Kelly Summers
Simi Valley,CA
Summary
Dedicated, diligent and focused business professional with strong organizational and prioritization abilities. Completes multiple tasks simultaneously and follows through to achieve project goals. Handles tasks with accuracy and efficiency. Excellent communication and time management skills with varied and wide-ranging experience in both the Government Business and Commercial Insurance environments.
Overview
32
32
years of professional experience
Work History
Developer Senior, Business Info Developer, Business Analyst II, Business Analyst I, Project Coordinator, Senior Claims Associate, Risk Management, Fraud and Abuse, Audit/Recovery Specialist, Customer Service
Anthem
01.1992 - 01.2019
- 27+ years of experience in health care with extensive knowledge of medical claims, membership, provider and pharmacy data areas for Medicaid / Medicare and Commercial programs. Over 20 years Adhoc Reporting and Data Analysis.
- Workload Management: Triaged 2 work in-take queues and assigned work to our team.
- Managing multiple deadlines by multi-tasking competing priorities.
- Experience in querying, data extraction and data transformation using SQL coding on various platforms. Database management and design.
- Ability to learn quickly and readily and effectively apply that knowledge into action and application.
- Able to interact directly with customers to translate business needs into technical requirements.
- Ability to translate conceptual perspectives and needs from various functional areas and multi-disciplinary teams at many levels within the organization into data analytics, data sets and reporting.
- Ongoing impactful support work on multiple high-level initiatives and projects for Network Access, HEDIS, as well as Operations Refinements to Claims Processes workflows, etc.
- Experience in writing System Enhancements, Business Requirements, Workflows, Policy and Procedures.
- Experienced in testing project results to ensure data quality and requirements are executed successfully.
- Served in a lead role as a primary resource, Subject Matter Expert, also providing mentoring and training within immediate team and with other functional areas.
Office Manager
Advanced Products Sales
01.1987 - 01.1992
- Customer Service
- Payroll / Banking
- Database Management for Sales
- Lead sort and distribution to sales associates
- Shipping and Receiving
Education
High School Diploma -
Royal High School
Simi Valley, CA06.1987
Skills
- Excel
- Access
- Access Database Management
- Word
- SharePoint
- Outlook
- PowerPoint
- Crystal Reports
- Monarch
- Microsoft SQL Server
- Teradata SQL Assistant
- Toad
- AQT
- STARS/VIPS
Timeline
Developer Senior, Business Info Developer, Business Analyst II, Business Analyst I, Project Coordinator, Senior Claims Associate, Risk Management, Fraud and Abuse, Audit/Recovery Specialist, Customer Service
Anthem
01.1992 - 01.2019
Office Manager
Advanced Products Sales
01.1987 - 01.1992
High School Diploma -
Royal High School
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