SUMMARY:

• 7+ years of professional experience as a Business Analyst in Insurance domain with Property & Casualty.
• Worked on Documentum for Version Controlling, to maintain up to date changes in the Documents.
• Extensive experience in analysing and requirements gathering and writing system functional specifications.
• Insurance experience includes Personal Property Casualty and Commercial Automobile Product knowledge, Reinsurance for Commercial Property Casualty, Group and Life Insurance Systems.
• Strong experience in RUP Business modeling process.
• Extensive experience with Content Management tools such as Interwoven, Filenet, Sharepoint and Documentum.
• Successful in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML) using Rational Rose & MS Visio.
• Expertise in using Rational tools for creating use cases, version control, and defect tracking and monitoring and used the Rational Unified Process (RUP) methodology in all areas of the software development life cycle (SDLC)
• Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall
• Experience with designing and verifying databases on Oracle and SQL Server RDBMS using Entity - Relationship Diagrams (ERD).
• Used SSIS ETL Processes for extracting data from Excel files, text files, CSV files as well as ODBC and OLE DB Sources .
• Expertise in UML (class diagrams, object diagrams, GAP Analysis, use case diagrams, state diagrams, sequence diagrams, activity diagrams, and collaboration diagrams) as a business analysis methodology for application functionality designs using IBM's Rational Rose.
• Extensively worked on store procedures for new system changes and troubleshoot the existing store procedures to work more efficiently.
• Excellent knowledge and experience of creating source to target mapping, edit rules and validation, transformations, and business rules.
• Solid understanding of Business Process definition, Risk Analysis and SDLC methodologies.
• Coordinating and Developing QA activities and assist other project teams with data analysis, data mining and data profiling as needed.
• Conducted UAT; facilitated discussion between business team and QA team on determine the test requirements and pass/fail criteria; documented and reported user feedbacks to management team.
• Excellent oral and written communication skills, interpersonal skills, and analytical skills.
• Strong problem solving skills, capable of addressing relevant facts and recommending solutions

TECHNICAL SKILLS:

Microsoft Technologies: Microsoft Project, MS Office Suite.

Languages/Standards: SAS, SQL, ICD9, ICD10, XML

Defect Tracking Tools: HP QC/ALM, JIRA, Rally.

Content Management Tools: MS SharePoint

Business Modeling Tools: MS Visio, Balsamiq.

Graphic Tool: Smart Draw, SnagIt, Pencil, JustinMind Prototype.

Project Design Methodologies: Unified Modeling Language, Use Case Development

CRM Tools: MS Dynamic.

RDBMS: Oracle, SQL Server.

PROFESSIONAL EXPERIENCE:

Business Analyst

Confidential, Madison, WI

Responsibilities:

• Co-ordinated participation and sign-off of various business partners and customers and worked on Property and Casualty insurance company as an Underwriter.
• Writing new COBOL, DB2 programs to handle Claim centre messages (from front end via XML) processed in the Mainframe from the front end system called Claim Centre (CC) using GUIDEWIRE working with SQL SERVER Data.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Websphere and Cognos.
• Maintained a traceability matrix for all requirements and mapping to various Data Reporting Manuals, User Guides. And created Artifacts and defined Milestones and iteration plans for Inception and Elaboration phases of SDLC
• Maintained a traceability matrix for all requirements and mapping to various Data Reporting Manuals, User Guides (NCCI, IICMVA).
• Followed solely RUP methodologies during the course of the project. And conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
• Created and managed Project Templates, Use Case Project Templates, Requirement Types and Traceability Relationships in Requisite Pro.
• Evaluated testing results for each potential release build using Test Director, Quality Center and Bugzilla reports, listing summarized bug information in priority sequence, recommended viability of release for production.
• Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML methodologies and created business requirement documents and integrated the requirements and underlying platform functionality.
• Establish documentation for Agile methodology for implementation with a very water-fall-centric development team.
• Have sizeable adequate hands on exposure in Workmen Compensation, Commercial Insurance as well as Property & Casualty Insurance & its various intricacies
• Wrote Test Cases in Mercury Quality center that would test various Test scenarios and made sure the test cases and test process guarantee accountability to business and systems requirements.
• Developed the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge. Working with clients to better understand their needs and present solutions using structured SDLC approach.

