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Business Analyst/data Analyst Resume

Chicago, IL

SUMMARY:

  • 8+ years experience as a Business Analyst /Technical Analyst/ Quality Analyst.
  • A proactive high performer with proven ability to work with multi - discipline, cross-cultural teams and end users.
  • Experienced in customer/client interaction, deep understanding of business systems functionality and technicality.
  • Partner with subject matter experts to gather and develop detailed business requirements for system implementations and service requests.
  • Experienced with Medicare, Medicaid, Medicaid Expansion, Duals, Marketplace, Healthcare Benefits Administration, Affordable Care Act/Health Care Reforms.
  • Skills in developing Use Case diagrams, Sequence diagrams, State Chart diagrams, and Class diagrams.
  • Proficient in gathering business and technical requirements from both formal and informal sessions through interviews, NetMeeting, questionnaire, video conferencing, JAD sessions and conference calls.
  • Knowledge of TriZetto products and applications helpful.
  • Understanding Trizetto Clinical Care Advance/ MaxMC Landacorp Data model and helping business to understand and implement the same in new environment.
  • Strong knowledge of Use Cases, Sequence Diagrams, Collaboration Diagrams, Activity Diagrams, and Class Diagrams.
  • Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side
  • Strong experience and understanding of Medicaid and Medicare Services in health care industry, claims management process.
  • Used Android-SDK tools for Android application testing and android (Adb-log cat) debugging the defects.
  • Experience in mobile web or mobile application testing using functional, nonfunctional, regression, smoke, ad-hoc, integration, End to End, performance, Load, system and User Acceptance Testing.
  • Working knowledge in Simulators and emulators, cross browser testing like Fire Fox, Google Chrome, Safari and Internet Explorer.
  • Hands-on experience investigating, managing and / or resolving workers compensation claims .
  • Technically competent in Workers Compensation Case Management including complex claims, disputes, Regulatory matters, common law and litigated claims.
  • Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).Experienced working on EDI file protocols and transactions in implementing eligibility, Confirmation, Claims and Remittance Advise systems.
  • Proficient in execution of Test plans.
  • Design mockups and wireframes using Axure RP Pro.
  • Involved in mobile web Browser Compatibility testing such as IE, Fire Fox, Safari and Google Chrome.
  • Proficient in using Agile Scrum methodologies, participated in sprint/standup sessions, produced user stories, analyzed the Iteration Burn Down charts and reviewed defects.
  • Well acquainted Knowledge in writing SQL queries and has expertise in Test Case Design, Test Tool Usage, Test Execution, and Defect Management.
  • Experience working on accounting projects; taxation and accounts payables and receivables.
  • Organized Joint Application Developments (JAD), Walkthrough, Interviews, Surveys, Workshops sessions with IT Groups, stakeholders/clients/end-users.
  • Created and maintained tickets in JIRA for bugs and defects.
  • Knowledge of requirements management and/or prototyping (ALM, Jira, RallyDev, Balsamiq, iRise).
  • Extensively interacted with the designers, developers to ensure functional implementation of business requirements and QA Team in executing Test Plans, Test Scenarios and Test Cases for Claim Center Module using Guidewire
  • Working as Business Analyst on implementation of Guidewire claim Center for Auto, Property, General Liability and Workers Compensation lines of Business.
  • Knowledge of Guidewire integration framework and various integration methods (Web service APIs, Plugins, Messaging code, Guidewire XML models, templates etc.).
  • Involved in the Quality Assurance (QA) Life Cycle, which includes Design, Development and Implementation of the entire QA process and documentation of Test Plans, Test Cases, Test Procedures and Test Scripts.
  • Expert in application/system development life-cycles; concurrent development strategies, process streamlining, iteration modeling, DOORS, rapid application development (RAD/RUP/UML), and legacy/waterfall methodologies. Experience in providing actuarial and business consulting in Annuities & Life Insurance domain.
  • Domain knowledge of insurance industry with very challenging and demanding work environment. Broad experience in Property and Casualty Insurance including Auto, Home, and Marine Life insurance/Annuities.
  • Coordinating with admin systems for Life Insurance, Long term Care, Health and Annuities.
  • Understanding as Business Analyst the collecting and analyzing client’s business requirements of OLTP, ETL (Extraction/Transformation/Loading), Data Cleansing, Data Mapping, Data Modeling, Data Mining, Data Manipulation and Designing.
  • The Commercial Lines Business Analyst will report directly to the VP of Services. You will be an integral part of Valenís product development and delivery teams, working closely and collaboratively with Valen insurance domain experts, data analysts, engineers and customers.
  • Insurance experience includes Personal Property Casualty and Commercial Automobile Product knowledge, Reinsurance for Commercial Property Casualty, Group and Life Insurance Systems.
  • Solid understanding of Enterprise Data Warehouse (EDW), its components and processes, Data modeling, and ETL using SQL.
  • Adept in formulating Test plans, Test cases, Test Scenarios, Test Approach, setting up testing environment in conjunction with the Testing team and expertise in formulating test approaches with Load Testing, Integration Testing, Regression Testing, and User Acceptance Testing (UAT).
  • Worked extensively on testing tools like ALM, Quality Center, QTP.
  • Developed User stories consisting of UI Mockups and Business Rules to capture the functional requirements of the Guidewire Billing Center.
  • Major experience in Insurance suite product(s) like Guidewire, Insurity and with other proprietary insurance applications.
  • Good experience with Sanity Testing, Smoke Testing, White Box testing, Black Box Testing, GUI Testing, Functionality Testing, Positive and Negative Testing, Security Testing, Integration Testing, System Testing, Load Testing, User Acceptance Testing (UAT) and Regression Testing of Web Based Applications and Client-Server Applications.
  • Good Management, Execution and Documentation skills
  • Ability to handle multiple tasks and work independently as well as in a team.
  • Worked extensively on Life Insurance, Annuities, Claims process, etc.
  • Proven experience with life and annuities forms repositories and correspondence applications, including system generated and processor/ad hoc generated.
  • Coordinating with admin systems for Life Insurance, Long term Care, Health and Annuities.
  • Good team player with excellent written and verbal communication and interpersonal skills

