Camila W. Vause
Business Analyst, Health insurance
Nashville, TN · (615) 555 0134 · name@example.com · linkedin.com/in/camilawvause
Key Qualifications
EXPERIENCE
Nine years in health plan operations and information technology, six of them as a business analyst
INDUSTRIES
Health insurance, managed care, provider network administration
SPECIALTIES
Requirements elicitation, process mapping, claims adjudication rules, user acceptance testing
SYSTEMS
Jira, Confluence, ServiceNow, Snowflake, Tableau, Structured Query Language, Microsoft Visio
CREDENTIALS
Professional in Business Analysis, Project Management Institute; Certified Scrum Product Owner
EDUCATION
Bachelor of Science in health information management, Middle Tennessee State University
Executive Summary
Business analyst with nine years around claims and member enrollment systems at regional health plans. Turns the workarounds operations teams invent into written requirements engineers can build and auditors can trace. Works comfortably inside Health Insurance Portability and Accountability Act controls and closes requirement gaps before they reach a sprint.
Signature Achievements
- Rewrote the enrollment intake requirements behind eleven defects a release and held the next two releases to two defects each.
- Mapped prior authorization across four teams, removed nine duplicate handoffs and cut average turnaround from six days to four.
- Ran user acceptance testing for a claims edit release touching 200 contracted providers with no production rollback.
- Documented 62 undocumented claim edit rules so the vendor migration team could rebuild them instead of guessing.
- Built the requirement traceability matrix the plan now uses for every regulated release, cutting audit evidence gathering from five days to one.
Professional Experience
Business Analyst
Cumberland Valley Health Plan, Nashville, TN 2022 to present
Claims and enrollment work stream at a regional plan serving 410,000 members in Tennessee and Kentucky.
- Writes requirements and acceptance criteria for the adjudication backlog, roughly fourteen stories a two week sprint.
- Runs discovery sessions with claims examiners and network operations and converts verbal workarounds into current state process maps.
- Coordinates user acceptance testing with eleven business testers and drives defects to closure in Jira.
- Reviews release notes against Health Insurance Portability and Accountability Act minimum necessary rules before every deployment.
Business Systems Analyst
Volunteer Benefit Administrators, Franklin, TN 2019 to 2022
Third party administrator handling benefits for 160 employer groups across the Southeast.
- Gathered requirements for the member portal rebuild used by 88,000 covered lives.
- Wrote the data mapping specification for eligibility files exchanged with fourteen carriers.
- Sat in the weekly triage that decided whether an issue was a defect, a training gap or a new request.
Enrollment Operations Specialist
Harpeth River Benefits Group, Brentwood, TN 2017 to 2019
Enrollment processing team of nine at a small group benefits firm.
- Processed open enrollment files and reconciled discrepancies against carrier records.
- Wrote the desk procedures the team still uses for late enrollment exceptions.
Licensure and Certification
Professional in Business Analysis, Project Management Institute
Certified Scrum Product Owner, Scrum Alliance
Member, Project Management Institute Nashville Chapter
Education
Bachelor of Science in health information management, Middle Tennessee State University, 2017
Core Skills
Requirements elicitation · Process mapping · User acceptance testing · Claims adjudication rules · Data mapping · Structured Query Language · Jira and Confluence · Tableau reporting · Stakeholder interviews · Traceability matrices