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Whether your insurance specialty is life, health, risk management, home owners, business owners, automotive, or whatever - we're
still the contractors for you. As long as it requires eligibility determination and claims processing, we have it covered!
New HIPAA regulation got you stumped? Call us!
Need some DSS to determine gaps in your offerings? Call us!
Want to compare your coverage costs under self-insured's and other options! Call us!
Do we know all the answers? Sadly, no. But we are happy to help you do the research to find the answers you need.
Some of our insurance-related experience includes:
- ViPS Inc. for CMS, Woodlawn/Windsor Mill, MD 2006–2007
Participated in the Drug Data Processing System/Integrated Data
Repository & Drug Benefit Calculator (DDPS/IDR & DBC) for Centers for Medicare & Medicaid Services (CMS) Medicare Part D Prescription Drug Program. Led the ETL/BI Reporting Team. Handled
project planning and priority management.
- Blue Cross Blue Shield of Texas, Richardson, TX 2003-Present
Responsibilities: Set up the actuarial data mart.
Achievements: Developed the Decision Support Services (DSS) for the statistical control/actuarial efforts. Analyzed the membership and claims to support pricing determinations. Handled requests in this area by
internal and external customers. Areas requiring further study were identified and presented to the actuaries. Developed and administered catalogs, cubes, on-demand and scheduled reports, user classes,
and security.
- Travelers Insurance, Hartford, CT 2003
Responsibilities: Participated in the Personal Lines redesign and expansion project.
Achievements: Modeled and developed a more universal interface appropriate for different states, countries, and assorted regulatory levels. Modeled and designed mainframe, server, and web applications (n-tier).
- National Life of VT, Montpelier,VT 2000-2001
Responsibilities: Participated in the Commission Statement Redesign (CSD) project
Achievements:
Created a modular, flexible reporting system to provide customized statements with different levels and commission structures for the many companies under National Life’s corporate umbrella. Extracted the
business rules for the varied organizations.
- Medi-Consult, Palm Springs,CA 1997-99
Responsibilities: Participated in the universal eligibility project. Achievements:
Identified Y2K issues with regards to patient eligibility. Set up date windows for eligibility data imported from health maintenance organizations, preferred provider networks, and private insurance. Set
up reconciliation/ correction procedures among these organizations. Set up "universal" import system for data mining/warehousing. Identified core information in mission-critical systems for
disaster recovery and/or system migration between platforms, data analysis and data-mapping.
- Blue Cross Blue Shield of South Carolina, Columbia, SC 1997
Responsibilities: Participated in the blending of IT streams
to handle data processing for other Blue Cross Blue Shield organizations.
Achievements: Interpreted and implemented top priority changes to comply with HIPAA. Identified core issues in system
integration for expanded business area and database migration from TOTL to DB2, including impact analysis and data-mapping. This led to smoother transitions and pro-active enhancements.
- City Manager, Burbank, CA 1993
Responsibilities: Analyzed claims against the city in terms of risk management.
Achievements: This resulted in lower insurance rates with the probability of even lower costs the following year.
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