PROFESSIONAL SUMMARY:

• Overall 11 years of professional IT experience in Business Analysis, Software Testing, Quality assurance and supporting critical business applications in US Defined Healthcare, Finance and UK Insurance Domain.
• Excellent communication skills, writing skills as well as presentation skills. Experience working with business users as well as senior management. Proven track record of possessing excellent interpersonal skills and motivational attitude.
• Solid understanding of all phases of Software Development Life Cycle (SDLC) methodology (such as requirement, analysis, design, data modeling, business process modeling, implementation and deployment).
• Experience in all kinds of testing e.g. Unit Testing, Integration testing, User Acceptance Testing, Smoke Testing, Regression Testing, Performance Testing, Sanity testing, Functional Testing, SIT testing, Browser Compatibility Testing, GUI Testing and AS/400 & Mainframes Testing.
• In - depth knowledge of Rational Unified Process (RUP); risk engineering, data modeling and mapping, and design using UML (Unified Modeling Language), Rational Rose and Visio.
• Good knowledge of Oracle and SQL.
• Capable of managing multiple projects simultaneously.
• Exceptional problem solving and sound decision making capabilities.
• Experience in writing queries/scripts for data analysis and QA report testing.
• Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.
• Experience working in Medicare and Medicaid projects.
• Experience in conducting SWOT Analysis, Cost Benefit and ROI Analysis.
• Created Requirements Traceability Matrix to keep the stakeholders informed of the progress of the project.
• Strong expertise in Health Insurance Claim process, social services, Medicaid and banking.
• Extensive experience in conducting Joint Application Development (JAD) sessions for project definition involving analyzing requirements, requirement gathering, creating prototypes, user interface, database schema and system design.
• Well versed with Confidential, Facets, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD). Experience in writing Use cases and Functional Requirement Document.
• Organized, goal-oriented, self-starter, and ability to master new technologies, manage multiple tasks while following through from start to completion. Ability to inculcate new relevant skills with ease in a time sensitive frame.
• Flexibility in adaption to a wide range of work environments.
• Knowledge of ISO, Six Sigma and CMM standards. Certified Six Sigma Green Belt.
• Extensive experience of writing and executing test cases/scripts/conditions, defect and test ware management. A proficient manual functional tester.
• Exposure of using automated test scripts with QTP and Selenium.
• Estimating, creating, assigning and managing set of subtasks and tracking/resolving issues/risks/dependencies at task and Project level.
• Strong analytical, problem solving & organizational abilities.
• Having good understanding of US healthcare and all kinds of claims e.g. HCFA1500, UB92 and Pharmacy.
• Rich experience in various kinds of claims such as ITS, Confidential, FEP, Direct Pay etc.
• Highly experienced on various kinds of Pricing and Third Party Systems such as Pega, McKesson, DRG, Claimcheck, other external repricing, MMIS, Confidential etc.
• Extensive experience in claim level and detail level adjudication, Business rules Application, Pricing, Repricing, Rebundling, Unbundling, and other editing.
• Wide experience in all kinds of healthcare transactions such as Membership, Enrollment, Claims processing, Third party Repricing, EDI, Payments, Security, Premium Billing, Acturial Tables, Financial Ledger processing, Accounts Handling, Providers, References, EDI X12 Transactions etc.
• Proven track record of being an excellent individual contributor as well as an indispensable and critical team player.
• Experienced in managing mid-size teams and people from different locations and backgrounds.

TECHNICAL SKILLS:

Domain: Healthcare, Insurance and Finance

OS/Platforms: Windows, Linux, AS/400, Mainframes.

Ticketing/Tracking/Support: Amdocs Clarify, Amdocs Clear case, Amdocs Clear Support

Testing Expertise: UAT (Proficient), Database (Proficient), System, Functional, Regression, Smoke, Sanity.

Databases: AS/400, MS SQL Server, Oracle, DB2 using SQL, MS-ACCESS.

Test ware management: Test Director 8.2, Mercury Quality Center 9.2, HP ALM 11.0, JIRA.

Automated Testing Tools: QTP 9.1, Interfaces

Methodologies: Project Management

Business Modeling Tools: Web, AS/400, SQL/400, DB2/400, SOAP UI, AWD, I series Navigator, Mainframe DB2, SPUFI, CICS and JMR, SDLC, RUP, UML, CMM, MS Office Suite (Microsoft Word, Microsoft PowerPoint, Microsoft Excel), MS Project, MS Visio, Rational Rose.

