SUMMARY

• Six years plus of solid experience as a Quality Assurance Engineer in Health care, Insurance and SAP BI applications or domains.
• Good in creating test cases and scenarios using BRD, FRD, Use Cases, SDS, TDD, UML and Activity Diagrams and etc.
• Good knowledge in Web base Apps testing, Manual and Automation on UNIX and Windows environments with primary focus in manual and black box testing.
• Very familiar with testing tools such HP Quality Center, QTP, FTP's, SQL and etc.
• Strong HIPAA EDI 4010 and 5010 and ICD - 9 and ICD-10 processes for member, payers, providers including Coordination of benefits, Copays, benefits and etc.
• Good knowledge in validating XML and X12 files and Mortgage Loan Origination.
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Involved in Facets Output generation, Interface development and Facets Migration Projects.
• Provided analytical solution to the customers for Facets Production Issues.
• Solid experience in System, Backend and Front end, Regression testing, End to End testing etc.
• Very familiar with Waterfall and Agile SDLC’s methodologies.
• Good analytical, communication and problem solving skills.
• Good experience in SAP BI and BO testing.
• Knowledge of work flows and business and technical requirements
• Experience with user acceptance testing, functional and regression testing techniques
• Ability to extract data utilizing SQL (Oracle and DB2)
• Knowledge of Health Claims Systems - Professional, Institutional, RX, ICD-9, CPT4, PX/DX Relationships, and Medical Terminology
• Understanding of Healthcare Insurance Exchange Plan Management (HIX);
• Knowledge of OPL, COB, Pricing, Benefit testing - End to End Claims Business Process Testing
• Knowledge of defect management processes
• Knowledge of Mainframe/DB2
• Knowledge of Client Server applications

TECHNICAL SKILLS

Testing Tools: ALM/ HP QC, Quest, Availity, SQL, OPL online Screens, Mainframes, Diamond, Load Runner, FACETS

Databases: SQL Server, RBMS and Oracle

Documentation Tools: MS Excel, MS Office, Share Point, Requisite Pro, Microsoft Outlook

Languages: Visual Basic, HTML, XML, SQL, PL/SQL

Other Tools: Filezilla, WinSCP, SQL Plus, DB2 and QTP etc.

PROFESSIONAL EXPERIENCE

Confidential, Chantilly, VA

QA

Responsibilities:

• Worked closely with software engineers, internal and external customers to gather comprehensive testing criteria and plan requirements to ensure accuracy and timeliness of projects.
• Developed and maintained innovative Test cases based on Functional Requirements, Use Cases, user interface designs, system design documents and domain knowledge
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• Enrolled members through online screens and 834 Transactions to Facets.
• Modified the 834 file and then checked if the eligibility enrollment is properly loaded onto Facets.
• Processed 837P, 837I and 837D transactions, verified those 837 transactions were converted correctly to XML file format and verified the claims data loaded to Facets for further processing.
• Worked with Accumulators, Deductibles, Coordination of Benefits and Overrides of the Claim Line detail and used them for testing various claims scenarios in Facets.
• Maintained strong relationships with developers which helped in better execution of test plan.
• Worked extensively using SQL for Back End Testing to validate data in the tables of the database.
• Executed commands in Unix to view the files
• FTP the files to Unix server for processing.
• Analyzed and translated requirements and business design into Test Cases.
• Used Quality Center for bug tracking, reporting and analysis.
• Involved in coordination between the automated testers, manual testers and system administrator for the precise scheduling of test runs.

Environment: FACETS, Quality Center, SharePoint, SQL, UINX, Oracle DB, QTP, Microsoft outlook, Clear Quest.

Confidential, Florida, Jacksonville

QA Tester

Responsibilities:

• Created test deliverables and perform testing for internally developed or external purchased products
• Performed static, functional, technical integration and end-to-end
• Executed job streams for creating test beds, assigning test scenarios, writing test scripts and tracking defects to certify that applications meet technical and business requirements
• Analyzed and make specific recommendations on improvements that can be integrated into business processes
• Participated in reviews throughout the development life cycle
• Facilitated User Acceptance Testing by providing the necessary support to the business users
• Prepared Test Cases using BRD, TDD, Test Plan and Approach etc.
• Designed and prioritized test scenarios and test cases that will provide efficient coverage of requirements consistent with acceptable level of risk.
• Submitting electronic and paper claims
• Involved in end-to-end testing of 834, 837, 835 and etc.
• Set claim processing data for different Diamond module testing.
• Validated X12 and XML for EDI transaction.
• Tested the HIPPA EDI 834, 837/835 transactions according to test scenarios and verify the data on different modules.
• Conducted Back-End table testing using SQL and DB2.
• Executed commands in Unix to view the files and FTP the files to Unix server for processing.
• Tested claims Benefits, Payment, Authorization, Pricing for both institutional and professional claims.
• Performed Functional, Regression, and system testing for claims processing, members and providers.
• Extensively used SQL statements to query the Oracle Database for test data.
• Executed test cases, logged and reported defects.
• Responsible for Performing Integration Testing.
• Attended review, defect and team meetings.

Environment: Quality Center, Diamond, SQL, UINX, Oracle DB, QTP, Microsoft outlook, etc.