1. AETNA (SCHALLER ANDERSON)/March 2003 - Present
SENIOR APPLICATION SUPPORT ANALYST
APPLICATION SUPPORT ANALYST
In my current position, I coordinate a project team responsible for new plan
implementations including analysis of plan requirements, related documentation, and
configuration of all MRDT files, fee schedules, contracts, and benefits within QNXT.
 Conduct detailed analysis and research of problems ranging from the simple to
the extremely complicated by reviewing all elements of the issue from claim line
detail to the high level intent of the requirements in order to devise an accurate
solution.
 Knowledgeable of key functionality in multiple modules: Fee Tables, Contracts,
Benefit Plans, Claim Finance Codes, Configuration, and Medical Codes.
 Review benefit information and executed contracts to identify and properly
interpret the critical components.
 Effectively document and/or verbally communicate complex requirements to
people who may not have as much experience with QNXT configuration.
 Approve proposed configuration solutions to verify plan and regulatory
specifications are satisfied.
 Easily adjust to continually changing conditions and priorities.
 Use sound judgement to make decisions based on available information.
 Work independently and manage workload efficiently to ensure timely
completion of projects.
 Professionally represent department in cross functional meetings, interactions,
and written and verbal communications.
 Develop and maintain strong and effective working relationships with staff at
all levels across multiple departments within the organization.
 Effectively work within challenging situations to facilitate an appropriate
resolution.
 Mentor colleagues to advance their configuration, analytical, and
documentation skills by way of in-service training and individual coaching.
 Evaluate gaps in documented procedures to devise process improvement
recommendations.
 Perform quality assurance reviews on completed files to confirm the change
elements and policy standards have been met.
 Design procedures, job aids, and fact sheets to support training needs for
internal and external customers.
Skilled professional with 27 years of combined experience in health plan operations
including system configuration, training, quality assurance, and claims processing.
Detail oriented, collaborative, and highly motivated individual who works well alone
and with others. Performance in current position as a Senior Application Support
Analyst leading new plan implementations has been consistently rated as “highly
successful.”
Critical Thinker
Resourceful
Attention to Detail
Adaptable
Independent
Accountable
Collaborative
Team Leadership
Customer Focused
ASSOCIATE’S DEGREE
Southwestern College
General Studies
1995
California State University,
Fullerton
Psychology – 58 units
1985-1986
480.239.2695
slsjones@gmail.com
Chula Vista, CA
C O N F I G U R A T I O N A N A L Y S T

2. EOS COMPANIES/February 2001 – March 2003
CLIENT SERVICES SPECIALIST
Managed a variety of activities including issue research and resolution, file audits,
grievance and appeals, correcting claims, and system configuration. Utilized the
QMACS and USSI systems.
SCHALLER ANDERSON OF ARIZONA/September 1999 – February 2001
TRAINING SPECIALIST
Performed training for new staff as well as ongoing training for existing staff.
Developed training material to support documented procedures and audited finalized
claims to assess quality results. Utilized the QMACS system.
PREMIER HEALTHCARE OF ARIZONA/August 1997 - September 1999
CLAIMS AUDITOR TEHCNICIAN
Managed a variety of activities including issue research and resolution, claim audits,
grievance and appeals, training material development and delivery, and compiling
backlog reports. Utilized the QMACS, Meridia, and Diamond systems.
AETNA US HEALTHCARE/February 1989 – May 1997
FIELD TRAINER
Provided training for new and existing staff. Analyzed audit results to evaluate
training needs. Utilized the Aecclaims system.
CLAIMS BENEFIT SPECIALIST
Processed all types of medical claims including PPO and indemnity plans. Handled
sensitive and complex claims including coordination of benefits, Medicare secondary
payer, pre-existing conditions, and third party liability. Utilized the Aecclaims system.
QNXT 5.1
Medicaid, Commercial, and
Medicare Plans
Microsoft Office Suite
Basic SQL Queries
Remedy 7.5
CERTIFIED PRODUCT
PROFESSIONAL
QNXT 3.2
February 2008
480.239.2695
slsjones@gmail.com
Chula Vista, CA
C O N F I G U R A T I O N A N A L Y S T