IT SECURITY SPECIALIST Resume

SUMMARY

Highly accomplished professional with progressive experience in Property & Casualty Insurance, Pharmaceuticals and Healthcare Insurance. Committed to the values of compassion, professionalism, collaboration and responsibility. Account Management Business Relationship Expert Customer Service Business Analysis

Strategic Planning
Results Oriented
Project Planning
Budgeting

PROFESSIONAL EXPERIENCE

Confidential

IT SECURITY SPECIALIST

Responsibilities:

Responsible for governance over ISec Application/Network Technical Specifications and IBM Health Checks.
Conducted Quarterly 1&3 Production Access Control (PAC) testing in UNIX, Wintel and Mainframe environments for SOX audits.
Responsible for generating and deploying of company’s phishing exercises/campaigns and training of employees on security policies.
Managed and Coordinated HIPAA Phase 1 Security Audit Gaps. Mitigated/closed 52 audit gaps successfully.

Confidential

IT PROJECT MANAGER/BUSINESS ANALYST

Responsibilities:

Managed and successfully deployed Internet Hardening Project, progressed through various setbacks/project risks with vendor partners, and lead project to success on time within budget. (150k Budget)
Managed and successfully deployed Nexus Aurora 1.4 - miNion-doNar project, included responsibility of project plan, timeline, budget, scope, management of financials and creating of status reports for stakeholders. Deployed on time within budget with a savings of >10%.
Lead BA on Quality Lead Initiative project, worked with Marketing and Underwriting teams to come up with a process to capture quality leads for future CNA business. Gathered and developed high level requirements for project.
Completed RSDDs and negotiated Statement of Work (SOW) contracts with consulting lawyers. Proactively initiated and completed contracts and subcontracts via IT Procurement.

Confidential

REGIONAL ACCOUNT MANAGER

Responsibilities:

Liaison between patients, providers, MDs, pharmacies and insurance carriers to assure accuracy of insurance claim/coverage processing.
Identified reimbursement knowledge barriers and provided education to patients and providers to assist in effectively navigating through insurance and payor reimbursement processes.
Consulted physician office management on the various services we offered to streamline their reimbursement for both the physician and patient which included monthly field visits. Increased regional Rheumatology Access Solutions referral enrollment 20%.

Confidential

MEDICAL UNDERWRITER

Responsibilities:

Underwritten medical insurance policies for measurement of financial risks.
Audited individual insurance applications for discrepancies and requested. additional information to ensure that system maintained accurate and up-to- date information and analyzed for medical and financial risk.
Generated and submitted approval, decline and premium rate-up letters to applicants.

Confidential

PROVIDER CONTRACT ANALYST

Responsibilities:

Managed (8) major to mid-size Physician/IPA groups.
Updated and maintained physician contracts including loading new physician contracts, change of demographics, maintenance of Illinois credentialing, and product participation status. Also audited new provider contract loads and/or terminations.
Investigated and resolved provider related insurance claim/reimbursement issues; conducted monthly/quarterly provider meetings with Fee-For-Service groups.

Confidential

CLINICAL ANALYST

Responsibilities:

Interpreted and clarified customer requirements by researching data warehouses and developing appropriate data/information strategies. Created Access Databases to collect, manipulate and analyze data files. Databases increased automation by 90%.
Produced daily communications to our Pharmacy Benefit Participants and Physicians in reference to increase co-pay and/or any drug formulary plan changes/coverage.

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