SUMMARY:

• 8 - years of extensive experience in IT with Business/Systems Analyst, Gap Analysis, Risk Analysis and Quality testing of Web-based, Client/Server and N-tier applications on multi-platform.
• Experience in Property and Casualty (P&C) insurance including Auto, Home, and Umbrella, Health Care, Life insurance and Finance and Retail domains.
• Expertise in Agile, RUP, Scrum, Waterfall SDLC (Software Development Methodologies).
• In-depth knowledge of all the phases within the Software Development Life Cycle (SDLC) such as Requirements, Analysis/Design, Development and Testing.
• Extensive experience in conducting Joint Application Development (JAD) sessions, Requirement elicitation, documenting and managing stake holder requirements
• Profound understanding of insurance policies like HMO and PPO and proven experience with HIPAA 4010/5010 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim status), 834(Benefit enrolment), 835(Payment/remittance advice) and 837(Health care claims).
• Thorough understanding of P and C (Property and Casualty) insurance laws, regulations and company policies and insurance claims systems implementation.
• Good working knowledge in X12 HIPAA EDI standards (v4010/4010A1) and v5010 standards, NASCO and HL7.
• Experience in POS (Sale, Return, Suspend and Void) transactions and writing Business Rules for Coupons and Promotions in POS
• Worked in various healthcare areas like Enrolment, Benefits, Claims, Providers, Medicare and Medicaid.
• Experience in gathering Business and Functional Requirements, developing Use Cases, Business and Process modeling, capturing System Specs, designing Specification Templates and preparing Training/ Knowledge Transfer manuals.
• Experienced in conducting GAP analysis, SWOT analysis, Cost benefit analysis and ROI analysis.
• Excellent in performing Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Worked closely with project stakeholders, SMEs, and staff to understand the requirements and specifications for new applications along with re-engineering the existing applications.
• Good knowledge of SharePoint 2007 and 2010 and its features and functionality.
• Excellent in conducting User Acceptance Testing (UAT) and verifying performance, reliability and fault tolerance issues.
• Functional knowledge of various modules of Property and Casualty insurance like channel management, policy servicing, claims management, underwriting, reinsurance and finance.
• Demonstrated leadership in identifying and implementing appropriate technology solutions, application testing, Quality Assurance, specification gathering, team co-ordination, solving business problems, supporting company strategies while maintaining personal accountability.
• Proficiency in SQL and possess knowledge and experience of using various joins (inner, outer, left and right), tables and database connections etc.
• Good working knowledge of MS-Office (Outlook, Outlook express, Word, Excel and Power point).

TECHNICAL SKILLS:

Methodologies: Agile, Waterfall, SDLC

Defect tracking: ALM/Quality Center 11/10.0/9.5/9.2, TestDirector 8.0/7.6, Testlink

Open source tools: SoapUI 2.5/3.0/4.0

Languages: Java, J2EE, ASP, C#, VB.Net, SQL, PL/SQL, T-SQL, XML

Operating systems: Windows 2000/2003/XP/VISTA/7/8/10, Mac OS, Linux and UNIX

RDBMS: Oracle 12c/11g/10g/9i, SQL Server, DB2, Teradata, MS Access

Version control: MS Team Foundation Server (TFS), VSS, PVCS, Rational ClearCase

IDE’s: Visual Studio, Visual Studio Team System (VSTS)

Other tools: SQL*Plus, SQL Developer, TOAD, MS SharePoint, MS Visio, MS Project

Web/Application server: IIS, Apache Tomcat, WebSphere, WebLogic, JBoss

MS-Office: Outlook, Express, Word, Excel and Power point

PROFESSIONAL EXPERIENCE:

Confidential, Bloomington, IL

Sr. Systems Business Analyst

Responsibilities:

• Developed, maintained and communicated detailed systems requirements based on business requirements
• Facilitated Sessions to obtain detail system requirements.
• Designing, documenting, configuring BRD (business requirement document) and FRD (functional requirement document) in SharePoint.
• Responsible for requirement analysis, traceability evaluation and testing of Insurance ID cards as per the jurisdiction (Request ID Card)
• Responsible for writing Business Rules and Functional Requirements as per the state for Requesting Insurance card (Property and Casualty Insurance) for automated and non-automated states.
• Prioritized the requirements and created conceptual wireframes/prototypes and mock- ups for Detailed Policy View, Change Coverage’s, Lien Holder changes (P & C)
• Coordinated as a liaison between development team, test delivery and business architects to define requirement questions.
• Resolved gaps post finalizing the deliverables for the existing customer platform.
• Monitored and Evaluated requirement throughout the project life cycle.
• Developed the scope and vision documents that defined the primary goals, objectives and scope of the project.
• Coordinated User Acceptance Testing with Business Partners and Test team.
• Answered questions from developers and test analysts regarding requirements, testing and systems solutions.
• Involved in Unit Testing, Integration, and User Acceptance Testing.
• Bugs that would enhance the usability of the application were logged using Quality Center/ALM.
• Good ability to gather business and technical requirements from both formal and informal sessions utilizing a variety of software tools including, Use Cases and the rational tools.
• Collaborated on Test case Reviews.
• Updated and communicated updates to requirements during the project life cycle, which occurs as a result of RCN (Requirement Change Notification) or CR (Change Request).
• Highly recognized for excellent communication, project management capability, and the ability to successfully influence and drive harmony across cross-functional teams.
• Responsible for Creating FRD (Functional Requirement Document) and maintaining it.
• Facilitated Use Case Development during systems life cycle.
• Gathered inputs from various Business Partners and applied learning's to the project.
• Ensured all tasks stay on track while maintaining all documents in SharePoint.
• Documented and Uploading Requirements into Test link and maintained them throughout the project life cycle.

Environment: s: IBM Lotus Notes8.5.3, Test link 1.9.3, MS Suite, MS Visio, MS Project, SharePoint 2007, Snag IT, HP Service Desk/HP Service Manager, QlikView, ALM/Quality Center, Rational Suite, IBM WebSphere, Java, J2EE, MQ Series, Oracle 11g, SQL, TOAD, UNIX, Windows XP/7.

Sr. Business Analyst

Responsibilities:

• Involved in Business functionality review meetings and Use-Case Analysis.
• Validated HL7 ADT (Admit Discharge Transfer) and HL7 ORU (Observation Result Message) message types for various Hospital Information exchanges.
• Worked on Business Functionality, Use Case Specifications, Risk Analysis, Documentation and Build Verification.
• Testing of HL7 Message Validation and sending of ADT Messages like ADT A01, ADT A04 and ADT A08.
• Mapped the requirements to test cases (Traceability matrix).
• Prepared and Processed the HL7 ADT and ORU messages through Core point and attain Clinical lab results and other data in Clinical Portal.
• Validated HIPAA (4010 to 5010 Conversion) rules and HL7 Standards.
• Designed and implemented basic SQL queries for QA testing and report/data validation.
• Analyzed the System Requirements, Functional requirements and Business Requirement Documents.
• Performed Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Created the As-Is Model and To-Be Model of the system and performed a complete GAP analysis to identify problems and inconsistencies with the business specification and the existing system.
• Applied an in-depth knowledge of healthcare systems and healthcare business for the development of complex processes and projects in hospital information exchange.
• Determined alternate methods, procedures, and changes in processing methods and practices.
• Extensively used HP Quality Center for mapping Requirements, test planning, executing test cases and tracking defects.
• Coordinated with the entire team acting as a scrum master to see team delivers highest quality of deliverable.
• Worked within a growing knowledge of HIPAA 837, 835, 834, 820, 270, 271, 276, 277, and 278, EDI, Privacy, Security, and Medicaid. Experienced with different life sciences disease codes.
• Performed Data mapping and data translation in HL7 version 2.2.
• Involved in the meeting with business Process Owners, SME (Subject Matter Experts) and store users for Requirement gathering in Definition Stage.
• Participated in manual testing and UAT with the development team and QA team.

Environment: Rational Requisite-Pro, UML, MS Project, HL7, Manual testing, Quality Center 10.0, Agile, Java, J2EE, IBM WebSphere, Web services, XML, Oracle 10g, SQL, TOAD, EDI X12 4010 & 5010, MS Office 2010, UNIX and Windows XP.

Sr. Business Analyst

Responsibilities:

• Actively involved in Complete Business Requirement capture.
• Actively participated in designing RTM (Requirement Traceability Document) and SSD (Solution Specific Document).
• Created Business Requirement Document-BRD.
• Involved actively in Use Case Creation and Business Case Template.
• Completed the User Acceptance Testing along with the Test Team.
• Participated in Business Checkout and successfully completed Business Implementation.
• Coordinated with the entire team as a single point of contact in taking weekly status meetings and checked the status of the team creating a detail report and delivery to the project manager.
• Central point of contact for all Training Modules, Work flows, Business Process.
• Worked Closely with Subject Matter Consultants (SMC’s) to understand the Complete Business Process, Document the key Requirements, Data Elements of Unemployment Insurance.
• Involved in designing and developing Work Flow Diagrams, Data flow diagrams and Physical Data base design.
• Good Knowledge of HIPAA Compliance Lifecycle, HIPAA Insurance Regulations and Claims Processing, Medicaid & Medicare.
• Claims Transactions according to the HIPAA 5010 standards.
• Involved in Designing the Test Scenarios and Test Cases with the Test Team.
• Played a crucial role in interacting all necessary stakeholders to define functional requirements relative to the Life Health Claim System.
• Conducted JAD Sessions with various stakeholders to develop the structural design of the application enabling it to meet the required business standard.
• Identify all the gaps in requirements and track them to closure.
• Clarified client requirements, business needs and project scopes, via feedback sessions and client meetings, in collaboration with all stakeholders.
• Developed UML models for modeling static and dynamic aspects of Wealth management portal.
• Worked on mapping State Farm business requirements with FINEOS out of box system functionalities.

Environment: Lotus Notes, Rational ClearCase, MS Visio, MS Project, ICD-9, ICD-10, UML Rational Rose, Quality Center 10.0, SoapUI 3.0, Web services, Agile, SharePoint, Java, J2EE, WebSphere, Java Script, Eclipse, Hibernate, XML, Oracle 10g, SQL, TOAD, MS Office 2010, UNIX and Windows XP.

Sr. EDI Business Analyst

Responsibilities:

• Reviewed technical documentation to understand the Business logic and technical aspects system.
• Gathering requirements from SME’s and Stakeholders in order to get a better understanding of client business processes.
• Developed test plans, status report for the management review for complete end-to-end testing for SOA.
• Responsible Forward Mapping and Backward Mapping analysis of ICD-9 & ICD-10 Conversion for CM (Diagnosis Codes) and PCS (Procedure Codes).
• Worked on agile methodology using Scrum.
• A rticulated Business Requirements from User Interviews and then converted requirements to Business Requirement Documents (BRD) and System Requirement Specifications (SRS).
• Participated in JAD sessions for requirement gathering, analysis and design.
• Created transaction sets and mappings in various ANSI X12 EDI formats like X12 837, X12 835 (Remittance Advice), X12 834, X12 270/271, X12 276/277 and X12 278.
• Involved in maintaining Requirements Traceability Matrix (RTM) using Rational Requisite Pro.
• Involved in GAP analysis of 270 and 271 transactions from EDI X12 4010 to EDI X12 5010.
• Worked to build extensions for FACETS Members, Claims, and Billing and enrollment applications.
• Involved in migrating EDI X12 4010 transactions to EDI X12 5010 transactions.
• Experience in compliance testing of EDI X12 5010 level 1 and level2 messages.
• Created test scenarios for 5010 repository to ensure maximum test data coverage and to reduce burden of manually created ANSI test data.
• Validated claims status in NASCO model office.
• Checked HIPAA compliance using EDIFECS tool.
• Tested new developments of X12 837 claims, 835 payment files.
• Used Portico, Inspector (Initiate) to check provider and subscriber information.
• Mapping requirements with Test plan in Quality Center.
• Responsible for checking the error reports in NASCO model office.
• Interacted with the UAT team to solve issues related to the defects.
• Test results are documented using MS Word and maintained Excel sheets for personal tracking of the defects.

Environment: Rational Requisite Pro, MS Visio, Quality Center 9.0, Agile, Java, J2EE, Struts, IBM WebSphere, Web services, XML, XML Spy, Oracle 10g, SQL, SQL Developer, MS Office 2007, UNIX and Windows XP.

EDI Business Analyst

Responsibilities:

• Analyzed, defined and designed the system requirements for the Medicare Independent Verification and Validation (IV&V).
• Responsible for maintaining HIPAA compliance.
• As a member of the Medicare IV&V team conducted an assessment of Medicare Part A claims processing system.
• Involved in building up a new Medicare insurance policy using Power Managed Health Services (MHS) for Private Fee for Service (PFFS).
• Improved process for payment of Medicare Secondary Payer claims through revised workflows.
• Updated and modified progress and resources allocation in MS project for the team.
• Designed and created GUI for the Electronic claims submission.
• Responsible for problem analysis, re-searching solutions and presenting recommendations.
• Worked with the 820 Medicare reconciliation applications.
• Created and maintained Gantt chart for project analysis.
• Regularly monitored and reported project status for review of upper management.
• Utilized EDI translation software to convert the files into a format that could be imported into the company's ERP.
• Involved in the development of test plans, test cases and expected results, and coordinated the tests with the QA team to verify implementation of new features and enhancements.
• Validated the reports and files according to HIPAA enforced standards.
• Apply new approaches and concepts to improve the productivity and efficiency of Facets testing.
• Worked with XML files created using XML schema.
• Created transaction sets and mappings in various ANSI X12 EDI formats like X12 837, X12 835, X12 834, X12 270/271, X12 276/277 and X12 278.
• Developed test cases and test scripts for system and UAT testing.
• Reported and tracked bugs using Quality Center and discussing about the bugs in the weekly status meetings.
• Developed and executed manual test scripts using test plan and test lab sections of Quality Center for System, Integration and Regression testing of the application and followed up until it resolves.
• Maintenance and updates of various files and documentation using Word, Excel and Access.

