Wendy Alston has over 25 years of experience as a Business System Analyst and Claims Specialist at Blue Cross Blue Shield of North Carolina. She has excellent analytical, problem-solving, communication, and presentation skills. Alston has managed multiple projects simultaneously and consistently been promoted to positions with increased responsibility over her career. She currently performs analysis, testing, and problem resolution as a Business System Analyst for FEP Support at Blue Cross Blue Shield.

1. 419 Collington Dr
Mebane NC, 27302
919- 304-0255 /919- 444 -3834
Wapittsboro1@gmail.com
WendyAlston
QUALIFICATIONS:
Business System Analyst with excellent analytical and problem-solving skills, including ability to interpret
and present quantitative data with accuracy and attention to detail. Excellent mathematical or statistical
aptitude, communication, analytical, interpersonal, and presentation skills. Expert at managing multiple
projects simultaneously with proven ability to manage own work and meet deadlines. Consistently
promoted to positions of increased responsibility, advancing five times within a nine-year period.
PROFESSIONAL EXPERIENCE:
Blue Cross Blue Shield ofNorth Carolina 09/1993 to Present
Business System Analyst I, FEP Support 12/2008- Present
 Perform analysis to define, analyze, and develop solutions to production systems/procedural
problems
 Coordinate, develop and execute testing plans with Business area and IS; serve as point of contact
for business testing activities
 Ensure testing appropriateness to meet business requirements, document test plans and scenarios,
execute test plans, verify test results for accuracy,relevance and completeness
 Provide final signoff and/or make recommendations the business owner on User Acceptance
Testing results
 Maintain requirements traceability of test plans and results for small application changes.
 Assist with analysis and development of business processes to ensure quality, cost effectiveness,
timeliness of customer service,and regulatory requirements and mandates are met.
 Provide ongoing user support for ad hoc questions, inquiries, and service requests.
 Handle all functions related to operational system support including quality assurance
 Claims testing for production moves
 Problem resolution, development and training
 Manage daily work flow to meet deadlines
 Track Business performance by producing reports, communicating results, making
recommendations, and documenting process problems or changes
 Identifies and understands issues, problems and taking opportunities to help better all areas in FEP
 Conduct data analysis and provide feedback to business areas via telephone, email or 1:1
interaction
 Resolve small, less complex production issues by:
o Performing initial triage for severity and business impact of application failures,
o Troubleshooting root cause and documenting business requirements,
o Develop applicable business processes
o Document functional specifications or use cases,reviewing and approving technical
specifications

2. o Coordinate with other Plan teams and Vendors to devise, test and implement remedies
 Identify new areas for learning- using newly gain information from Senior Business Analysts, Self
taught, Word Documents thru Job aids
 Regularly creating and taking advantage of learning opportunities
 Ability to work in cross-functional project teams and independently
 Assume responsibility and accountability for successfully completing assignments
Blue Cross Blue Shield ofNorth Carolina 04/2007 – 12/2008
Operation Specialist,CGO Department
 Acted as a single point of contact for internal and external customers
 Resolved issues for customer call-ins and/or inquiries in a 24 hour turnaround
 Processed all phases of claims to reflect appropriate certificate liability
 Performed COB adjustments and training to others
 Assisted with State PPO projects, processing claims, performed audits, provided feedback, created
Excel spreadsheets
 Assisted with Medicare projects, processed Medicare claims, Prior Deductible Credit(PDC)
queries, on the floor training, daily claims mailboxes- emails to be resolved and answered in 24
hour turnaround
 Daily maintenance of Coordination of Benefits(COB) mailboxes, making sure emails were resolved
and answered in a 24 hour turnaround
 Assisted in managing daily workflow for the COB unit, Daily Inventory sheets
 Performed/conducted Claims and corporate audits for special projects
 Completed refund process for initiation of funds recovery
 Duplicate reports, auditing, training, giving feedback to co-workers
 Assisted with internal and external customer phone calls
 Reporting and tracking of daily numbers
 Assisted with the EOB Balancing projects
 Assisted with writing COB/SOP Guidelines and Work Flow Processes
 State CMM Migration validation, State project clean-up queries
 Attended weekly, biweekly and monthly meeting
 Subject matter expert for operational system and procedural issues to the business
 Set-up ongoing job procedures/ SOP’s for new or revisited information needed to manage ongoing
activities within the claims unit
 Reported concise and well-documented information via Excel spreadsheet to supervisors,
managers and directors
Blue Cross Blue Shield ofNorth Carolina 06/2005 - 04/2007
COB Claims Specialist, CGO Dept
 Acted as a single point of contact for internal and external customers
 Resolved issues for customer call-ins and/or inquiries
 Processed all phases of claims to reflect appropriate certificate liability
 Performed COB adjustments and training to others
 Assisted with State PPO projects, processing claims
 Assisted with Medicare projects, PDC queries, on the floor training,
 Assisted in managing daily workflow for the COB unit, Daily Inventory sheets
 Performed audits for special projects in a timely matter
 Reported concise and well-documented information via Excel spreadsheet to supervisors,
managers and directors

