SUMMARY:

• 9+ years of experience in diversified fields of IT and Healthcare Practices as Sr. Business Analyst/ Consultant and QA
• Played multiple roles as business analyst on Business Process management/ requirements projects and is well - versed in requirements elicitation and analysis, Pre sales activities and consulting
• Successfully managed client projects for new products and enhance existing products implementation to meet requirements with constantly changing norms and compliance requirements
• Experience in identifying Business Process risks, risk analysis, providing baseline acceptance criteria and deliverables
• Experience in Business Requirements elicitation including UI Portals (5+ years of experience), delivery, manage change requests and create/ update business processes
• Expertise in requirement documentation using Use Cases, User Stories, Process flow diagrams, Page Specs, Mapping Documents and Report Specs in Rational Requirements and other industry standards
• Thorough Understanding of Software Development Life Cycle (SDLC), involved in various phases like Requirements, Analysis/Design, Development and Testing
• Worked on various project implementation methodologies including Waterfall, Iterative and Agile
• Expertise in QA skills and have done Integration, UAT and Regression testing. Documented Test scenarios and Test Cases
• Effective communication skills and record for coordination with business and IT
• Expertise in Healthcare Insurance domain for Enrollment,, Claims, HIPAA 5010, ACA, ICD-10, EMR/EHR
• Performed Business Development and Presales activities for new and existing clients in the different geographical area

TECHNICAL SKILLS:

Languages: C, C++, SQL

Platforms / O.S: DOS, MS Windows 9x, 2000, XP

Data Bases: Microsoft Access, IBM DB2 7.1

Tools Used: MS Office, MS Visio, IBM Rational Requisite Pro, Pega, Case 360, Clear Quest, JIRA

WORK EXPERIENCE:

Confidential, California

Healthcare Consulting/ BA/ QA

Responsibilities:

• Gather requirements for the Producer Services, Broker Commissions and QA departments
• Gather requirements for the Producer portal to capture new mandatory fields which will be required by Salesforce
• Gather requirements and mapping for interface between Producer Portal to Salesforce to sync producer data
• Interface requirements between Salesforce to PEGA to populate data fields for selected producers
• Gather and document UI requirements for new PEGA screens which replaces old legacy system GAMMA
• Integrate downstream system to transfer commission rates
• Identify QA checkpoints in the flow and capture requirements to automate QA flow
• Analyzed and updated workflow for New Group, Renewals, Changes and termination for automated and ad-hoc cases
• Gathered requirements for QA reports to analyze system performance and quality of data

Confidential, Minnesota

Healthcare Consulting/ BA/ QA

Responsibilities:

• Gathered system requirements for the new Medicare application for the Cost products
• Performed business process mapping and updated the business process flow to accommodate the changes
• Analyzed workflow changes for Agent and Members under Indexing and processes in Pega
• Documented Business requirement using Business Process, User Stories, Functional Specifications, Use Cases, UI/ Page Specs and Report Specs, Data mapping with vendor fields on the Portal application submissions
• Updated letters and reports templates and rules to process printing requirements
• Performed QA lead role, documented Test scenarios and Test Cases

Confidential

Responsibilities:

• Studied ACA compliance requirements and understood the impacts on IFP and SG business
• Documented business processes and Pega/ Case 360 system changes for the Underwriting and workflows
• Prepared User Stories, Use Cases, UI/Page Specs and Report Specs, Data Mapping for portal and backend systems
• Helped on test case preparations, defect tracking and resolved defects
• Identifying ACA compliant changes and applying to the existing Customer/ Agent flows and Back end systems
• Performed QA lead role, documented Test scenarios and Test Cases

Confidential

Responsibilities:

• Prepared Business requirement document for benefits piece of Government and Commercial Claims Migration project
• Discussed and coordinated business requirements and ETL activities with solution providers and business/ technical teams
• Prepared Use Cases, File transfer specifications for ETL process and report specifications
• Worked with Business SMEs, Cross-functional team’s BAs, Solution Architects to finalize the requirements
• Performed QA lead role, documented Test scenarios and Test Cases