Environment: Manual testing, Quality Center 9.0, MS Project, Visual Studio Team System (VSTS) 2008, C#.Net, ASP.Net, XML, XML schema, MS SQL Server2005, SSIS, T-SQL,MS Office and Windows XP.

BA/QA Tester

Responsibilities:

• Analyzed the business requirement documents, Functional specification documents to prepare Test cases and effort estimation.
• Acted as Scrum team member for the agile core process team applying Scrum principles.
• Performed Manual Testing, System Testing, Acceptance Testing, Functional testing and database testing for verifying application functionality.
• Performed functional testing, system testing, and integration testing and end-to-end testing.
• Created test cases in Quality Center and made sure all the functionalities are covered.
• Developed Test Evidences, Test summary Report documents and uploaded to Share Point.
• Performed Manual Testing for the entire application by executing the test scripts.
• Checked the integrity of the database by writing and executing several SQL Queries.
• Used Quality Center in reporting and tracking the defects.
• Created Requirements Traceability Matrix and tracked the testing progress through all the test cycles until the successful sign off.
• Created daily status reports and distributed with the stake holders and the project team.
• Positive and Negative Test scenarios were created and tested to test the functionality.
• Created test plan, test cases and test condition matrix for feature testing.
• Developed and executed manual test scripts using test plan and test lab sections of Quality Center for System testing, Integration testing and Regression testing of the application.
• Used Quality Center for test plan execution and defect tracking.
• Created SQL scripts to change data and validate service response.
• Responsible for preparing the user documentation and helping the users in UAT.
• Maintenance and updates of various files and documentation using Word, Excel and Access.

Environment: QualityCenter 9.5, Manual testing, RUP, MS Visio, Agile, Java, J2EE, JBoss, Struts, Spring, AJAX, iBatis, XML, Oracle 10g, SQL, TOAD, MS Office 2007 and Windows XP.

Business Analyst

Responsibilities:

• Participates in the resolution of application problems pertinent to Investment Systems applications in collaboration, if required, with the support teams or third-party vendors.
• Document or define Investment System Application operational workflows.
• Participates in internal audits processes for Investment System Applications.
• Coordinates the development of application production schedules with business users.
• Gathered user and business requirements through open-ended discussions, brainstorming and prototyping. Assigned priorities to all of the requirements.
• Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
• Performed Gap analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements.
• Designed and developed project document templates based on SDLC methodology.
• Facilitated JAD sessions with management, users and other stakeholders to define the project and to reduce the time frame required to complete deliverables.
• Used MS Project for updating management about the status with Gantt charts, and progress reports.
• Worked on AGILE methodology to provide accurate, qualitative and quantifiable data.
• Performed the As-Is and To-Be processes analysis, which helped to determine the gaps and also look in to the organizational change management and training initiatives needed at the later stages of the project.
• Translated the business needs into system requirements, communicating with the business on a broader scale and with an in-depth view.
• Prepared Business Requirement Document and then converted Business requirements into Functional Requirements specification.
• Conducted user interviews at both in-house and client locations, gathered requirements, analyzed the requirements, and managed it using Rational Requisite Pro.
• Analyzed business requirements and segregated them into Use Cases.
• Created Use Case diagrams, Activity Diagrams, Sequence Diagrams, and OOD using Rational Rose according to UML methodology thus defining the Data Process Models.
• Created project prototype for better visualization and understanding of the software solution.
• Assisted the QA team in designing the test plan and test cases.
• Performed User Acceptance Testing (UAT).

Environment: Rational Requisite Pro, RUP, Rational Rose-UML, MS Visio, MS Project, TestDirector, Oracle 9i, SQL, PL/SQL, .Net, MS Office and Windows XP.