Summary of Qualifications:

• 7+ years of extensive experience in the field of Information Technology with and Software testing on various platforms.
• Experienced in all phases of Software Development Life Cycle(SDLC) which includes Analysis, Development and Release process
• Worked with other development teams to teach them the correct usage of Agile and created document templates that acted as the baseline for other projects. Followed the Agile methodology and extreme programming concepts of project development. Analyzed and incorporated User Stories in different release plans for the sprints in Scrum process.
• Diverse work experience on Unit Testing, Smoke Testing, Functionality Testing, Integration Testing, GUI Testing, System Testing, Regression Testing, Sanity Testing, Performance Testing, Database Testing, User acceptance testing (UAT), Compatibility Testing and Product Assurance Testing for Web based and Client/Server applications
• Experience with testing performance of Web application, using tools like web sphere, ILOG, SOA environment.
• Strong knowledge in batch processes involving data migration.
• Proficient in writing Test Plans, Test Scripts, Test Scenarios and Test Cases for both Manual and Automated Testing.
• Expertise in performing software bug tracking using Bug Tracking Tools - Mercury Quality center, Test Director, Team Track, and Rational Clear Quest.
• Experience in configuration of claims adjudication systems, FACETS 4.31/4.71/4.81.
• Experience on Backend testing to write the SQL queries using Oracle, SQL Server and executing the queries using TOAD tool.
• Extensive work with various Rational tools like Requisite Pro- Requirement gathering/maintenance, Use Case document maintenance, Clear Case- version control and Clear Quest/Test Director for bug tracking, Rational Rose for Use case diagrams, Sequence diagrams and activity diagrams.
• Worked with other development teams to teach them the correct usage of Agile and created document templates that acted as the baseline for other projects. Followed the Agile methodology and extreme programming concepts of project development. Analyzed and incorporated User Stories in different release plans for the sprints in Scrum process.
• Experience in creating manual test cases from requirements, design, specifications and process flow diagrams
• Experience executing manual/automated test cases and doing Ad Hoc testing, Black Box, White Box testing.
• Experience logging defects and tracking to resolution.
• Experience with best practices and structured QA methodology
• Worked in ETL environment involving Informatica /DataStage.
• Worked on Business Intelligence tools like Cognos, Business Objects.

Education
B.Sc Environmental Science TU Nepal 2001

Technical Expertise:
Process/Modeling Tool: Software Development Life Cycle (SDLC), MS Visio, Quality center, Test Director, QTP Rational Rose, Win runner, Load runner, EC map, Rational RequisitePro, Rational Clear Quest, (VSS) VISUAL SOURCE SAFE 2005
Methodology: OOAD, UML, RUP, Business Modeling
Databases: MS Access, SQL server, Oracle,
Languages: DB2 Query Management Facility, SQL, Java, XML and HTML
Operating Systems: MS-DOS, WINDOWS 98/2000/NT/XP
Office Tools: MS Office 2003/2000, Word, Excel, PowerPoint, Access
Project Management: MS Project 2003/2000

BCBS MA2012 Feb-Current
Confidential, Boston, MA, 02155

Blue Quote Individual (BQI) is a web based application (hosted by Connecture) that will replace the following three existing/current systems that handle Individual market new and renewal business process.

• Individual Family Quoting System (IFQ): IFQ is an intranet web application that is designed / used for processing Individual NEW Business processing.
• E-Health: E-Health is a customer facing web based application (Hosted by a Vendor) that is designed / used for quoting and accepting medical insurance applications from Individual Marker customer. Inter BCBSMA sales associated manually enter eHealth application into IFQ.
• Blue Quote Plus (BQ+): BQ+ is a web application (hosted in BCBSMA network) that is designed / used for processing Small Group and Individual Market.

Responsibility:

• Participate and preparing the Integration Test plan and migration check for promotion of the project from Dev to Prod.
• Design test case and test scenario for member enrollment process, 834 EDI transaction.
• Validate the different component of BQi project in different environments.
• Work with Business team involved in the project to understand the requirement
• Write and track the defects to assess the quality of the project.
• Participate in daily status, defect tracking meeting.
• Ensure the implemented system meets the requirement of the Business community.

Confidential, May 2011 - Jan
3217 Lord Baltimore drive,
Milford Mill, MD
Data/Business expert.