3. Blue Cross Blue Shield ofNorth Carolina 01/2004 - 06/2005
Customer Service Specialist, FEP
 Acted as a single point of contact that provided proactive, consistent, accurate,and excellent
customer service to both internal and external customers
 Displayed the expertise necessary to quickly and thoroughly answer questions related to the
resolution of inquiries about claims
 Knowledgeable of the plan policies, rates,and membership
 Processed all phases of claims adjustments to reflect appropriate certificate liability.
 Assisted in managing daily workflow for the COB unit
 Accurately received, researched,and resolved customer/provider inquiries. Completed refund
process for initiation of recovery
 Determined the appropriate method and execute the required steps to adjust claims when necessary
Blue Cross Blue Shield ofNorth Carolina 07/2002 - 12/2003
COB Specialist, FEP
 Managed daily workflow to meet deadlines and take appropriate actions to follow through on all
work
 Received and responded promptly and accurately to inquires from customer services, subscribers,
providers and other commercial carriers regarding other carrier information via telephone, email or
correspondence
 Processed and investigated all phases of claims adjustments to reflect appropriate certificate
liability
Blue Cross Blue Shield ofNorth Carolina 02/2000 – 07/2002
Claims Specialist, State Claims CMM
 Responsible for analyzing, researching and entering all CRT difficulties, multiple-transaction, aide
system, and plasm suspends into system
 Performed follow- ups daily to ensure timely processing
 Interpreted and applied information given on all claims, membership, and provider screens.
 Utilized all manuals as needed to make appropriate decisions to clear claims for payment or denial
 Maintained accurate daily counts, identify system and coding problems, and communicate with
management when completed
 Relate concise and well-documented problem logs to supervisor
 Processed and adjusted claims when needed and follow through to assure correct actions were taken
UNC Physicians and Associates, Chapel Hill NC 10/1999 - 02/2000
Claims Representative
 Researched information for various Explanation of Benefits codes
 Prepared daily workload for customer service contact
 Daily phone calls to request appropriate authorization number and eligibility for Medicaid
recipients, and enter authorization in system
 Updated and/ deleted termed policies from the data system
 Made appropriate adjustments when necessary

4. Generations Family Health Plan, Durham NC 02/1999 - 08/1999
Claims Adjudicator
 Prepared medical and facility claims adequately to be entered and adjudicated into the system
 Entered vital information on claim, such as,authorizations, medical criteria, benefits and pricing
with special guidelines
 Determined the appropriate method and implement the required steps to process, and adjust the
claim properly
 Performed quality assurance on all claims that are processed within a timely manner
 Avoided prompt pay issues by validating that the payment has been sent properly to the provider
Blue Cross Blue Shield of North Carolina 09/1993 - 02/1999
On -line Claims Examiner, State Claims
 Processed subscriber submitted dental, OCR, and professional claims
 Operated CRT,PC, copy machine and 10-key calculator
 Mailed back claims that requires additional information from either parties
 Correct claims that have a suspense error, by following the process Aide/Adjustment guideline
EDUCATION
Business Computer Programming, Central Carolina Community College, Sanford NC
General Office, Central Carolina Community College, Pittsboro, NC
TECHNICAL SKILLS
 Microsoft Office: Word,
Excel, PowerPoint
 Power MHS
 LRSP
 IPD
 MaxMC
 Service First
 HP Service Center
 Magic
 Mobius
 Doc Request,
 Weekend Tester
 Special Projects
 Fax machine
 Lean Training
 Type 50 wpm
 Computer literate
 FEP Direct
 Excellent telephone etiquette
 Blue Art (Automation Tool)
 SME (Subject Matter Expert)
 HP Quality Center
CERTIFICATIONS
 Anatomy and Physiology
 Medical Coding I
 Medical Coding II
 Certified Business Analyst
 Medical Billing and Insurance
 Expanded Medical Terminology for Healthcare
Professionals
 Medical Coding Boot Camp