Scrum methodology.

ATS compatibility score: 29.0 (No Fit)