Facets upgraded from 4.31 to 4.81 : FACETS 4.81 Upgrade (Phoenix) Project

Universal American's (UA) Medicare Part D program (Membership, Billing & Customer Service) are hosted by CSC. Trizetto's Facets 4.31 is the applications used for maintaining Medicare Part D program. My role in this project is Medicare Data/Business expert. UA was recently acquired by CVS. After the acquisition 2 new projects started.Integration of UA and CVS Membership data and migration into one platform

I worked as a Data/Business expert. on various projects under theMedicare Part DAnnual Eligibility Period (AEP) initiative for the CVS/Caremark account at CSC as part of the Development team under the Run & Maintain group. The initiative was about providing ongoing production support to CVS/Caremark as far as their needs forMedicare Part Dis concerned except processing claims for the same. I was involved in performing various business analysis activities like attending Workgroup Sessions along with creating the functional specification documents after receiving the business requirements documents from CVS/Caremark amongst other things like actively performing testing and validation.

Responsibilities:

• Created Functional Specifications Documents from the Business Requirements Documents received from CVS/Caremark.
• Involved in updating and/or reworking previous documentation to get them in sync and up to date.
• Participated and provided input in enterprise architecture design and development.
• Coordinated the work done by the data architects and the rest of the infrastructure team with the production operations, development and QA teams.
• Performed review of the mandates sent by CMS forMedicare Part Dto figure out the updates needed to be made to meet the new mandates released on a quarterly basis.
• Made recommendations for the transformation roadmap and provided support during the transition phase.
• Participate in batch processes involving data migration.
• Maintained the live project risk database that showed the various attributes of each and every foreseeable risk.
• Participated in creating risk mitigation plan and planning different approaches for minimizing the risk and its consequences.
• Logged defects in JIRA to maintain Test requirements and to communicate the bugs with the Developers.
• Performed Backend testing extensively by writing SQL validation queries in Oracle Toad against the database.
• Validated records, structure of tables, Indexes, Triggers in tables after migration from Facets 4.31 to Facets 4.81 database.
• Extensively involved in testing CMS Audit Reports and Daily Sales Report in Apex Reporting Portal.
• Extensively worked on PEGA CM tool to update the status of the project in order to be able to meet the internal audit within CSC.
• Attended weekly status meetings to provide status updates, raise concerns about potential impediments and discuss any other issues with the development team.
• Attended workgroup sessions to complete various sections in the functional specifications document.
• Involved in manually testing the application from the back-end using TOAD and from the front end using FACETS to carry out data validation.
• Attended weekly internal and external CCB meetings to discuss the progress and impediments of various projects with the upper management and the client.
• Created testing criteria, test scenarios and test cases by using the documents created in the analysis phase of the project.

Environment: MS Office Tools, UML, MS Visio, Windows XP, Oracle, SQL, MS Project 2003, Siebel, Rational Clear Quest, Rational Clear Case, Cognos, Rational Rose, BD2, FACETS 4.81, JIRA .

Confidential, Schenectady, NY April 2010- March 2011
Quality Lead Analyst

Revenue Data Management (RDM) team handles all the inbound and outbound Meds II files between MVP and NYS, including Vendor files. In both ROC and SCH systems, the outbound claims extract files to NYS and inbound response files from NYS are currently stored in the system (which only IT has access to) and network drives (which both IT, RDM and all other departments have access to) as independent files. Only in ROC systems, both the inbound and outbound data are stored in Oracle tables. However, none of these Meds II data are being exported to a Data Warehouse kind of environment on a monthly basis at either ROC or SCH systems, for RDM to directly access this data and perform their own queries and monthly analysis. RDM currently imports this data to a homegrown MS Access database and works through that. RDM needs this access to Meds II data, so that they can better manage the effectiveness of the Meds II submission by staying on top of any errors and quickly performing any reporting needs.
Since all the Meds II data are currently stored in independent files or work tables, there is a lot of work involved by both IT and RDM to manually handle these files, load it and analyze it on a monthly basis. Some of this manual IT work would no longer be needed if this Meds II data is readily available in DW for RDM to directly query them and analyze those results.
Storing the MVP and all vendors Meds II data in DW will represent a central storage area for large volume Meds II data including historical data. This data can also be accessed by several departments other than RDM. Also RDM would be able to increase their reporting capabilities that IT is currently working for them. Moving the data to DW also falls under the current government program storage structure we have in place for Medicare (RAPS) products.

