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Sr Benefit Analyst/ Product Designer Resume

NJ

PROFESSIONAL SUMMARY:

  • Over eleven years of experience as Business Analyst, Senior System Analyst, Benefit File Coder / Benefit Analyst and having diversified experience in Software Development Life Cycle. All expertise includes in depth knowledge of Analysis, design, development and implementation of mainframe, Client / Server, Web - based and CRM applications.
  • Highly skilled in transforming the needs of business users and stakeholders to the functional/technical requirements
  • Served as a critical resource and liaised between subject matter experts and technologists throughout the project life cycle
  • Excellent conceptual and technical skills to create Business Requirements Document, Functional Specifications Document, Process flow Diagram, and Detailed Design Document.
  • Analyzed and defined business processes both "as is" and "to be".
  • Conducted a Joint Application Development (JAD) session with stakeholders and business partners to resolve open issues.
  • Developed use cases using UML and MS Visio for an ease with system interaction.
  • Good at communication verbal as well as written and good at team work.
  • In-depth knowledge and a practical experience of using Agile, Scrums, Business Process Reengineering, System Requirements Specification and Functional Requirements Specification, Rapid Application Development and MS Visio.
  • Comprehensive knowledge of agile software development cycle, white box testing, and web based application testing
  • Sound knowledge of change management tools, User Acceptance Testing phases, programming technologies, and automated testing fundamental concepts
  • Extensive experience in working with business, identifying business requirements.
  • Participating in JAD sessions, writing BRD (Business Requirements Document).
  • Extensively used the Blue print and Rally applications
  • Defining project scope/out of scopes.
  • Define, plan and implement Business Readiness.
  • Define UAT (User acceptance Testing) test scenarios.
  • Review and approve UAT testing
  • Partnered with developers to automate manual processes, saving time and money while decreasing errors.
  • Collaborated with stakeholder groups across the organization to ensure business and technology alignment. Proposed solutions meeting defined specifications and needs
  • Responsible for conducting test of software components by coordinating with product engineers
  • Handle the tasks of interacting with engineers in performing automated testing and in developing testing tools
  • Assigned responsibilities of preparing test scripts and analyzing software to provide testing solutions
  • Handle the tasks of preparing defect reports, developing automation strategies, and perform automated testing of back end systems
  • Experience in Healthcare domain as a Business Analyst in Mainframe and Client Server Applications.
  • Experience in Auto domain as a product designer for Connected vehicles- Over the air updates

TECHNICAL SKILLS:

Languages: C, C++, C#, SQL, VisualStudio.NET

Database: DB2, IMS/DB, Microsoft Access, Oracle

ETL /Reporting Tools: Informatica, COGNOS

Modeling Tools: MS Visio, Rational Suite (Rose, Requisite Pro)

Hardware: IBM/S-390, ES-9000

Operating System: MVS/ESA, Windows (NT/9X/XP), UNIX

Testing Tools: FILE-AID, Rational Robot, Test Director

Products: Confidential, FACETS, ClearQuest Ms Project,Blue Print, Rally

Testing Skills: Manual and Automation Testing

PROFESSIONAL EXPERIENCE:

Confidential

Sr Benefit Analyst/ Product Designer

Responsibilities:

  • Consume new configuration parameter definitions
  • Manage configuration parameter initialization
  • Manage configuration parameter decoding
  • Manage configuration parameter modification
  • Manage configuration parameter change history
  • Design new next generation Client solution by integrating Latest technology
  • Perform technical activities related to development and product design/enhancements
  • Analyze the requirements to the smallest set that will provide the biggest impact in advancing business objectives.
  • Take care of defect prevention, defect causal and other quality related activities.
  • Analyze and test the deliverables and promote the deliverables to the required testing environments.
  • Implementing various interface and ensure system customization conformance to business specifications and requirements
  • Interact closely and directly with business customers and the IT product teams based out of US for understanding the requirements and delivering the products for NA region.
  • Perform the research and proof of concept along with the research team and verify and validate the prototypes with the business to improve the quality of the solution delivery and fasten product development
  • Support Breadboard tests conducted by Product Development teams and make sure that the solutions are working as intended.
  • Conducting the workshop for requirement gathering by engaging the business teams.
  • Understands business process complexity and influence business partner requirements in support of enterprise objectives.
  • Identify the requirements to ensure end-to-end service performance from the end user’s perspective.
  • Generating the detailed functional and logical scope along with the design specifications for the new products developed based on the business requirements
  • Communicate effectively across multiple stakeholders to support project and organizational change objectives
  • Educate developers/testes on a project’s business context to ensure productivity and solution quality
  • Responsible to quantify project resource requirements and effectively engages project stakeholders in the estimation process
  • Create solutions that advance architectural objectives and identify opportunities for creating reusable enterprise services.
  • Responsible to design Application Architecture preparing application landscape diagrams
  • Build cross functional business knowledge, predominantly in Manufacturing and Connected Vehicle Space
  • Responsible to prepare Project Charter document and Use Cases.
  • Responsible in designing solution.
  • Responsible to prepare Application design and IT Landscape.
  • Create solutions that advance architectural objectives and identify opportunities for creating reusable enterprise services.
  • Data collation and active participation for Technology reviews (EAA), Infrastructure reviews
  • Contributing in Application Architecture design and preparing application landscape diagrams
  • Managing Client/based application Issues, Device compatibility Issues, Integration Issues, response time /performance issues and process-miss issues.
  • Coordination Trainings and Post Launch Production issue monitoring
  • Identifying Change requests, preparing the necessary documents and escalation to the respective teams

Environment: WebSphere, Oracle/MS SQL, Struts/JSF, JMS, Accurev, RSA9, Microsoft Visual Studio 2012/2015, Mircosoft Azure SQL DB, Microsoft .net Framework SDK

Confidential

Sr Systems and Business Analyst

Responsibilities:

  • Organize the JAD (Joint Application Development) sessions with business and technical teams.
  • Develop the Business requirements document (BRD).
  • Transform the business requirements into business use cases, business requirements and technical requirements.
  • Created and maintained membership data in Membership system.
  • Analyze Business requirements and develop project plan.
  • Developing a clear understanding of existing business functionality and processes.
  • Understanding the Requirements and write the CSR in PDM to convert business requirement to benefit coding language.
  • Written complex queries using MS Access to conduct data analysis required for benefit calculations.
  • Extensively used the HRBK application for benefits code analysis.
  • Extensively worked on BFAST and BFM tools for benefit analysis and generated adhoc reports using MS Access.
  • Worked on preparation of test scenarios and Test Plan.
  • Accountable and responsible to deliver the project on time and with minimal issues.
  • Performed User Acceptance Testing UAT.
  • Responsible to track the issues and find out the root cause of issues.
  • Test the claims through HEHK application for all the scenarios.
  • Validate and document the results using HIQK, HRBK and File maintenance applications.
  • Very good knowledge on Defect analysis and Management
  • Very good knowledge on HI7m and EDIX12
  • Communicate test defects and results to Team Lead and Coders using spread sheet
  • Responsible to track the issues and find out the root cause of issues.
  • Involved in QRM (Quality Review Meetings) and continuous process improvement meetings.
  • Responsible to load all changes in to production and production validation.
  • Involve in quality review meetings and continuous process improvement meetings.
  • Worked on claim stop request, recovery, and release of claims in production environment.
  • Adjudication of production claims.
  • Good working knowledge on ICD-10 diagnosis codes, CPT/ HCPCS codes, provider file.
  • Worked on manual pricing of claims.

Environment: Windows 7 Enterprise,, MS-Office-2007, Confidential host (Terminal Emulator), Mainframes (IBM TPX 3270 terminal, Mnemonic Code Language, CICS, BFAST, BFM tools TSO,MVS,JCL,COBOL), Project data manager, MS - Access, MS-Word, Ms-Excel.

Confidential

Business Analyst

Responsibilities:

  • Responsible for validating the ICD 9 diagnosis codes and ICD 10 diagnosis coding and testing for all the Confidential plans.
  • Performed New Group coding and testing for the ICD 10 group
  • Involved in ICD9 / ICD 10 claims Analysis, design, Implementation and Documentation.
  • Involved in preparing the test scenarios, test plan for Qualifier Table values.
  • Involved in GO /NO GO discussions with Confidential leaders and IBM leaderships.
  • Received “Appreciations” from Confidential and IBM as a “Key Contributor” for ICD 10 project.