TECHNICAL SKILLS:

Project Methodologies: Rational Unified Process (RUP), Agile, Waterfall

Business Modeling Tools: Rational Rose, Axure RP, MS Visio

Defect Tracking Tools: Rational Clear Quest, Mercury QC, Jira

Operating Systems: Windows NT/XP/2000/2003, UNIX

Databases: Oracle, SQL Server, MS Access, DB2

Languages: C, SQL, HTML, PHP, ASP

Quality Assurance: STLC, Bug Life Cycle

Automated Testing Tool: Quick Test Professional, Win Runner, ALM, Test Director

Business Applications: MS Project, MS Office Suite, MS Share Point

PROFESSIONAL EXPERIENCE:

Confidential, Chicago, IL

Business Analyst/Data Analyst

Responsibilities:

  • Conducted JAD sessions, WebEx and Seminars with business users, SMEs and developers to document and define current end to end work flow processes.
  • Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus for BRD and FRD and business docs.
  • Performed Requirements Gathering and Analysis, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
  • Experience with Trizetto Facets 4.71, 4.81 and 5.01.
  • Extensive working experience with TriZetto's Facets tool.
  • Healthcare Tools Trizetto Facets 4.51, Claredi, Amisys, QNXT.
  • Provided SDLC Methodology for developing the applications that were used by the field executives to completely rely on automate payments posting for Medicare, Medicaid and commercial payers by using electronic payments or by phone.
  • Used agile methodology for gathering requirements and testing them.
  • Followed Agile methodology using to create/maintain: Use Cases, User stories, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams.
  • Worked on business drawing software Axure RP for creating mockups and wireframes of application user interface.
  • Coordinated and participated in grooming sessions to elaborate on User Stories and ensure each user story provided clear information.
  • Conducted test execution, prepare daily status reports.
  • Experienced in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
  • Currently working in the Production Support of Product Name/Project Name product for its fortune 500 clients for their life and annuities products.
  • Coordinating with admin systems for Life Insurance, Long term Care, Health and Annuities.
  • Wrote business scenario, test scenarios, test cases in excel sheet, imported them to ALM and prioritized backlog with project manager.
  • Investigates Workers Compensation claims to determine the exposure to the business and negotiates/advises advanced claim settlements.
  • Produces and analyzes Workers Compensation claim trending reporting, which will then be shared with management and used as consultative or expert advice on projects or to develop long term or short term business strategies. These reports are used to help determine department structures, along with staffing needs and requirements.
  • Experience in commercial Property and Casualty, Commercial Lines and Personal Lines Insurance, Underwriting, Rating and Guidewire experience with national carriers.
  • Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing. Worked for various mandates such as Grandfather Rule, Rescissions, D-26, Pre Ex-19, Preventive Care, Operating Rules etc.
  • Created precise website functionality, via the Axure RP tool (wire framing), used to create the Functional Requirements Document (FRD) for the project.
  • Involved with the coders in evaluation of CPT and ICD-9 codes to ensure that the diagnosis meets medical necessity for the specific CPT code.
  • Prepare use cases, test planning, and other test preparation and execution activities.