Responsibilities

• Coordination of the Test Environment creation and setup, including data elements and scripts
• Worked with other development teams to teach them the correct usage of Agile and created document templates that acted as the baseline for other projects. Followed the Agile methodology and extreme programming concepts of project development. Analyzed and incorporated User Stories in different release plans for the sprints in Scrum process.
• Participate in functional/technical design meetings
• Create detailed test plans bases on analysis of requirements and design documents.
• Write test case scripts and execute; document detailed results and summary report.
• Execute systems and data quality testing to ensure all development deliverables are production ready.
• Perform System, Regression, Integration and Performance testing
• In collaboration with other team members, analyze raw data to ensure the data will meet the business need.
• Coordinate UAT with business representatives.
• Monitor and resolve testing issues.
• Maintain defect status and description.
• Act as lead tester on projects.
• Manage testing tasks concurrently on multiple projects.
• Work with the business owner to identify key data elements that will be monitored on an on-going basis to ensure a high level of data quality within the DW.
• Develop automated testing scripts to improve testing effectiveness and productivity
• Research production issues.
• Act as technical resource to other testers.
• Recommend, develop, document and implement process improvements
• Document, educate & train others in processes & standards.

Environment: MS Office Tools, UML, MS Visio, Windows XP, Oracle, SQL, MS Project 2003, Siebel, Rational Clear Quest, Rational Clear Case, Cognos, Rational Rose, BD2, Business Objects 5.1, FACETS 4.71, Informatica, Mercury Quality .

Confidential, Shreveport, LA Oct 2008 to Mar 2010
Quality Lead Analyst

Information Systems Manager. Maintain Claims Management software (FACETS 4.51), which includes Medical and member modules Premium Billing, and client account maintenance. Responsibilities include working directly with the client and the client technical support teams to define, analyze, and document detailed system requirements. Coordinate with appropriate team(s) for improving auto-adjudication via Plan Building and Benefit Logic. Coordinate troubleshooting efforts and communicate system issues to end users. Additional responsibilities include support and training to the end user for system enhancements as well as ongoing support for current production systems. Maintain all current processes and procedures. Responsible for all software upgrades and updates. Responsible for all EDI transactions. Proficient in HIPAA requirements, including all transaction sets for X12

Responsibilities

• Reviewed and analyzed the Business Requirement Documents and User Specifications.
• Developed standardized FACETS testing, implementation and QA processes.
• Validate the EDI transactions 276/277 claim status request and response.
• Experience in configuration of claims adjudication systems, Facets 4.51
• Worked in DB2 data base, Share point.
• Involved in data validation, Extract, Transform and load from one data base to another by doing sql querry.
• Manage the business rules by the help of websphare ILOG
• Testing both inbound and out bound and XML files and prepare analysis document with various results.
• Responsible for working with the State to review and modify process flows to increase productivity and effectively utilize FACETS features not provided by the legacy systems.
• Create member, enroll member, assignment provider to enrolment.
• Participated in Automated regression and Non-Functional test plans.
• Assisted informational needs in mapping of Test Cases by the help of Quality center.
• Maintained Test Matrix with the test results obtained used Clear Quest to track the Bug.
• Validating all the information from HIPAA to FACETS.
• Analyzed inbound X12 HIPAA files and execute Trading partner testing and integration.
• As a point person need to train and guide the testing team during test script preparation.
• Involved in identifying the base testing efforts on a prioritized feature schedule.
• Addition of a new provider, Attaching Pay to/PCP affiliations to a provider. Modifying Org Policy for an employer and fee tables i.e. making changes in fee amount, effective and terminate fields etc.
• Troubleshoot any problems found within FACETS/QMAC and when testing the SQL data database while validating against the business rules.
• Involved in Back end testing to write the SQL queries and execute the queries using TOAD.
• Constructed Test Design, Test Cases and involved in creating/updating Test Summary Report and Defect Summary Reports.

Environment: MS Office Tools, UML, MS Visio, Windows XP, Oracle, SQL, MS Project 2003, Siebel, Rational Clear Quest, Rational Clear Case, Cognos, Rational Rose, BD2, Business Objects 5.1, Informatica 6.1, FACETS 4.51, Mercury Quality Center, Websphare, ILOG.

