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  The Senior Manager, Data Architecture Data Engineering is responsible for translating business strategic goals into future-state data engineering and data science solutions. This includes delivery full life-cycle from execution roadmaps, to implementation, and to production operations. This role drives the creation and maintenance of enterprise data and analytics capabilities, data reference architectures, and integrated data analytics technology roadmaps that will guide our strategic investments and enterprise strategy.Translate business strategic goals into actionable future-state data engineering and data science architectures and solutions.Delivery of full life-cycle Data Solutions from execution roadmaps, to implementation, and to operations. This includes a specific focus on ELT and ETL Data Pipeline solutions from inception to production.Lead end to end solution delivery of enterprise data warehouse, data marts, and data lake with governance.Drive the creation and maintenance of enterprise data and analytics capabilities, data solutions, and integrated data analytics technology roadmaps that will guide our strategic investments and enterprise strategy.Deliver architecture connecting Data Science, Data Engineering, and Data Analytics practices together to deliver impactful data products.Strong partnership with DevOps, DataOps, business partners, engineering teams, and data management.A minimum of ten (10) years of experience in IT with a minimum (6) years in data architecture and data solutions are required.Successful track-record in managing a team of Data Engineers and Data ScientistsSkilled in hybrid cloud data platforms and analytical technologies including Azure andor GCP data infrastructure, Spark, Data Lake, Data Warehouse and Data Marts, BI reporting with PowerBI, Metadata Management, Data Governance, Master Data Management, Data Catalog, and Business Glossary.Ability to document, communicate, implement, and operationalize complex architectures.Experience with ELT and ETL Data Pipeline solutions from inception to production.Proficient in SQL, NoSQL and columnar databases.Experience with SparkPyspark and JSON.Excellent grasp of Computer Science fundamentals - data structures and algorithms.Must have Panda Data Frames knowledge and best practices, execution engines, DAGs (airflow, dagster, luigi, etc), and Kubernetes.Proficient with GitLabFamiliarity with Azure data factory preferred, Google data flow or AWS GlueExperience with Biomedical Informatics, S3Azure blob store, Machine Learning and AI, Unstructured Data, and Data Democratization is preferred.Experience with Agile methodologies, Kanban preferred, and using tools like Jira and Confluence to facilitate the work.Bachelor s degree in computer science or a related discipline required. Master s degree preferred. RECRUITERS NOTES The role will definitely be hands-on and will require excellent communication skills. The hiring manager mentioned the following technologies AImachine learning data warehouses product support Cloud experienceAzure must be open to new technologies. Working with the Product Development Team. Act as the point of contact will create a group that helps the product teams. Create data warehouses for analytics. MUST have excellent communication skills verbal and written. This person will envision strategy and must be able to effectively communicate that strategy to others. The organization has asked me not to advertise the compensation. If you contact me I would be more than willing to share it with you. For over 50 years this non-profit organization has made it their mission to protect patients from unsafe and ineffective medical technologies and practices. More than 5,000 healthcare institutions and systems worldwide including four out of every five U.S. hospitals rely on the services of this organization to guide their operational and strategic decisions. In addition, they serve public and private payers, federal and state agencies, policymakers, ministries of health, associations, and accrediting agencies. Benefit from a healthy work-life balance while staying on the leading edge of technology and thriving in an innovative startup-like culture minus the risk. Sleep well knowing you are helping achieve a world where safe, high-quality healthcare is accessible to everyone. Excellent benefits to include work from home, flex-time and 19 days starting vacation. Its a nice place to work!

ATS compatibility: No Fit (score: 21.0)