  • ICD 9- ICD 10 Conversion Analysis - Worked in the analysis of the ICD- 9 to ICD-10 codes using HP Code Explorer and ICD Professional Navigator.
  • Supported Regression team on monthly upgrade release by submitting claims for different claim types with new ICD-10 codes with range of testing scenarios (positive & negative) and made necessary changes to ensure that claims are getting paid as expected.
  • Supported EDI (x12): concentrated on 837 (I/P claims), researched errors, validated data to source system and ensured data was formatted accurately as per HIPAA 5010 guidelines.
  • Extensive understanding & experience of migrating insurance suite solutions to Guidewire solutions
  • Experience working on Guidewire Claim Center, Policy Center and Billing Center
  • Developed Training Strategies, Training Manuals, Process flows and Job aides on Guidewire projects
  • Analyze the feasibility of and develop requirements for enhancements and defects related to the current Guidewire claims system
  • Worked on the Guidewire Policy Center 8.0, Billing Center 7.0, Claims Center 8.x/7.x
  • Interacted with business heads to finalize the product backlog for the Guidewire application.
  • Prepared ICD-10 Technical Scope Document using inventory as a basis.
  • Identified and documented requirements for the ICD-10 Enhancement.
  • Performed Gap Analysis and Impact Analysis for conversion of ICD-10.
  • Involved in forward Mapping from ICD-9 to ICD-10 and backward mapping from ICD-10 to ICD-9 also involved in Custom Mapping.
  • Capable of leveraging a deep functional knowledge of the solution/platform to clearly articulate via stories in JIRA what the desired end state of a feature is to software engineer.
  • Analyzed and rectified EDI 834, 835 and 837 error claims failed in productions.
  • Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
  • Worked with Facets claims data for claims subject area, Enrollment and billing data for member/Subscriber, and Product subject areas.
  • Worked with all Facets Provider of software development from requirements gathering to testing, configuration and international deployment.
  • Worked on FACETS subsystem such as billing and enrollment.
  • Validated the mapping of data from X12/Flat Files to the database and database to X12/Flat Files.
  • Involved in E2E Claim processing and major work was involved with creating 837 P/I files manually.
  • Tested Medicare claims to verify COB requirements.
  • Performed E2E testing of claims processing from FTP server to the DB2 database and adjudicating those claims in Mainframe.
  • Used MS Visio and MS Excel to develop wireframes and user flows for a business process monitoring software.
  • Created user stories, use case diagrams and Business Process Flows, and Activity Diagrams using Microsoft Visio.
  • Created defects, attended triage meeting, retested the fixed defects and mapped them back to the requirements in ALM.
  • Responsible for different Data mapping activities from Source systems to SQL Server.
  • Key role in data analysis, relation modeling and data migration, query tuning /Optimization.
  • Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports.
  • Created and executed test plans that improved data warehouse report quality using Word, Excel and Access.
  • Collected data using Microsoft Excel and Access.
  • Developed training documents using MS PowerPoint.
  • Was involved in User Acceptance Test using the test cases given by the client before releasing the application.
  • Created new and modify existing SQL server queries, views, packages, and ETL jobs.
  • Wrote and executed SQL queries to retrieve and validate the test data and claims status.