Business Analyst

Confidential, Livingston, NJ

Responsibilities:

• Facilitated JAD sessions with SMEs and business analysts from other feeder systems for a detailed analysis and a better understanding of impact of various projects on each other.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Worked extensively with MS Excel and MS access, Updated the impacted MS Access tables.
• Developed test plans with QA team and helped to develop test cases for system testing, integration testing and performance testing.
• Facilitated and led JAD sessions aimed at functional requirement walkthroughs for all the impacting projects and updated the documents based on recommendations (if any).
• Mapped process flow; assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Prepared for GAP Analysis; identified and documented improved areas to meet capital requirement regulations for Basel II Compliance.
• Involved in Managing Data modeling, Data ware project from Logical design and implementation of Oracle Database
• Project was implemented using the agile(scrum) methodology to produce artifacts in the different phases of the Software Development Life Cycle (SDLC).
• Worked with Data Extraction, Transformation and Loading. Metadata architecture was also provided, for the purposes of query enhancement and clarification of data relationships. Also built the foundation for process implementation in MS-SQL. Interface with the Wholesale Commercial Loan and Mortgage user group to address issues.
• Prepare extremely detailed ETL design documents and target-source mapping templates based on requirements gathered.
• Extracted data from Oracle database with SQL Developer, and performed SQL query, data analysis, data ware and verification.
• Interviewed Business Users to gather Requirements and analysed the feasibility of their needs by coordinating with the project manager and technical lead.
• Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
• Prepared Business Requirement Documents (BRD's) after the collection of Functional Requirements from System
• Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Developed QA Test Plan, test conditions and test cases, as well as assisted with QA team in System Testing using Mercury Test Director
• Designed and Developed ETL (Extract, Transformation & Load) strategy to populate the Data Warehouse from the various source systems feeds.
• Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML methodologies.
• Led and conducted JAD sessions for requirements gathering, analysis and design of the system.
• Created context and workflow models, information and business rule models, Use Case and Object Models during the analysis using rational tools.
• Documented and delivered Functional Specification Document to the project team.
• Used MS Project to manage schedules, deadlines and resources and collaborate on the project.
• Interacting with the developers on resolving the reported bugs and various technical issues.
• Assisted the QA team in designing the Test Plan and Test Cases for User Acceptance testing.

Confidential

Responsibilities:

• Expertise in ensuring compliance of Initialcredentialing / re-credentialing files.
• Responsible for preparing and facilitating credentialing verification files for committee presentation and approval.
• Took care of Accreditation, submissions, surveyor interviews and actively participated in the file review meetings.
• Performed monthly quality audit reviews and appeals.
• Provided quality and coaching feedback sessions to the Credentialing Coordinators.
• Ensured the accuracy of data integrity elements with the credentialing files.
• Ensured that Credentialing/ re-credentialing compliance metrics are met with NCAQ. JACHO guidelines.
• Collaborated with management to review, develop, and implement new workflows.
• Created and maintained Standard Operating Procedures (SOP) and Business Rule Documents (BRD), documents related to physicians' contracts.
• Collaborated with management to provide performance appraisals scores to the team.
• Prepared malpractice files for committee review regarding the providers' sanctions and adverse actions.
• Coordinated new hire training and development materials.
• Developed and maintained training materials for quarterly refresher training.
• Thorough knowledge on Primary source verification of the Providers like Education through National Student Clearing House, DEA, CDS, Specialty boards and, Sate License through state regulatory boards, and Secondary verifications like hospital/IPA (independent practice association) affiliations, Work history, through CAQH website.
• Prepared Welcome/Denial Letters to practitioners completing the credentialing process.
• Reviewed physician applications for completeness of credentialing policies and procedures.
• Handled Executive phone and written inquiries to providers.
• Responsible for documenting criminal background verification of physicians, Nurse practitioners, and physician assistants. Also responsible for authorizing delegated credentialing.