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It Product Owner/business Analyst-claims Resume

Boston, MA

SUMMARY:

  • Strategic, results oriented and innovative IT Product Owner (Certified Professional Product Owner PPO I), Scrum Master (Certified Professional Scrum Master PSM I), Business Analyst/Business Systems Analyst, having 8+ years of experience with unique blend of business and technical skills to lead infrastructure and software initiatives for business growth and development.
  • Lead cross - functional project teams and established a close-working relationship with stakeholders, business partners, and technical staff, ensuring alignment between solutions being delivered and business goals.
  • Leverage analytical, problem-solving, leadership, and interpersonal skills to deliver IT projects that support enterprise-wide technology change, new product development, cost reductions, security/ regulatory compliance, and customer satisfaction.
  • Over 8+ years of experience as IT Product Owner, Scrum Master, Business Analyst and Business Systems Analyst in Healthcare and Property and Casualty insurance
  • Strong understanding of Business Requirement Elicitation, Gathering, Analysis and Documentation
  • Thorough experience in conducting Joint Application Development (JAD) sessions with clients and cross functional teams
  • In-depth work experience in Software Development Life Cycle (SDLC) using Waterfall and Agile Scrum methodology
  • Strong knowledge of STLC (Software Test Life Cycle), Test Strategy and Defect Life Cycle
  • Thorough experience in eliciting business needs and converting them into system specifications
  • Through involvement and participation in all phases to develop Requirements Management Plan, Vision, Software Requirements Specification (SRS) and Business Glossary documents
  • Strong knowledge and experience in conducting system analysis, business and system process design, diagramming data and process mapping, applying Unified Modeling Language (UML)
  • Performed test planning, prepare test plans and traceability matrix, perform user acceptance testing of work products and document them
  • Proficient in the documentation of system and business requirements and specifications, design and development of use-case scenarios
  • Expertise in Sprint planning using story points and reviewing burndown chart to see the progress of the scrum team
  • Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse. Excellent knowledge of Data Warehouse concepts and worked on data migration projects
  • In-depth knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI) and ICD-9 to ICD-10, HCPCS coding
  • Worked with (ACS) X12 5010 and (ASC) X12 4010A including the various Claims Transactions such as: 837 (submit medical claims), 835 (medical claim payments), 270 (benefit/eligibility inquiry), 271 (benefit/eligibility response), 276 (claim status request), 277 (claim status notification),278 (Authorizations and Referrals) and 834 (enrolment)
  • Extensive knowledge on the various health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO (Preferred provider organization), HMO (Health maintenance organization), and POS (Point of Service).
  • Expertise in performing and understanding of the all the Manual Testing Methodologies
  • Hands-on experience in assisting QA teams in Smoke Testing, Sanity Testing, Functional/System Testing, Regression Testing, Positive/negative Testing and User Acceptance Testing (UAT)
  • Helped QA team in creating Test Strategy, Test Plan, Test Scenarios and Test Cases from Functional Requirement Specifications
  • Experience in writing SQL Queries for Data Mapping, Data Integrity and Data Validations
  • Hands on experience on writing SQL codes on RDBMS-SQL Server, Oracle and DB2
  • Provided support to UAT team to ensure timely deliveries
  • Excellent working knowledge in Project Life Cycle and clear understanding of Project Management
  • Excellent business communication and presentation skills. Adapt at creating, editing, and coordinating extensive communication networks to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts
  • Team player, energetic, result-oriented, fast learner, excellent communication skills with strong research capabilities

TECHNICAL SKILLS:

Software Languages: JAVA, Python

Operating Systems: Linux, Windows XP/7/8/10, MacOS

Management Tools: Rational Requisite Pro, JIRA, HP ALM

Internet Technologies: XML, HTML5, CSS3, JavaScript

Project Methodologies: Waterfall, RUP, Agile Scrum

Design Tools: Microsoft Visio, Rational Rose

Databases and DB Languages: Oracle, SQL Server

Data Analysis Tools: SQL, R, Tableau, SAS

Others: MS Office, MS Excel, MS Access, SharePoint, MS PowerPoint, MS Project

WORK EXPERIENCE:

Confidential, Boston, MA

IT Product Owner/Business Analyst-Claims

Responsibilities:

  • Acted as a primary communicator and link between stakeholders and cross functional teams to make sure there’s buy-in from stakeholders on all major decisions and strategy and clear instructions and deliverables for the developers
  • Acted as the leader responsible for maximizing the value of the product created by a scrum development team and acted as a business strategist, product designer, market analyst and project manager
  • Developed vision and strategies for the product and presented this to stakeholders and helped development team to meet their goals during the sprint.
  • Did understand and anticipated the client’s needs to more effectively manage the development process
  • With the vision, strategy, and product priorities set, spent a significant amount of time overseeing the actual development of the product. Played active role throughout each event, including planning, refinement, review, and sprint.
  • During the planning stages, worked with stakeholders to identify and organize the steps required for the next iteration, and then worked on refining the processes, identified areas for improvement and supported the sprint
  • Owned and managed the product backlog. Created the list of backlog items and prioritized them based on the overall strategy and business objectives. Mapped out project dependencies to inform the necessary sequence of development
  • Because the product backlog was changing frequently, so made the list accessible and available to all stakeholders (particularly developers) to ensure optimized performance and project outcomes
  • Prioritized needs, juggled the triangle of scope, budget, and time, and prioritized according to the needs and objectives of stakeholders
  • Worked with stakeholders to identify and organize the steps required for the next iteration and then conducted meetings with team to refine the process, identified areas for improvement, and supported the sprint
  • Was accountable for each stage of the development process and the final product. Played primary role in inspecting and evaluating product progress through each iteration. Made the judgment calls on the performance, deciding if the team needs to go back to the drawing board or if they can move on to the next steps
  • Used various tools during the project-MS Visio, MS Project, MS Excel Jira, SQL, HP ALM, Balsamiq during the project

Confidential, Norfolk, VA

Business Analyst/Scrum Master

Responsibilities:

  • Worked with Scrum Master in helping team to transition from Waterfall to Agile Methodology
  • Led daily stand-up meetings in the absence of scrum master
  • Worked with Product owners on prioritizing Product Backlog, creating Sprint Backlog and managed User stories
  • Participated in sprint planning, daily scrums, testing, retrospectives and sprint reviews.
  • Worked with outside organizations and business partners to coordinate cross-team dependencies to meet project objectives
  • Captured and Traced Project requirements using JIRA
  • Created Business requirement document (BRD) and Technical requirement document (TRD) as it relates to receiving data, data quality and data profiling
  • Defined the scope of the project, wrote user stories, designed documents and business requirements in support of requirements
  • Guided the development teams to break down large and complex user stories into simplified versions for execution
  • Entered and updated Issues (Epics, Stories, and Tasks) onto JIRA Agile application
  • Identified and worked with Scrum Master to remove obstacles that will keep the team from achieving their goal
  • Served as a liaison between Clients and Technical Staff to resolve any conflicts
  • Wrote SQL queries on SQL Server data base to evaluate inbound data
  • Created SQL queries to pull data for testing and data validation for presenting it to downstream and upstream users
  • Analyzed Production Claims Issues and Claims Impact Ability to document current Configuration Build
  • Provided data analysis of data as requested by the business prior to Audit
  • Reviewed data to ensure data integrity, accuracy and validity
  • Performed ad hoc reporting functions for special needs and requests
  • Reporting and dashboarding analytical results to client through Tableau

Confidential, Louisville, KY

Business Analyst

Responsibilities:

  • Defined the scope of the project, gathered business requirements and documented them
  • Utilized Agile Scrum methodology to configure and develop process, standards and procedures
  • Interacted with the product owner to understand the core purpose of the project and groomed the product backlog along with Product Owner and prioritized user stories for sprints
  • Developed roadmaps by transforming stakeholders’ input (user stories) into a high-level project proposal in the initial planning stage
  • Identified high-level business requirements, functional and non-functional requirements to accomplish the user stories provided by the product owner
  • Participated in providing high level solutions and design development of the new updated system. Wrote and promoted the vision for the system
  • Involved in detailing project mission, Data process Flow Diagrams and timelines
  • Created wireframes for the enhancements made to the application for the development team
  • Maintained the change notification request document and communicated with the developers in each iteration review meetings
  • Assisted the Project Manager to develop both high-level and detailed application architecture to meet user requests and business needs
  • Formed a bridge between the Product Owner, Scrum Master and different teams with effective presentations and communication
  • Created User Stories and Use Cases to help IT and QA team to get a better understanding of the application
  • Prepared Business Workflow models that covers "How" business processes will be accomplished
  • Prepared Workflow diagrams, analyzed AS IS and TO BE scenarios, designed new process flows and documented the business process and various business scenarios
  • Conducted Impact analysis of changing requirements and negotiated with users based on the analysis results
  • Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance testing
  • Ensured the quality assurance, client documentation and user acceptance testing were successfully accomplished and approved of
  • Played an active role in users and providing support on any issues by providing user manuals, guides etc.
  • Wrote SQL queries on SQL Server RDBMS for data mapping required for developers to write codes

Confidential, Chicago, IL

Business Systems Analyst

Responsibilities:

  • Involved in interviewing business users, SMEs, end users and gathering requirements, reviewing and then documenting them in a standard template
  • Served as liaison between the Business, Data Modelers and the ETL team to ensure that the data warehouse was implemented according to the business needs. Interacted with the Business Intelligence team to understand the designing of the new data warehouse
  • Created the Business Requirement Document and then wrote the Functional specifications based on the high-level requirements which were documented into the Functional Requirement Document
  • Delivered business and technical solutions on time by collaborating with the business and prototyping teams
  • Assisted the Solutions Architect with the development of logical designs of the solution
  • Developed close working relationship with Product Management organization to understand product roadmaps, strategies, and goals with the intent of aligning customer-specific architectures with Information product strategies
  • Solved business and technical issues by developing prototypes and ad-hoc technical solution
  • Assisted the project manager to develop both high-level and detailed application architecture to meet user requests and business needs
  • Conducted session meetings with the BA team and SMEs for extracting the exact business needs about the new data warehouse. Also conducted review meetings to make any necessary changes to the documented requirements
  • Used SQL to query the existing data warehouse. Required data was exported to an excel sheet which was then provided to the Business Intelligence team for their analysis purposes
  • Ensured Medicare claims are being coded accurately by Providers to ensure appropriate risk score are assigned to members
  • Developed the user flow diagrams for business process of the company using Microsoft Visio manipulated and extracted data and Business objects used for reporting
  • Used JIRA for issue management, sprint optimization, resource management, capacity planning, generating analytical and progress reports like Burndown Charts

Confidential, Columbus, OH

Business Analyst/Business Systems Analyst

Responsibilities

  • Worked as Business Analyst for the project to gather and document verification requirements for Policy, claim center and billing center
  • Researched and Analyzed Business needs and ways to improve property and casualty specifically policy contracts and processes administration
  • Gathered requirements for the Guidewire Worker's Compensation, Personal Auto and Commercial property in Claims Center
  • Collaborated with the business team in the creation and completion of project charters and project scope for Guidewire Policy Center and Claim Center
  • Captured business requirements in form of user stories using JAD sessions, brain storming sessions, focus groups and personal interviews to understand current policy administration system and ensured coverage on business values, story points and acceptance criteria
  • Identified gaps in existing Policy Administrating Systems and Guidewire Policy Center and diligently designed “As-is” and “To-be” process, in scope and out of scope documents
  • Did Troubleshoot overlap and data quality issues by looking through the office of existing policy administration's data lineage, systems, and triggers for signs of bugs and malfunction
  • Involved in project to configure claims system to in corporate worker's comp claims data from various legacy systems as the responsibility for the administration of the state's Worker's Compensation Security Fund was transferred to the organization
  • Performed data integration and data mapping and data extraction management along with data cleansing while migrating data from legacy system to Guidewire Policy Center with Guidewire Data Hub
  • Elicited, documented, modeled, validated and prioritized functional and non-functional requirements using interviews & data analysis for insurance policy lifecycle i.e. right from policy creation to policy renewal
  • Helped the product owner in creating product backlogs and Sprint Backlogs
  • Collaborated with the Scrum Master and Scrum teams in Estimation and Velocity planning. Also, participated in conducting Sprint Planning, Daily Stand Up, and Sprint Review & Retrospective meeting
  • Managed sprints i.e. burn down charts, project velocity, sprint backlogs and product backlogs using JIRA
  • Created detailed diagrams such as Use Case Diagrams, Data Flow Diagrams (DFD's), Activity Diagrams, Sequence Diagrams, Entity Relationship (ER) Diagrams and Workflow Diagrams for integrating Policy Center and Claim Center data
  • Set up definitions and process for scoping, document test cases, test phases included integration testing, end to end testing and user acceptance test (UAT) and documenting the results for policy underwriting rules, rewriting rules, policy rate making and pricing
  • Analyzed and ensured efficient transition of all technical design documents and developed various SQL packages to provided support to application developers
  • Extensively involved with the ETL team for ETL process and worked in the SSIS environment

Confidential

Business Systems Analyst

Responsibilities:

  • Worked with the business community to define business requirements and analyzed the possible technical solutions
  • Co-authored business requirements document (BRD) with project teams. Extracted, discussed, and refined business requirements from business users and team members
  • Conducted workflow, process diagram and gap analysis to derive requirements for existing systems enhancements
  • Collaborated with the QA team to ensure adequate testing of software both before and after completion, maintained quality procedures, and ensured appropriate documentation is in place
  • Helped the testing team documenting the system requirements and testing system development
  • Designed and implemented basic SQL queries for QA testing and report data validation

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