PROFESSIONAL EXPERIENCE:

Confidential, Sayreville, NJ

BA Lead/ Healthcare SME

Responsibilities:

• Use Amdocs clarify to create cases, or work upon assigned cases/tickets, and to follow the STLC.
• Use HP ALM 11.0 and JIRA to create/log/track defects progress and to follow the defect life cycle.
• Research, define and analyze changes to both state and federal laws affecting the Medicaid Management Information System (MMIS).
• Actively involved in ICD-9 to ICD-10 transition for the organization.
• Well versed with Healthcare terminologies, rules and information regarding Confidential Regulations, PHI etc.
• Extensive experience working on Healthcare payer data. Expert in analyzing the data.
• Implemented and utilized Extreme shift left Automation technique in Agile methodology. Focused on testing executable requirements, architecture, and design models.
• Help in conducting Gap Analysis (GAP), User Acceptance Testing (UAT), and System Integration testing (SIT) and SWOT analysis. Performed GAP Analysis for Confidential 4010 and 5010 transactions.
• Facilitate Electronic Data Interchange.
• Using EDI tools and validators to verify mapping to X12 format.
• Recommend changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like Confidential / EDI formats and accredited standards ANSI.
• Serving as a project management analyst on multiple initiatives involving maintenance and systems changes for Confidential implementation.
• Interacting with subject matter experts on a daily basis to establish proficiency in the business processes.
• Gathering business requirements during sessions with SMEs as assigned by the Client.
• Participation in Joint Application Design (JAD) sessions with development teams.
• Performing validation of documented business requirements against business processes as assigned by the Client to ensure that business requirements accurately represent the needs of business stakeholders.
• Providing verification of developed software in accordance with business requirements and technical specifications as assigned through User Acceptance Testing (UAT).
• Utilizing the change and configuration management system to prepare documentation of application change requests.
• Utilizing Microsoft Office software and the department’s change and configuration management system to define and document functional specifications and software test plans.
• Extensive experience performing business process analysis, gathering and documenting user requirements.
• Experience communicating technical concepts to non-technical audiences.
• Extensive experience in validating user requirements, providing written test plans, verifying product functionality and coordinating testing activities.
• Experience with the translation of business process requirements into technical requirements.
• Experience in producing business and/or technical documentation related to the requirements, specifications, traceability matrices, design, process and data flow diagrams, data migration, testing, and training.
• Completed system documentation, researched system requirements, participated in system testing and verification for Confidential implementation.
• Gathered and documented existing client processes and data in order to perform gap analysis between client's system and McKesson's system in order to access client's readiness.
• Identified specifications for billing and accounts receivable requirements, performed gap analysis and presented information to technical team to identify system requirements.
• Facilitated strategic meetings between various technical teams and hospital administrators resulting in identifying key differences in clinical systems.
• Completed DST's Project Management class. Utilized Project Management Institute (PMI) methodology.
• Loaded and maintained Health Care Certificates and Riders in Document Database
• Wrote and entered SQL language in Benefits at a glance (BAAGS) chart templates
• Generated reports and performed data validation. Implemented and maintained account benefit updates in system as part of National Health Care Reform mandates.
• Implemented Obamacare changes for the organization, in the current project.
• Extensive experience with managed care claims processing. Possess expert level knowledge of Confidential 5010 EDI X12 837I, 837P, 837D file formats; X276, X277; X820; X834 and NCPDP D.0 pharmacy claims processing.
• Extensive and hands on experience with relational BI tool OpenText BI Query User. Experienced in Mainframes and TSO/ISPF.
• Extensive experience in encountering claims work flow from original submission by provider to health plan to health plan to State Medicaid agency.
• Expertise in analysis, testing and development of healthcare EDI files. Expertise in data creation and manipulation through SQL.
• Expertise in producing professional business documentation, Ability to facilitate business requirements and discussions with client staff on business and functional topics
• Performing SIT testing, Functional testing, GUI testing, Compatibility testing and Regression testing.
• Evaluate and review new tools and identify the best fit solutions that meet industry standards.
• Work closely with Client SEPG group to identify testing needs and updates to automation guidelines
• Validate XML using soap UI tool
• Review functional and technical requirements, vendor handoff documents to expose inconsistencies or contradictions, lack of clarity or insufficient details
• Guide UAT team on testing strategy, test planning, test data conditioning and testing.
• Preparing and presenting various metrics like Defect Density, Environment Availability, Cost Per Script, Early Defect Detection Rate and Quality Metrics
• Experienced in budgeting, resource identification, cost estimations and proposals
• Consult with business stakeholders and project managers to identify program objectives and timelines.
• Actively participate in project team to discuss design reviews, articulate design concepts and suggest usability enhancements to the Business.
• Interface with the Business, developers and project managers on daily conference calls.
• Provide status reports to senior management, the Business and testing partners on test scenarios, environmental issues and hardware configurations
• Appraisals, separation, resolving grievances, career progression planning for all the reportees.
• Testing Risks Identification and mitigation plan for the identified risks.
• Quality Center Administrator for Company’s testing QC Domain.
• Adding Users and Quality Center Permissions for Confidential resources.
• Partnering with Third party teams for identification of Security testing scenarios and sharing the results for the same.
• Sharing of new implementable innovative ideas to improve the product and enhance customer satisfaction.
• Liaison with other testing teams to validate the data flow from AWD to Confidential and then back to the core product.
• Participate in Audits and provide demos to the auditors on the required scenarios.
• Coordinate and work with leaders and PMO to determine resources and secure capacity for QA
• Was an active FA member of the SCAMPI CMMI Ver 3, in which the organization got certified successfully.
• Worked as a Healthcare SME on Confidential ’s (client side) for DST, and performed User Acceptance Testing (UAT) for them, which garnered a lot of appreciations.
• Experienced in all kinds of healthcare transactions such as Membership, Enrollment, Claims processing, Third party Repricing, EDI, Payments, Security, Premium Billing, Acturial Tables, Financial Ledger processing, Accounts Handling, Providers, References, X12 Transactions etc.
• Actively involved in ICD-9 to ICD-10 transition for the organization.
• Responsible for daily call with client regarding work management and assignment to the team.
• Responsible for making and analyzing various types of Project trends, Estimation and schedules variances, slippages, Defect trend analysis, RAG reports, Metrics etc.
• Managing the Test Effort Estimation, Resource Demand and Capacity Planning Management.
• Prepare and analyze Quality Metrics to drive process improvements, identify issues and risks.
• Extensive experience of working on hosted services model and SaaS models.