Environment: IBM Mainframe, Confidential, NPS, HEHK, HIQK, HURK,EFDE,MS Word, Excel, MS Access

Confidential

Sr System Analyst

Responsibilities:

  • As a Sr System Analyst I closely work with Confidential leaderships and Analysts
  • Involved in HIPAA/EDI claims Analysis, design, Implementation and Documentation for Confidential .
  • Developed and implemented EDI applications to process health care transactions as per the HIPAA implementation guide.
  • Involved in testing the 837 claims for payment validation.
  • Involved in preparing the test scenarios, test plan for health care claims payment/Advice
  • Responsible for receiving the Testmart grids, sharing the work to teammates and managing the groups / Packages, sending them to proper Confidential Analysts.
  • Our HCR team is assigned for Emergency services and Preventive Care Services.
  • Client supplied TestMart grids and scenarios to access the results for 350 National groups and packages.
  • Created Contracts through the EFDE application.
  • Performed Confidential claims testing (slash/work claims, perform inquiries in provider, sundry, IHMO, and eligibility and other segments).
  • Work with the team to provide over all leadership and helping them to work with the Confidential applications -HIQK,HEHK,HURK,EFDE etc..,
  • Provided documentation of test results to Confidential analysts.
  • We performed quality reviews and reported errors from testing process as compared to expected results.

Environment: IBM Mainframe, NPS, HEHK, HIQK, HURK,EFDE,MS Word, Excel, MS Access

Confidential, NJ

Benefit File Coder

Responsibilities:

  • Study and evaluate the different plans that are signed for the New Group / Account
  • Worked on defining the Group / Section / Packages for the new or existing group
  • Mine existing particular / sub-particular / column code to match benefits to reuse existing code
  • Define and code new particular and sub-particular code
  • Perform Testing in Model Office NPS Environment according the New group implementation checklist
  • Prepare and data mine claims to verify and test the new benefit structure created
  • Write CSRs / code CSRs
  • Worked with Fees, Limit Strings, Benefit Strings, Ded/Max categories, GENO Tables, Particulars, sub-particulars and columns
  • Analyzed the Benefit Strings / Particulars / Sub Particulars for the test results / Defects.
  • Work with the team to provide over all leadership and helping them to work with the applications -HRBK,HIQK,HEHK,TPOL,HSSK,HURK,EFDE etc..,
  • Mine existing particular / sub-particular / column code to match benefits to reuse existing code
  • Define and code new particular and sub-particular code
  • Extensively Worked HRBK - Benefit file Particular and sub particular code and other Benefit coding.
  • Extensively Knowledge on HEHK - for claims testing and work the claims and release the claims for Authorization process.
  • Extensively Worked HIQK- Application for subscriber selection, Claims Inquiry.
  • Excellent understanding of the column routing and column categories.
  • Very through understanding of testing the claims, Authorization membership.
  • Perform Testing in Model Office NPS Environment according the Group implementation checklist
  • Prepare and data mine claims to verify and test the new benefit structure created
  • Write CSRs / code CSRs
  • Worked with Limit Strings, Benefit Strings, GENO Tables, Particulars, sub-particulars and columns

Confidential

Business Analyst/ Test Analyst

Responsibilities:

  • Understood the Provider and the claims processing systems
  • Analyzed current system and developed design for the new system changes.
  • Coordinated with business and acquired the requirements.
  • Analyzed the requirements and designed the Business Requirements document and Functional Specification document
  • Designed Process flow diagrams and data flow diagrams.
  • Extensively worked on the EDI 837 claims for all lines of business.
  • Extensively worked on EDIX12
  • Prepared Test Strategy, Test Plan and Test Case documents.
  • Involved in System Integration testing, User Acceptance testing and regression testing.
  • Executed, Validated the test cases and documented the test results.
  • Provided management with test grids, tracability matrices and weekly status reports.

Environment: IBM Mainframe, MS-Office, MS-Outlook, PowerPoint, NPS

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