Confidential, Long Beach, CA Sept 2007 - Sept 2008
Business Analyst

FACETS Implementation for STAR, CHIP and STAR+LTC Programs for the State of Texas Health plan.
Molina Healthcare, Inc. is among the most experienced managed healthcare companies serving around 900,000 members who have traditionally faced barriers to quality healthcare - including low-income families and individuals covered under Medicaid, the Healthy Families Program, the State Children's Health Insurance Program (SCHIP) and other government-sponsored health insurance programs.
Molina started its operations in Texas and planned to use the FACETS managed care product from QCSI. In relation to this, they decided to restructure and re-route all existing EDI transactions into and out of FACETS for which some 40 EDI and Non-EDI Interfaces (both Inbound as well as Outbound) were developed for STAR (State of Texas Access Reforms), CHIP (Children's Health Insurance Plan) and STAR+LTC (State of Texas Access Reform Plus Long Term Care) involving all the major departments within Molina like Provider, Eligibility, Benefits, Member Services, Authorizations, Claims Submission, Capitation, Long Term Care, 270/271, 834, 835, 837.
Molina wanted to build a two-way interface between FACETS and WinStrat to achieve DRG - Diagnosis Related Groups / APC - Ambulatory Payment Classification Grouping and Pricing for Medicare and Medicaid/Medical Claim(s). Earlier Molina used WinStrat (a solution developed by HSS) for hospital reimbursements but a lot of manual intervention effort was required in the process, which was significantly reduced and automated by this Project.| FACETS Configuration Activities included ensuring that the claims are priced correctly all the DRG/APC. Medicare provider contract terms in FACETS are updated / created with FFS contracts with 100% DRG/APC contracts.

Responsibilities:

• Interviewed business users asking detailed questions to gather business requirements, wants, and needs concerning the project and carefully recorded the requirements in a format that can be understood by both business and technical teams
• Developed standardized FACETS testing, implementation and QA processes.
• Testing both inbound and out bound and XML files and prepare analysis document with various results.
• Responsible for working with the State to review and modify process flows to increase productivity and effectively utilize FACETS features not provided by the legacy systems.
• Participated in Automated regression and Non-Functional test plans.
• Analyzed inbound X12 HIPAA files and execute Trading partner testing and integration.
• As a point person need to train and guide the testing team during test script preparation.
• Involved in identifying the base testing efforts on a prioritized feature schedule.
• Addition of a new provider, Attaching Pay to/PCP affiliations to a provider. Modifying Org Policy for an employer and fee tables i.e. making changes in fee amount, effective and terminate fields etc.
• Troubleshoot any problems found within FACETS 4.41/QMAC and when testing the SQL data database while validating against the business rules.
• Assisted business in developing requirements and test cases for submitting Trizetto Product Enhancement Requests.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML.
• Involved system testing on EDI transaction 270/271 for both inbound and out bound using EC map.
• Assisted informational needs in mapping of Test Cases.
• Performed GUI testing, Integration testing, Regression testing, Ad -hoc testing, Negative testing, End to End testing, Load testing, User Acceptance testing on multiple projects
• Wrote Test Scenarios, Test cases in excel sheet and imported them to Test Director and used Clear Quest to track the bug.
• Logged defects in Quality Center, Test Director, re-tested defects, analyzed defect with Business Analyst, Users and Developers.
• Involved in writing the positive and negative test cases.
• Working closely with User group and Developers.
• Used SQL Plus to query the oracle database.
• Used DB2 QMF framework for cross-platform, rich workstation application.
• Validating XML file.
• Reviewed Performance/Stress testing results done by analyzing Task distribution diagram, Transaction Profile and User profile, creating virtual users and analyzing different reports.

Environment: JSP/servlets, JDBC, MS-Project, Visio, Rational Rose, clear case, Requisite Pro, Quality center Oracle, EC Map.

Confidential, Simi Valley Aug 2006 - Aug 2007
Business Analyst

Farmers Insurance one of the Largest insurer of both private personal line passenger automobile and homeowners insurances, and also provide wide range of other insurance and financial service product. NWCS ( National Worker compensation system ) is Web Base Application developed in Siebel oracles . NWCS is migrated project, the existing system WC (Worker Compensation) WCS Flat file to NWCS Siebel Oracles. NWCS is many external system like Pega (Hero for Claim creation), Financial Engine for Financial transaction, Coverage for Claim coverage verification. Lotus Note, Bill Review (NDC and PMSI), use Portal access for document upload to the NWCS system from external System by Insured and employee. QAS address verification for contact and Vendor.
Preliminary Workers Compensation Claim handling is done manually, vendor creation, Payment and Reserve for vendor and Contact.