Environment: Mainframes, AS/400, DB2/400, COBOL ILE, SQL, Foresight, Windows, Rational Clear Quest, MS Access, Windows, Rational Test Manager.

Confidential, El Segundo, California

BA/QA Engineer

Responsibilities:

• Requirements - Work with Requirements Consultant (RC)/Benefits Service Manager (BSM) to gather and clarify Requirements.
• Project Blueprint - Estimating, creating and assigning set of subtasks and defects to associates of support teams.
• Reviewing and ensuring successful completion of testing activities.
• Review Testing -Review that the work done is appropriately documented and executed successfully.
• Utilized Agile methodology to ensure enhanced processes and services are technically, operationally, and legally supported by analyzing and compiling business requirements solidifying successful implementation.
• Designed Test Plans and Test Cases for User Acceptance testing (UAT) with the help of QA teams.
• Utilized RUP to configure and develop process, standards and procedures.
• Good knowledge and experience on Property and Casualty (P&C) business.
• Interfaced with business users to prepare and update Business Process Requirements for the new release of Insurance tools.
• Prioritized outstanding defects and systems problems, ensuring accuracy and deadlines were met.
• Performed GAP analysis of business rules, business and system flows, user administration and requirements.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Used the Rational Unified Process (RUP) to develop the different phases of Software Development Life Cycle (SDLC).
• Prepared Business process models; used Visio to create use case diagrams.
• Designed mockup and wireframes to communicate visual data flow to the end users.
• Developed use cases, activity diagrams and sequence diagrams for a clear understanding of the vision document.
• Recommended corrective actions, if necessary, along with the progress against Development/Action Plan routinely to the Project Manager.
• Administered and coordinated User Acceptance Testing and obtain final system acceptance sign-off with the help of Program Manager.
• Conducted Risk Engineering to derive and execute action plans on time.
• Conducted Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
• Wrote SQL Queries in MS Access to sort data and analyze the large set of data during project life cycle.
• Involved in creating/maintaining of transactions in Mainframe System and accountable for testing incoming transactions of Mainframe system.
• Production Support -Support production environment (defects and trends) and execute work flow and defect management with Outside Delivery Group (ODG).
• Gathering, understanding and analyzing requirements, writing test cases/scripts/conditions and reviewing them. All using Quality Center.
• Execution, analysis and troubleshooting of test cases
• Data driven framework approach using QTP and MS-Access.

