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PROFILE
Result-focused IT professional with proficiency in Application Management, Application Development and Project
Management with experience in a wide variety of business applications. Delivered numerous large projects that
significantly raised productivity and accuracy by utilizing the best of proven and leading-edge technology. Proven
Ability to build strong relationships with staff and clients using negotiation talent, persuasion and demonstrated
commitment. Effective leader who builds a strong, cohesive team, using planning, organization and collaboration skills
to deliver team results above individual ability levels, frequently surpassing client expectations. Self-motivated and a
problem solver, enjoys pursuing new challenges to strengthen abilities, enhance knowledge, and bring greater
success to employers.
TECHNICAL SUMMARY
Programming
Languages: COBOL, CICS, Eztrieve+, DYL280, JCL, REXX, CLIST, XML, ACL
Standards/ HIPAA, EDI transactions (837I, 837P, 837D, 270/271, 276/277, 997, 835), Sarbanes-Oxley
Compliance: Audit (SOX), Control Objectives for Information and related Technology (COBIT)
Services & TSO/ISPF, MS Visio, MS Office Suite, MS FrontPage 98, MS Project, DFSort, ICETOOL,
Tools: SYSB-II, CA7, CA11, CA1 (TMS), FAVER, ENDEVOR, LIBRARIAN, PANVALET, FileMaster,
DumpMaster, InterTest (Batch/CICS), FileAid, XPEDITER, Abend-Aid, STROBE, MQ Series,
Transidiom, BizTalk, Informatica, CLARITY, Uni-Center, Quality Center (formerly TestDirector),
SMART TS, CLAREDI, INFOPAC, MAINVIEW
PROFESSIONAL EXPERIENCE
• Developed and implemented automated calculation of interest/penalties and identification of mandated benefits for
the Processor 1 system; utilizing user maintained tables by State; decreasing the time required for examiners to
adjudicate claims and assuring compliance with all States regulations.
• Redesigned Medical claims Explanation of Benefits (EOB) to provide better clarity to policyholders and assure
compliance with State DOI departments.
• Automated Adjudication of duplicate claims and claims received on lapsed policies.
• Collaborated with McKesson and implemented process to identify and prevent fraudulent claim activity.
• Partnered with Concentra and implemented solutions for PPO primary and secondary repricing to save both
HealthMarkets and policyholders money.
• Worked directly with KPMG and Price-Waterhouse-Cooper (PWC) on internal audits and SOX initiatives.
• Provided Quarterly, Semi-Annual and Annual compliance reports to all States DOI in the required formats and at
the requested frequency. Also provided financial reporting on claims where necessary.
• Designed, developed and implemented Gramm-Leach-Bliley Act (GLBA) annual privacy notification process.
• Researched, designed, developed, and implemented HIPAA 835 EDI transaction (Electronic Remittance Advice);
integrated with the existing batch EOB processing for efficiency; saving valuable processing time and expense.
HILDA CRAWFORD
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• Facilitated and documented project meetings, tracked project task and reported status to Project Manager and
Business Unit Leaders.
• Managed Change Control via Endevor for this Project.
• Coordinated testing and implementation tasks.
• Created an automated test environment creation tool; utilizing ISPF, REXX and CLIST, to allow developers and
quality assurance technicians isolated environments to develop and test their code and table changes, providing for
a better production product and fewer production outages.
• Worked with Sprint to provide Land Line Long Distance to SBC customers as part of SBC Mobile Phone Bill.
• Developed interface process between Mortgage Loan Origination application and Mortgage Loan Billing System.
• Responsible for all Vendor Application upgrades.
• Provided all Application Reporting.