Confidential, Washington, DC

Business DataAnalyst

Responsibilities:

  • Conducted JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications.
  • Responsible for preparing Business Requirement Document (BRD), Functional Requirement Document (FRD) and then translating into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
  • Understand the business case and prepared test cases and execute the cases to ensure systems meet as per business requirements.
  • Worked on Regulatory Reporting RRD Data Warehouse for compiling Workers Compensation statistical reports to external regulators and states.
  • Developed a Business Acceptance testing strategy and plan. Provided daily technical assistance by responding to inquiries regarding errors and problems while booking policies and claims in Wheatley insurance system for commercial auto, general liability, worker compensation, and commercial package.
  • Responsible for converting for Mutual Life Insurance, the Fixed and Variable Annuities PC administrative system to the mainframe Vantage.
  • Collected & documented the requirement of Business Teams from Annuities, ASPF, Policy & Program Evaluation Team, and Project Sponsors & Actuaries.
  • Expertise in the Property, Casualty, Annuities, Disability, and Supplemental Insurance policies and having good command on SWIFT messaging and commercial Property and Casualty and Personal Lines Insurance experience with national carriers.
  • Closely worked with all BA’s and stake holders for reviewing User Stories and scoping documents.
  • Involved in documenting the business process by identifying the requirements and also involved in finding the system requirements.
  • Experience with MS Office, Agile software development (SCRUM), JIRA.
  • Created, assigned, and maintained tickets in JIRA for bugs and defects.
  • Used Agile methodology during the development of the project. Involved in Scrum Calls, Stand up meetings
  • Involved in developing and maintaining Test Matrix and Traceability Matrix, and performing Gap Analysis.
  • Attended daily scrum meeting for the Android and for iOS with the UAT, developers, business analyst and with the project manager.
  • Identify, manage and document the status of open issues. Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments, utilizing TriZetto or Optum for research and correction.
  • Vendor management between TriZetto and CareSource.
  • Knowledge of TriZetto products and applications helpful.
  • Involved in testing of iOS devices and Android Devices (Samsung Galaxy and Nexus Motorola Droid and RAZR, Nexus tablet etc).
  • Transferred files and folders through FTP file transfer Protocol, Run MSP (Mobility Service Platform) server to deploy the Profile through MSP and Updated the Build on new hardware.
  • Regularly interacted with Developers to discuss Various Problems and issues and participated for bug scrubs if necessary.
  • Worked on implementation of Mobile web/and mobile application on smart phones that includes iPhone GPS and Breadcrumbs. LTE, Android, Smart TV (Samsung), and iPad.
  • Verified Hardware on different Wired and Wireless (Blue Tooth) handsets supported Environment including radio, Microphones and speaker with different.
  • Knowledge of Guidewire integration framework and various integration methods like Web service APIs, Plugins, Messaging code, Guidewire XML models, templates etc.
  • Strong working knowledge in Guidewire Policy Center product & Billing Center.
  • Logged the defect using iPhone configurability for iOS, and used SDK for Androids Cat-log and used snip tools, and fire bug for .com testing.
  • Worked independently and Co-ordinate well with development team and Requirement team.
  • Extensive analytical skills to analyze back end logic and run test script execution.
  • Participated in bugs and enhancement review meetings.
  • Created SQL joins, sub queries, tracing and performance tuning for better running of queries.
  • Used MS Visio to create Use Cases, Activity Diagrams and app Mock-ups to baseline functional requirements.
  • Evaluated and tested the different App builds (iOS, Android, Windows) to verify that app functions according to requirement. Performed regression testing, system integration testing and user acceptance testing for App and website.
  • Responsible for the full HIPAA compliance lifecycle life cycle from gap analysis, mapping, implementation and testing for processing of Medicaid and Medicare Claims.
  • Gathered business requirements from the users, both in terms of enhancements to existing systems and in entirely new applications.
  • Developed high level system models by analyzing the existing models and incorporating the suggested changes.
  • Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams.
  • Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and technical Specification and documented in Quality Center.
  • As a functional consultant, implemented Guidewire Policy Center through an Agile Scrum development model.
  • Have worked in Guidewire Policy Center from End-to-End and involved in Policy Info, Person Info, Losses and Violations, Coverage's, Risk Analysis Customizations.
  • Tested the data converted from legacy (IMS/CASE) application to Guidewire Policy Center and Guidewire Billing Center, validating the conversion, documenting and resolving data conversion issues.
  • Involved in the UAT Testing for Guidewire policy/billing centers during the production run.
  • Have worked in Guidewire Policy Center from End-to-End and involved in Policy Info, Person Info, Losses and Violations, Coverage's, Risk Analysis Customizations.
  • Analyzed and logged defects in HP Quality Center and interacted with the developers to resolve technical issues.
  • Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test Conditions the performance of the application from various dimensions.