Environment: QTP 9.1, MS-Access, Windows XP, Java, VB.Net, Quality Center, User Acceptance Testing (UAT), Rational Unified Process (RUP), Rational Clear Quest, Joint Application Development (JAD), MS Access, Windows, Rational Test Manager, MS Office, Requirement Traceability Matrix (RTM).

Confidential

Business Analyst/ Test Engineer

Responsibilities:

• Gathering, understanding and analyzing requirements, writing test cases/scripts/conditions and reviewing them. All using HP ALM 11 (Quality Center).
• Conducting Functional, Regression and System Testing for Various Modules
• Coordinating the creation/update/review and execution of automated and manual test cases
• Using Agile methodology to strengthen risk mitigation techniques and improved process efficiencies while meeting stringent regulatory requirements.
• Communicating QA risks, milestones, and status to Leadership and Project Team.
• Design, prepare and report test results through data dashboards.
• Open and track defects to resolution.
• Ensure the efficiency, integrity and completeness of tasks related to Quality Assurance and Testing.
• Whenever required, debug the Cobol (V5R4M0) programs to double check and ensure a genuine issue, before recording it as a bug.
• Analyze the program dumps to deduce the possible root cause of issue, and checking/ correcting the setup errors, if any, thereby reducing the unnecessary wastage of precious testing time.
• Manipulation of program files and tables through SQL/400.
• Execution, analysis and troubleshooting of test cases
• Ensuring balanced allocation of testing tasks including test execution, discussing defects within team / with project team, logging, tracking and closing defects in Test Director and reporting to Test lead / Test manager.
• Key Role in Test Strategy and estimation. Conducting Scope, Test readiness review, and recovery meetings.
• Generation of precode data using QTP.
• Coordinating with different Technical and leadership bands.

Environment: QTP 9.1, Mainframes, Windows XP, Java, Quality Center, JIRA, VB Script.

Confidential

Test Analyst

Responsibilities:

• Requirements - Work with Requirements Consultant (RC)/Benefits Service Manager (BSM) to gather and clarify Requirements.
• Project Blueprint - Estimating, creating and assigning set of subtasks and defects to associates of support teams.
• Reviewing and ensuring successful completion of testing activities.
• Review Testing -Review that the work done is appropriately documented and executed successfully.
• Production Support -Support production environment (defects and trends) and execute work flow and defect management with Outside Delivery Group (ODG).
• Responsible for making and managing RAG reports, Defect trend analysis, Project trends, Various types of variances - slippages etc.
• Writing cobol programs, as and when required, on V5R4M0.
• Working on US healthcare and all kinds of claims e.g. HCFA1500, UB92 and Pharmacy on a daily basis.
• Processing of various kinds of claims such as ITS, Confidential, FEP, Direct Pay etc.
• Working on various kinds of Pricing and Third Party Systems such as Pega, McKesson, DRG, Claimcheck, other external repricing, MMIS, Confidential etc.
• Processing of Medicare and Medicaid members.
• Performing claim level and detail level adjudication, Business rules Application, Pricing, Repricing, Rebundling, Unbundling, and other editing.
• Debugging cobol programs, analyzing dump logs, and accessing root causes.
• Manipulating programs in real time, through debug, to test and validate certain scenarios which are not possible to test otherwise, given the limited time frame.
• Transferred I-O Modules into native COBOL Programming.
• Trained other employees on the new COBOL programming and its functions and uses.
• Perform validation of the code.
• Designated SQA for my team.
• Used Agile methodology.

Environment: AS/400, OS/400, COBOL ILE, SQL/400, JIRA, Quality Center, Clarify, SOAP UI.