Responsibilities:

• Reviewed and analyzed the Business Requirement Documents and User Specifications.
• Developed Test Strategy for manual testing
• Designed the TestPlan for all the phases of Testing followed by the Project Plan followed by V model.
• Prepared the verification check list to be followed in the various stages of the application under testing.
• Managing & coordinating QA onsite and offshore resources for the project testing.
• Involved in business requirement analysis through Business Requirement Specifications and business blue print documents.
• Prepared the build validation test cases for testing the builds to accept for testing
• Interacted with BA Functional and Technical Leads/Developers for understanding the requirements
• Identifying the test scenarios followed by the Use case docs.
• Understanding the UML design docs to see the functional flow.
• Developed functional test cases using Quality center 9.0
• Designed and maintained Defect Management Process followed by the defect life cycle.
• Prepared traceability matrix and published the reports followed by all the phases of the testing.
• Successfully managed the project within the project schedules.

Environment: Siebel Oracles RAC 10.2.03. SQL, PL/SQL, Linux 4, DB2, Quality Center 9.0

Confidential, Pittsburgh, PA June 2005 - July2006
QA
Project 1(Highmark, Pittsburgh & IBC (Independent Blue Cross) Philadelphia Integration) Integration divided into multiple verticals and worked on Direct Pay Premium Billing Vertical project. Highmark's system has been decided to be the Future (Newco) system; the Direct Pay Premium Billing project includes converting all IBC members' billing information into the Highmark system.

Project 2 (ITS Conversion): Migrated the ITS functionality of Blue
Square application from the home grown systems of BCBS into FACETS4.41. The existing systems were written in Mainframe and C++. The new functionality was provided in FACETS. Systems corresponding to the host plan were converted first and then the home plan systems. The goal with conversion was better handling of messages like 835/834/837I/P between host plan and home plan. The existing batch processes had limitations in error correction procedures and faster processing of messages, these limitations were addressed in the migrated system. Some existing processes were utilized for interfacing with FACETS, for e.g. remittance reports and explanation of benefit reports were still sent through the existing mainframe system while the batch processing of inbound and outbound ITS transactions was made more efficient by the usage of FACETS. Billing module was taken from the existing systems and interfaced with FACETS.

Responsibilities:

• Developed standardized FACETS testing, implementation and QA processes.
• Proficient to write the QTP scripts using VB Script and executed through QTP.
• Testing both inbound and out bound and XML files and prepare analysis document with various results.
• Responsible for working with the State to review and modify process flows to increase productivity and effectively utilize FACETS features not provided by the legacy systems.
• Participated in Automated regression and Non-Functional test plans.
• Assisted informational needs in mapping of Test Cases.
• Maintained Test Matrix with the test results obtained.
• Analyzed inbound X12 HIPAA files and execute Trading partner testing and integration.
• As a point person need to train and guide the testing team during test script preparation.
• Involved in identifying the base testing efforts on a prioritized feature schedule.
• Addition of a new provider, Attaching Pay to/PCP affiliations to a provider. Modifying Org Policy for an employer and fee tables i.e. making changes in fee amount, effective and terminate fields etc.
• Assisted business in developing requirements and test cases for submitting Trizetto Product Enhancement Requests.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML.
• Involved system testing on EDI 835/834/837I/P for both inbound and out bound using EC map.
• Assisted informational needs in mapping of Test Cases.
• Performed GUI testing, Integration testing, Regression testing, Ad -hoc testing, Negative testing, End to End testing, Load testing, User Acceptance testing on multiple projects
• Wrote Test Scenarios, Test cases in excel sheet and imported them to Test Director
• Logged defects in Quality Center, Test Director, re-tested defects, analyzed defect with Business Analyst, Users and Developers.
• Involved in writing the positive and negative test cases.
• Working closely with User group and Developers.
• Used SQL Plus to query the oracle database.

Environment: ITS, NASCO, FACETS 4.41. QConnect ASP.NET, ODBC, Javascript/HTML, MS-Project, Visio, Rational Rose, clear case, Requisite Pro, Quality center, Test Director Oracle