PROFESSIONAL SUMMARY:

• 9+ years of experience in Application Analysis, Quality Assurance, and UAT testing of application systems in Client/Server and Web environments.
• Experience working on different modules of Trizetto Facets claims processing system.
• Experience in testing HealthCare applications and medical systems in different environments.
• Strong knowledge of Software Development Life Cycle (SDLC), Software Testing Life Cycle (STLC).
• Extensive experience in Functional, Integration, Regression, User Acceptance (UAT) and backend testing.
• Strong Knowledge of Health Insurance, EDI, and various EDI Transaction sets including 837, 270/271, 834, 835, 278, and 276/277s.
• Experienced in creating Medical and Dental claims, enrolling subscribers and members in Facets 4.71/4.51/5.01/5.30
• Experience working on testing reports, inbound and outbound extracts, and integrations.
• Extensive experience in creating Test Plans and Test Cases for Client Server Applications and web based applications.
• Expertise in Manual and Automated Quality Assurance testing of Client/Server, Web applications using Spira Test, Win Runner, Load Runner, QTP and HP (Mercury) Quality Center (Test Director), Rational clear Quest.
• Strong SQL skills including complex queries for backend testing and data analysis.
• Strong Analytical skills, excellent communication and interpersonal skills, team player and self - starter.

TECHNICAL SKILLS:

Methodologies Waterfall, Agile: Languages: C, C++, SQL, PL SQL, HTML, XML, Java, .NET

Database Tools SQL Developer, TOAD: Project Management: MS Project 2010/2013/2016 , CA PPM

Other Tools Rational Requisite Pro, Clear Case, MS-Office Suite, Service: Now, Jama, EDI Notepad, UltraEdit, FrontRange

Databases MS SQL Server 2000/2008/2014 , MS Access: Testing Tools:: Spira Test, Mercury Quality Center, QTP, MS Team Foundation Server

PROFESSIONAL EXPERIENCE:

Confidential, MO

FACETS QA Analyst

Responsibilities:

• Tested Professional, Institutional and Dental claims in Facets.
• Manually entered Professional, Institutional and Dental claims in Facets.
• Tested 837 outbound claims from different trading partners.
• Participated in various reviews and meetings with the development team.
• Wrote SQL queries in SQL Server to perform Backend Testing.
• Reviewed design documents, business requirements and prepared test cases.
• Involved in Identifying and setting up test data to be used for test execution.
• Developed and executed test cases and test scenarios and followed up defects using Spira Test
• Performed Security Testing.
• Performed System Integration Testing, User Acceptance Testing and Regression Testing.
• Performed Facets Front-End Functionality Testing.
• Prepared test cases and tested Provider, Eligibility, Dental and Medical Extracts.
• Supported EDI team in testing 835/834.
• Worked with developers and tested production fixes.
• Worked with BAs in an open season project using FACETS MEET.
• Wrote SQL Queries for business to validate data.

Environment: Trizetto FACETS, Claimfacts, Spira Test, MS Outlook, MS Office, SQL Server, MS Access, Trizetto MEET, EDI Notepad, Sharepoint, FrontRange, Report2Web, UltraEdit and XML .

Confidential, Indianapolis, IN

QA Analyst

Responsibilities:

• Developed Test Cases, Test Scripts and a Traceability Matrix by analyzing the Technical and Functional Specs.
• Performed Integration testing, Functional testing, and UAT.
• Tested the functionality of the Extensions that meets the BRD requirements.
• Analyzed and processed Medicare claims using the EDI transactions 270/271, 278.
• Involved in validation of HIPAA for 834, 837, 835, 270, 271, 276, 277.
• Involved in claim adjudication process of Facets application.
• Performed Functional and Regression testing of Facets.
• Extensively worked on testing of the Subscribers/Family modules.
• Worked on Facets 4.71 Customer Service application.
• Involved in processing claims in Facets and validating the full cycle process to make sure the checks are generated and 835’s are generated.
• Extensively involved in data validation between 834 Membership file to Facets backend tables.
• Worked on HIPAA compliance in validating claim numbers and ICD9 codes.
• Constantly involved in review meetings and made sure testing is done based on the QA master plan and deadlines are met.
• Involved in testing Member Enrollment, Eligibility Enquiry, Eligibility Response, Claim Status Enquiry.
• Involved with backend testing and verified that the EDI data transactions were going fine in the database.

Environment: EDI HIPAA Gateway, Mainframe Environment, Quality Center, Microstrategy 8.0, Unix, Mainframes JCL, DB2, SQL Server, Trizetto Facets 4.71, MS Word and MS Excel

Confidential, Philadelphia

Test Analyst

Responsibilities:

• Assisted in writing efficient and effective test plan, test strategy, system testing, end-to-end test and user acceptance test plan.
• Performed end-to-end “system integration” testing which covered the entire business process flow from the initial Point of Sales through to all the (10) downstream systems and XML output files, including apps/interfaces.
• Developed and executed SQL queries to verify the proper insertion, deletion and updates into the Data Warehouse supporting tables and cubes.
• Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction. Populated ICD-9, EDI X12 transaction sets 835, 837, 270, 271, 276, 277 and 5010.
• Responsible for Claims processing, coordination of benefits and pricing process.
• Assisted business users in defining UAT test cases and plans; Established and maintained test cases and test data in Quality Center.
• Queried in SQL to validate data in database and Facets.
• Tested the membership and claims files (XML) in Facets.
• Logged defects in QC and maintained track of the defects throughout the life cycle.
• Analyzed HIPAA EDI transactions in XML and X12 responses and of 270 and 276 and looked for defects for amendment.

Environment: Java, oracle, DB2, IBM Mainframe, Unix, QC, Hyperion, XML DTD Schemas, HL7, HIPAA, Ultra-Edit32, Facets

Confidential, Hartford, CT

QA Tester

Responsibilities:

• Developed test plan and overall test strategy for the program using test manager.
• Developed test cases and test scripts for system and UAT testing.
• Involved in analyzing the requirements and understanding production volumes of Claims Processing.
• Tested the interfaces and management reports.
• Performed the data driven test by pumping different sets of data.
• Validate the Hospital and Medical Claims processing.
• Validated the reports and files according to HIPAA enforced standards.
• Tested the User interfaces for the Health care web application.
• Tested work flow integration of various modules.
• Involved in Functional testing, Integration and Regression testing.
• Queried database by writing SQL queries.
• Tested claims and validated the claims on mainframes.
• Tested various reports.
• Performed volume testing by transmitting batch files and validating them.
• Participated in GO/NO-GO meetings.
• Tracked defects using clear quest & conducted Bug-Reviews meetings.
• Coordinated with Business, Project Managers, and developers.

Environment: HIPAA Gateway, Mainframes (COBOL, DB2, JCL, TSO/ISPF, CICS, MVS), Java, J2EE, EJB, XML, Oracle 8i, Rational Test Manager, Rational Robot, Rational Clear Quest, Windows NT, UNIX, MS-Word, MS-Excel.