Confidential, Bronx, NY

Business System Analyst

Responsibilities:

  • Performed GAP analysis as pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process
  • Responsible for Documentation in each phase of Agile Methodology, Risk Assessment, and Validation & Verification process.
  • Assisted the project manager in the creation of the project charter BRD, FRD & vision document during the inception phase of the project.
  • Conducted JAD sessions with business users and Subject matter expert and stakeholders to define project scope, to identify the business workflows & task analysis and determine whether any current or proposed systems are impacted by the new development efforts.
  • Used Quality Center to plan tests, manages test assets, create and run manual and external scripts to check GUI and functional features of the AUT.
  • As a liaison between the developers and management, was instrumental in resolving conflicts between stakeholders and technical development teams.
  • Identify source systems, and designate data points files for annuities modeling and experience studies efforts.
  • Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, data dictionary and data analysis.
  • Generated all Medicare claims review and transmitted to Medicare.
  • Developed, designed & implemented department plan to configure new Facets integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
  • Designed packages to support HIPAA requirements for claim such as CPT or HCPCS coding codes, ICD -9 coding.
  • Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I, P, D) and 820) standards.
  • Worked on adjudication and on eligibility- Enrollment, Billing, Group/Member Insurances.
  • Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
  • Transferred ClaimCenter and Guidewire platform knowledge to the customer staff and consultants in a mentoring role.
  • Contributed in the build and design of organizational Wiki that provided comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership management
  • Involved in Up-gradation of HIPAA X12 4010 transactions to HIPAA X12 5010.
  • Involved in Hospital and Medical and adjudication claims.
  • Worked extensively with facets modules such as Claims, Membership, Billing, Benefit and plan.
  • Analyzed EDI X12 - 837I/P, 835 and 834 transactions consistency related to providers, payers, subscribers and other related entities.
  • Knowledge of personal retirement space / product solutions (e.g., Education Savings Accounts, Individual Retirement Accounts, Annuities, Life Insurance).
  • Experienced with Rational tools like Rational Req Pro, Clearquest, ClearCase, JIRA, Rational Rose, and FACETS.
  • Experience in facilitating the test process by using bug tracking tool JIRA.
  • Created workflows in enrollment system with what client expects.
  • Provided SDLC Methodology for developing EDI applications used by hospitals to completely automate payments posting for Medicare, Medicaid and commercial payers electronic payments files.
  • Created Mock-up forms in MS word for better visualization and understanding of the software solution.
  • Created detailed use cases, use case diagrams, and activity diagrams using MS Visio.
  • Led and managed the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that the HIPAA regulation are met across all the modules
  • Responsible for unit testing and working with System/Integration testing team in debugging/resolving any issues raised during testing.
  • Provided data workflow, including legacy system profiling, mapping of data, documentation of business rule validations, and reconciliation of historical claims data for an enterprise integration of Guidewire Claim Center.
  • Experience in commercial Property and Casualty, Commercial Lines and Personal Lines Insurance, Underwriting, Rating and Guidewire experience with national carriers.
  • Extensive knowledge in Guidewire Insurance Suite for Personal Lines and Commercial Lines, Workers Compensation, General Liability and Commercial Package.
  • Writing new COBOL, DB2 programs to handle Claim center 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.

Confidential, Chicago, IL

Sr. Business System Analyst

Responsibilities:

  • Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the proposed system.
  • Elicited functional and non-functional requirements, conducting and facilitating requirement sessions
  • Participated and led daily stand-up meetings in line with Agile Scrum methodology.
  • Experienced in Agile and Scrum, and the development of associated project artifacts (i.e., user stories, Product bag lock and acceptance criteria).
  • Participated in testing activities like Test planning, estimation, test case preparation and execution, incident logging and reporting.
  • Map actuarial concepts (annuities valuation, reserving, reinsurance) to data model structures: identification of existing, or creation of new business terms their descriptions and sourcing.
  • Coordinated between communication channels to keep key stakeholders and team members apprised of goals, project status, and resolving issues and conflicts (meeting facilitation, JAD sessions, collaboration workspaces, project reporting).
  • Worked in Scrum teams and facilitated grooming sessions to identify and prioritize user stories.
  • Develop regression models to predict the impact of different parameters on emission levels. Correlate the model predictions to test runs and predict the emission levels for different hypothetical configurations.
  • Gathered high level requirements from the business, created user stories, and prioritized the backlog with project manager.
  • Gathered requirements from the business and prepared modified mock-ups for system design.
  • Collaborated in building a business analysis process model using Rational Rose and Visio.
  • Created Business Requirement Documents as a result of meetings with the Business Areas and obtained business sign offs on the documents after reviewing the final documents with them.
  • Converted High level requirements into Epics and high level User Stories and derived the lowest level of clear and concise User stories.
  • Provided daily technical assistance by responding to inquiries regarding errors and problems while booking policies and claims in Wheatley insurance system for commercial auto, general liability, worker compensation, and commercial package.
  • Working as Business Analyst on implementation of Guidewire claim Center for Auto, Property, General Liability and Workers Compensation lines of Business.
  • Analyzed and evaluated User Interface Designs, Technical Design Documents and the performance of the application from various dimensions.
  • Responsible for financial planning and statement analysis for expense management; Kept track of current liabilities such as accounts payable, payroll payable and accrued payable.
  • Involved in preparing several Use Cases, Business Process Flows, and Activity Diagrams using Microsoft Visio.
  • Maintained the Traceability Matrix Table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked.
  • Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
  • Hand coded and implementated HTML emails and landing pages through Dreamweaver.
  • Worked with facets claims data for claims subject area, Enrollment and billing data for membership subject area.
  • Capture information from Centers for Medicare and Medicaid Services enrollment forms.
  • Developed Test Plan; Hands on Test Script Development; Test Script Execution.
  • Conducted user acceptance testing (UAT) to ensure system designed for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims.
  • Involved in FACETS Configuration planning for ICD-10 with SMEs, Trizetto Team and Third party vendor.
  • Led client discussions relating to the Facets configuration of a standard Medicare Advantage plan.
  • Worked in Membership module, Claims Module and Provider module of FACETS.
  • Involved in the FACETS configuration, customization, benefit analysis, data model.
  • Analysis of inbound and outbound interfaces and extensions to FACETS claims processing system
  • Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
  • Obtained business requirements in form of User Stories from business users and stakeholders using JAD sessions, brainstorming sessions, focus groups and personal interviews to get a better understanding of the client's business process and business need for the Guidewire Claim Center implementation.
  • Prepared the Integration Requirements for the Integration points between Guidewire claim Center and Client's legacy systems and other 3rd party service providers.
  • Knowledge of Guidewire integration framework and various integration methods (Web service APIs, Plugins, Messaging code, Guidewire XML models, templates etc.).
  • Executed testing and troubleshooting of HTML emails and landing pages across all email platforms, as well as technical issues relating to HTML templates.
  • Performed Data Analysis, Data profiling and Data validation by writing SQL queries using TOAD.
  • Analysis and Design of the Facets data model to ensure optimal system performance and tuning
  • Supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
  • Expertise in the Property, Casualty, Annuities, Disability, and Supplemental Insurance policies and having good command on SWIFT messaging and commercial Property and Casualty and Personal Lines Insurance experience with national carriers.
  • Wrote business case scenarios for HIPAA EDI Transactions.
  • Worked on Life Insurance and Annuities domain for big Insurance players such as Ameriprise Financial Services, Met life, American General AIG, Foresters, Pacific life, Phoenix insurance, Transamerica and American Family.
  • Analyze Annuities accumulation and payout lifecycles: cash flows, terminations, selections, and utilizations.
  • Validated HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277, 837/835, 834, 999 acknowledgment for enrollment transactions and performed UAT.
  • Used Microsoft Office suit to develop the documents such as Visio for creating wireframes, Word, Excel and PowerPoint for creation of Business Requirement documents.
  • Logged defects in ALM/Quality Center (QC) and interacted with the developers to resolve technical issues.
  • Involved in writing the Test Cases and Test Scenarios based on the Functional Specification and Technical Specification in Excel and exported them in HP ALM/Quality Center.
  • Assisted the team members to develop Service Oriented Architecture (SOA), and data warehouse system (EDW) to utilize data mining for data analysis.
  • Used SQL, Data Warehousing and Data Cleansing for the arrangement of customer data. Used Data mapping for collecting the data.
  • Formed advanced SQL Queries and used Microsoft Excel to investigate data issues in the Data Warehouse and worked with the Users and Technology Team to formulate a solution to resolve the issue.
  • Highly experienced in Doors/Rally/JIRA/HPALM for requirements management and defects tracking.
  • Experience using BI Tools, Java, Redis/Kafka, Confluence, SQL, Jira and other technology systems relevant to the position.
  • Experience with MS Office, Agile software development (SCRUM), JIRA.

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