Confidential, Georgia

Responsibilities:

• Received Knowledge transfer from Client to understand the current process flow of the X2/ OS+ PBM products
• Worked as a Scrum master and helped team to stay focused and reach consensus during the daily scrum
• Prepared User Stories and Business requirement document to address required changes in the OS+ base product
• Prepared Project Back log and Scrum back log lists using JIRA
• Worked with technical and testing team to solve any application related issues
• Delivered PBM domain KT to team

Confidential, California

Responsibilities:

• Completed process improvement for current business process flow for all core and surrounding systems of the Client
• Prepared transaction flows for core and surround systems to identify potential impacted systems
• Managed Core and 24+ surround systems (Including Claims, and IVR) and Communicated issues/ queries to the client
• Worked with cross functional teams for delivery of Requirement Assessment and Business System Design document

Confidential, Maryland

Responsibilities:

• Collected & Reviewed Application/Employee/Process & Tools data
• Performed comprehensive Portfolio Analysis using CBA (Cost Benefit analysis)
• Synthesized Outsourcing Solution
• Finalized Employee transition approach (Retained, re-badge, transferred, released)
• Delivered final Assessment reports

Confidential, Mississippi

BA/ QA

Responsibilities:

• Business Requirements Gathering from the Systems users including Clinical staff, Doctors and Nurses
• Evaluated the competitor application features/functionality
• Validated the process flow and Data elements in the existing system and updated/ designed new process flows using business process mapping and SIPOC diagrams
• Delivered domain KT to the team
• Performed QA lead role, documented Test scenarios and Test Cases for UI

Confidential, Minnesota

BA/ SA

Responsibilities:

• Prepared the Business Requirement Documents for the new Portal functionalities
• Prepared Use cases for various new UI functionalities and enhancements i.e. Register on portal, renew/ refill prescriptions, drug list lookup, locate the provider/ doctor, locate a pharmacy, IVR, Add to cart, Manage my account, etc
• Validated the existing Requirements and design to prepare Use cases for various features/ functionalities
• Delivered KT to the offshore team

Confidential

Responsibilities:

• Requirement gathering and Feasibility study for the Medicare Advantage Risk adjustment System in the Government Sponsored Healthcare space
• Worked with the team of 15 (Architects, Team coordinators. Developers) to build a Confidential solution

Confidential

Responsibilities:

• To provide assistance as a System Analyst in preparation of Business Requirement Document (BRD) for new SPRF’s
• Identification of the gaps in the BRD, that may impact the B2B system
• Preparation of High Level Design Documents for new SPRF’s, Requirement Traceability Matrix (RTM) Document.
• Preparation of Detail Design Documents and Data Matrix Documents with Visio flow
• To review the test cases prepared by QA team
• Knowledge transfer and document review amongst the peers and the Dev team

Confidential - OM

Responsibilities:

• Preparation of the Project Proposals, Pricing of Projects, Project Management Processes.
• To Design and document the high level process flow diagrams for minimal process improvements using DMAIC
• Worked upon the “Deep Dive Analysis Report for EFS OM” to reduce ticket influx by 30% and to improve SLA compliance by 50%
• Used Pareto chart (80/20 rule) to identify the major problems and completed the Root Cause Analysis on the incidents
• Identification and automation of the manual processes (Reports, Repeatable task etc)
• Handled multiple teams, Status Update, Issue Escalation, Client Handling and Interaction
• Delivered the desired services in time with the help of team work, enabled by Team building exercises
• Standardization of the project related documents and the repository structure for the Bi-monthly Audits
• Involved in preparation of Quarterly UHG OM - Newsletter

Confidential

Software Developer

Responsibilities:

• Was part of the high level design team which designed the Process flow
• Designed and delivered the product within the timeline
• Documented Technical and User support to help cater to various naïve clients