Security Architect

• Aug 2022 - Present

VP of Information

• Dec 2021 - Jul 2022

Director EDI

• Jan 2020 - Nov 2021

• Deployed Power BI dashboards and reports across multiple departments in the company. • Managed 10K plus policies, 2.5M dollars of monthly billing, and 100K plus annual calls. • Identified data trends for billing department—approved, declined, refunded, chargeback. • Developed data visualization for the member services department showing various KPI and SLA thresholds. • Partnered with various departments to ensure analytical output is in line with stakeholder needs and knowledge. • Developed executive storyboard for a company in a glimpse dashboard. • Created Datasets from various data sources—excel files, csv, fixed length text files. • Utilized Power Query and DAX for several dashboards • Implemented data normalization and sanitization for daily incoming data dumps. • Identified processes to segregate original data from corrected data for audit trails. • Performed daily, weekly, monthly eligibility and vendor payment files • Initiated projects like data classification, operations process documentation, KPI identification, SLA definitions. • Created various VLOOKUP’s, pivot tables, and data imports procedures. • Currently working on getting Data Analyst Certification with focus on R from Harvard Show less

Senior Manager EDI

• Aug 2018 - Dec 2019

• Managed the EDI team to performed daily eligibility and data tasks • Started a data driven team to start a new reporting and error identification intercept system. • Introduced new claw back policy to identify payment overages to carriers and vendors, delivering 2 million plus savings to the company in the first year. • Receiver of “going the extra mile” 2018 award • Receiver of “innovator of the year” 2019 award • Developed and implemented new file delivery policies. • Initiated a process documentation effort for new onboarding, as well as routine processes. • Utilized advance knowledge of MS Excel and Access and cross-trained the team for multiple skills. • Worked with IT to finalize email compliance policies for HIPAA. Show less

Manager Assurance and Development

• Jan 2011 - Jun 2018

• Developed and Maintained security policies and procedures. • Periodic IT risk and vulnerability testing for webservers. • Participated in intrusion detection and prevention policy making. • Performed walkthroughs by gaining an understanding of the operations, analysis and appraises of obtained data and assessing the internal controls; conducted their testing, identified issues and recommendations and performed their documentation. • Knowledgeable of PCI compliance in regards to gateways. • HIPAA compliance coordination for TPA regarding premium processing and claims adjudication. • Aligned department goals to short- and long-term quality and IT strategies, and communicated these goals to the department, quality, and other areas of IT. • Instrumental in designing a reporting module to bridge legacy database systems and current database systems. • Demonstrated in-depth knowledge in insurance claim re-pricing, including dental, life, auto, and medical. • Ensured strict compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations and Insurance TPA (Third Party Administrator) both operational and IT. • Facilitated software training for adjusters to develop competencies and achieve the maximum level of potential. • Reviewed policy compliance through generating (using SQL) and analyzing data from Company software and databases. Show less

Senior Consultant

• Jan 2011 - May 2018

Client engagements varied between audit, assurance, and development domains. • Periodic IT risk and vulnerability testing for web servers. • Team Lead for a National Insurance Umpire website development. • Client business process optimization project. • Information and Data classification • IT Asset management • Identity and access management. • Process documentation, findings and client meetings. • Software training for end users. Client engagements varied between audit, assurance, and development domains. • Periodic IT risk and vulnerability testing for web servers. • Team Lead for a National Insurance Umpire website development. • Client business process optimization project. • Information and Data classification • IT Asset management • Identity and access management. • Process documentation, findings and client meetings. • Software training for end users.

IT Project Manager

• Jul 2003 - Dec 2010

• Performed testing of various IT and Applications controls. • Conducting opening and closing meetings with the client and other team members. • Actively coordinated a false positive blacklisted email server. • Implemented Data Recovery, Retention, and Backup Rotation policies and procedures • Rendered comprehensive customized web-based application solutions in All-Tech Claims, Xpert Claims, and Universal Risk • Spearheaded and mentored the Application Development, Design, Implementation, and testing teams. • Assisted in Business Process Optimization through development and automation of new integrated systems. • Coordinated daily operational aspects of a call center consisting of 100 people toward fulfillment of corporate goals and objectives. • Maintained compliance with Association for Cooperative Operations Research and Development (ACORD) • Developed and Maintained system for property and casualty (P&C) insurance for auto, commercial, residential, marine, RV, and heavy machinery. Show less

IT Manager

• Jul 2001 - Jun 2003

• Established incident response management lifecycle. • Played a vital role in the overall/strategic direction of multiple quality applications. • Assumed full responsibility in managing team work, arranging meetings, and preparing weekly reports. • Exemplified keen abilities in Insurance ICD 9 coding, a numeric diagnostic code used by insurance companies to determine whether or not to pay for a medical test, treatment, or procedure. • Prepared, compiled, and organized electronic medical records (EMR) in doctor’s clinic for future reference. • Built and cultivated long-term quality relationships with in and out network insurance providers. • Handled the fulfillment packages, collection of money, and member/enrollment data management. • Provided exceptional claims and operations services to effectively meet diverse client needs. Show less

Application Engineer

• Aug 2000 - Jul 2001

• Highly regarded for providing exceptional service in designing and maintaining e-Commerce corporate website. • Part of the development team to modify the SBT accounting package based on Visual FoxPro. • Highly regarded for providing exceptional service in designing and maintaining e-Commerce corporate website. • Part of the development team to modify the SBT accounting package based on Visual FoxPro.