SUMMARY

• Healthcare Insurance Product Owner & Manager with 15+ years of experience across USA/ Canada public & group healthcare insurance sectors, responsible for strategizing business needs with the client & ensuring product marketability
• Responsible for driving key initiatives to balancing the customer’s business requirements with organization’s vision
• Have extensive knowledge and experience in all functional areas of Healthcare Insurance domain
• Have played multiple roles including Product Owner, Product Manager, Requirements Manager, Design Lead, Sr. Business Consultant, Business Analyst across various engagements
• Experienced in implementing various IT SDLC models including Agile
• Proven capability in COTS implementation, Legacy modernization & greenfield development projects.
• Independently execute plans while working with key internal stakeholders
• Ensured projects are process compliant, tracked, shared & on time

TECHNICAL SKILLS

• Product Owner & Product Manager
• Curam Product Lead & Manager
• Sr. Business Consulatant
• Sr. Business Analyst

PROFESSIONAL EXPERIENCE

Confidential

Product Owner & Product Manager

Responsibilities:

• Responsible to maintain an annual revenue stream of $14M within Medicare & Medicaid domains
• Ensuring the integrity of payment made by the CMS or the State to the Plans and provide recommendations to recoup payments
• Creating product road map and listing out the features which need to be implemented and the sequence of implementation
• Keeping abreast of CMS & State Medicaid changes to ensure the product remains compliant to the regulations
• Work with & manage a 12 - member Offshore Product Development and a 6-member onsite product maintenance & operations team within an agile environment
• Working with Technical Architects to move products to AWS
• Manage relationship with 27+ health plan customers including HCSC, Centene, Excellus, Cambia etc. to ensure they remain satisfied with the product and the services provided
• Participating in workshops to identify customizations needed and productionize the product for the customer
• Generating insightful analytics for customers based on State 834 & 820 data and Plan membership data
• Conducting a comparative market analysis to understand and position various products in Medicaid or Medicare market
• Identifying new revenue opportunities for existing MCOs by mining Claims & Enrollment data
• Visiting customer offices to provide them with the demonstration of Product capabilities in this area
• Participate in the recruitment process

Confidential

Curam Product Lead & Manager

Responsibilities:

• Working with the State to define a strategy to implement IBM Cúram product for the State Eligibility & Enrollment Medicaid Program comprising of multiple MAGI & NoN MAGI products for meeting ACA guidelines.
• Working with the State through Requirements, Gap Analysis and Functional Design Phases
• Ensuring the solution is compliant with CMS 7 Standards and Conditions and inline with the MITA framework
• Leading a team of multiple BA’s comprising of personnel from multiple vendors
• Working with the State in understanding the current (AS-IS) Business Process and defining the To-BE Business Process using BPMN 2.0 for the new Eligibility & Enrollment System compliant with ACA regulations.
• Working with Directors and Administrators for streamlining their Business Process for their respective departments
• Creation of requirement and scope management plans and operationalization of the same
• Ensuring process compliance in Requirements phase and traceability using IBM Rational Requirements Composer across the project lifecycle
• Working with Technical team to understand and harmonize technical & business requirements
• Conducting Kick off Sessions before each phase for various department personnel who would be participating in that phase
• Conducting JAD sessions with various Agency partners for functional design
• Creating and maintaining Product Backlog for development & test
• Creating various processes for the State and Confidential to facilitate smooth functioning
• Working with State Organizational Change Management Team to determine Change Impacts
• Working with Communications Team to ensure various Stakeholders are kept abreast of Project Developments and creating an environment supportive of the change
• Working with Child Support enforcement proposals and identifying system changes
• Participate in hiring and recruitment process

Confidential

Sr. Business Consulatant

Responsibilities:

• Involved in interacting with the customer, in creating Business Need Assessments, doing cost benefit analysis, detailing requirements, working with downstream teams design, develop, deliver & operationalize Health Insurance Platform
• As a Lead Business Analyst worked on understanding customers operating issues/constraints, proposing & building solutions to allow the enterprise work with upstream and downstream system seamlessly.
• Worked with customer teams on resolving pre-production operational issues.
• Networked with established support group within the organization, involved in Market research, gathered business requirements & involved in thorough understanding of horizontal /vertical target market opportunities. This helped matching Confidential ’s Solution as closely as possible with the needs of the customers
• Coordinated meetings between Onsite & Offshore team. Gathered Information from the Customer, Enterprise Architect, Design Architect, & transitioned to the team
• Conducted several Demos on Canada Medicare Systems with UI Architects, Design Architects, & Sales Team
• Assisted sales team with several concepts, strategic planning, presentations & business planning for various customers over RFPs.
• Provided continuous attention to technical excellence & good design
• Gained extensive knowledge on new emerging technologies that were directly or indirectly related to Confidential ’s business
• Close, daily co-operation between business people & developers. Kept most of the interactions Face-to-face
• Involved in profiling right skills & people to expand the customer needs
• Helping the various customer business & technical teams transition from legacy systems to the new platform

Confidential

Sr. Business Analyst

Responsibilities:

• Re-engineered BMS (legacy system) to build a versatile Health Insurance Platform containing Master Data Management, Provider Management, Policy Administration, Plan Management, Member Eligibility & Enrollment, Premium Billing, Medical Claims Adjudication, Life & Disability Claim Processing and Payment Systems.
• Worked with Customer teams to prepare a Requirement Analysis and Management framework.
• Analyzed BMS Visual Basic code and SQL stored procedures and documented as is functional requirements
• Worked with customer SMEs to convert as is functional requirements of BMS to match their business needs.
• Handled the requirements for Medical Claims Health, Drug, Dental and Life & Disability claims which consist of 180+ use cases
• Responsible for the creation of master artifacts such as Process flow diagrams, Business Rules Catalog, System Use cases, Error Message Catalog & getting these documents signed off from the customer
• Played a key role in identifying the services & creation of Service Repository, which forms the core of the project & also in line with the go to market strategy of customer
• Identified the dependencies across the project & contributed for the formation of DSM (Dependency Structure Matrix) which was further used for delivery scoping.
• Played a key role in creation of Domain Model.
• Responsible for the validating the correctness of Service Model, Use case Model, application design, data base design, service layer & Blaze rule engine code against the requirements.
• Periodically reviewing service code to verify adherence to functionality
• Involved in verifying the functional correctness of the test cases
• Involved in verifying the UI prototype to match with the functional requirements
• Conducted daily meetings with the offshore team (designers, developers & testers) for all the functional clarifications
• Ensured the mapping of all the requirement artifacts using RequisitePro
• Formulated the process for handling the change requests from various teams
• Worked with customer teams to get Change Requests approved and implemented
• Working with customer & internal teams during UAT Phase for defect management and defect triage
• Coached new entrants on the healthcare sector
• Worked as Onsite Coordinator for Other modules such as Master Data Management, Provider, Member enrollment, Product/ Policy Management etc.

Confidential

Business Analyst

Responsibilities:

• Re-engineered existing application in production system & build a new web based, HIPAA compliant Enterprise consisting of Master Data Management, Provider Credentialing and Re-credentialing, Member Enrollment & Maintenance, Medical Claims, COB/TPL, Accounting, Payments and Reporting subsystems.
• Worked with business representatives to understand requirements & priorities & ensure that IT work is appropriately aligned. Elaborated these requirements into Business & System use cases ensuring the sign off of these documents. In all 62 system use cases were written and signed off for Claims Entry, Adjudication and Adjustment.
• Worked with offshore development team to define backend processing requirements and its implementation.
• Worked with other COTS partners to understand the interface requirements (for DRG Pricing, Fraud Abuse management etc)
• Complete Ownership on Medical Claims Domain Professional/ Dental/ Institutional ; Thorough Understanding & hands on experience on Health Claim Adjudication System Medicaid including EDI Transaction Sets.
• Working closely with offshore development & testing teams on a daily basis to provide functional clarifications and work prioritization.
• Working with Program Management team for project planning and prioritization activities following Scrum framework of Agile Project Management Techniques.
• Working with customer teams to identify and plug requirement gaps.
• Involved in Change Control Board for handling the Change Requests & analyzing the impact of these changes
• Involved in Early Component Testing of Claims Adjudication modules using SOAP messages
• Create UAT test cases along with the customer team and support them during execution.

Confidential

Jr. Business Analyst

Responsibilities:

• Working with the Onsite team to understand Business functionalities for Medical Claims Professional / Institutional / Dental and Payment Engine
• Updating use cases based on inputs received from Customer and Onsite team.
• Providing functional clarification to Design, Development and Testing team
• Working on preparing Test cases, Scripts, Flow diagrams and test data for Claim Adjudication engine Professional/ Institutional / Dental and Payment Engine.
• Doing Peer Reviews (for Flow diagrams, Test Cases ) in other modules such as Provider, Member & Program Management
• Involved in Manual execution of the Test cases.
• Extensively involved in database verification activities using SQL
• Conducting early testing which involves testing each component of the Medical Claim Adjudication Engine by passing raw data to web services
• Involved in end to end functional testing.
• Managed & executed test cases/scripts through Silk Central Test Manager.
• Logged Identified Defects in Silk Central Issue Manager & IBM Clear Quest.
• Involved in identifying test cases to be automated

Confidential

Test Case Generation Tool

Responsibilities:

• Worked on Test Data Generation module
• Wrote Test cases for the tool related to Test Data Generation module
• Executed & verified Test Cases
• Active Participation in Sign Off Process of written Test Cases
• Involved in Graphical User interface testing.
• Involved in Functional Testing & logged Identified Defects in Bugzilla.
• Involved in extensive Database Testing using SQL.