- Over 7 years of experience in Business/ Systems Analysis, primarily on business requirements gathering and analysis, technical writing, functional and non - functional requirements gathering, and analysis
- Experience in developing business and functional requirements around HEDIS information
- Strong knowledge of Facets and actively involved in end-to-end implementation of Facets Billing, Enrollment, Claim Processing and Subscriber/Member module.
- Good knowledge of HEDIS (Healthcare Effectiveness Data and Information Set).
- 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
- Expertise in creating various artifacts like BRDs, Functional Specs, Used Cases, UML Diagrams, Data Mapping Documents, Test Plans and Test Strategies, pre and post RTMs and Status Weekly Reports etc.
- Strong visual modeling and Business Process Modeling (BPM) skills using Rational Unified Process (RUP) with tools like Rational Rose, and MS Visio.
- Comprehensive knowledge and experience in different SDLC methodologies like Agile/Scrum, waterfall, RUP, V-model
- Experience in Personal Property Casualty, Commercial Automobile, Reinsurance, Group and Life Insurance Systems, Home Owner Insurance.
- Excellent analytical, organizational, communication and documentation skills along with good project management skill to gather requirements to bring out the quality product.
- Knowledge in Data Modelling, Data Extraction, Transformations and Loading, Mappings Workflows, and Customized Analytics Reports.
- Expertise in the Data Analysis, Design, Development, Implementation and Testing using Data Conversions, Extraction, Transformation and Loading (ETL) and SQL Server, ORACLE and other relational and non-relational databases.
- Strong knowledge in Insurance Industry like- Property and Casualty Insurance, Life Insurance, Auto and Personal Insurance.
- Excellent written and oral communication skills with the ability to communicate appropriately in business and technical situations at all levels of project management.
- Assisted with implementation and ongoing support of Health Insurance Exchange (HIX)
- Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
- Well-versed in MS Visio, MS Project, Mockup screen, and Microsoft suite (Word, Excel, Access, Visio, Power Point, and Outlook) for analysis and presentation
- Expert in facilitating Joint Application Development (JAD), Rapid Application Development (RAD), interviews, and requirement elicitation sessions with end-users, clients, stakeholders and development team
- Experience in creating UML diagrams, Data Flow Diagrams (DFD), Use Cases, Class Diagram, Activity Diagrams, Sequence Diagram, and UML Modeling.
- Strong working knowledge in Guidewire Policy Center product & Billing Center
- Facilitated User Acceptance Testing (UAT)and test strategies with developers and testers, and participated in manual front-end testing to check all functionalities of different modules
- Involved in development of Test Plans, Test Cases, and prepared Requirement Traceability Matrix (RTM)
- Ability to create and analyze Business Requirement Documents (BRDs), Functional Requirement Documents (FRDs), Process flows, and Use Cases
Confidential, Hartford, CT
- Gathered detailed business & technical reqs and participated in the definitions of business rules and data standards.
- Reported and updated FACETS data to ensure proper configuration process
- Worked on EDI transactions: 270, 271, 834, 835, and 837 (PID) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrolment hence analyzing and documenting related business processes.
- Performed gap analysis of claims and enrolment business process for changes from SSN identifier to USI (Unique Subscriber Identifier) affecting for HIPAA EDI X12 transactions 837, 834, U277, 276/277, 270/271, 278,835 and 820.
- Delivered advanced health insurance analytics and development of statistical, predictive models.
- Created specifications for EDI HL7 (A28, A31, ADT) and X12 (837/835) transactions that were transmitted between Claims Editor and Legacy Billing application and external Payers.
- Worked with data migration and file mapping for various EDI transactions. Enhanced the Provider/Patient verification criteria using additional parameters based on the information retrieved from the EDI 837 I/P transaction files.
- Translated the EDI X12 data into XML format for initial transformation/migration.
- Facilitated functional requirement gathering from system users and prepared BRD.
- Created Business Process Mapping Diagrams and Documentation for the process improvement recommendations.
- Used MS Visio for flowcharting, Use Case process model and architectural design of the application.
- Implemented the Rational Unified Process (RUP) methodology guidelines with its various workflows and artifacts in Requirements Management and Development.
- Gathered and documented functional requirements and use cases for automation of operational and administrative business processes.
- Provided overall project management of multiple projects; successfully completed on-schedule and on-budget.
- Documented the "AS-IS" Business Workflows adhering to UML standards. Conducted JAD sessions to define requirements and finalize the Functional Requirement Document (FRD).
- Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD (Object oriented Design) using UML and Visio.
- Interfaced with team leaders, identify and analyse the given information, procedures and decision flows, evaluated existing procedures, methods and technical documentation. Communicated with executives, managers and other stakeholders regarding project scope.
- Responsible for business process analysis that includes requirements facilitation, definition & analysis, alternatives, software selection, prototyping, business process design and mapping.
- Maintained a Traceability Matrix to ensure that all functional requirements are addressed at the use case level as well as the test case level.
- Involved in identifying use cases, actors and writing use case narratives. Created use case diagrams and activity diagrams using MS Visio.
- Conducted meetings and JAD sessions for project definition, resource identifications and deliverable prototype identification.
- Interfaced with developers, analysts, customers and project managers to discuss requirements and recommended solutions, to help resolve issues.
- Led the User Acceptance Testing efforts to verify that the developed reports meet the requirements.
- Involved in developing the test strategy and helped in developing QA Test plans for Functional, Integration and System Testing
Confidential, San Antonio, TX
- Involved in Inception Phase and prepared vision statement and initial data models that contain Business Requirement Documents and supporting documents that contain the essential business elements and detailed definitions.
- Defined a repeatable process that is followed in the early stages of the Concept phase which defines risks and impact of product development.
- Worked with cross functional teams to define KPI's for each stage of the Product Development and Release Process.
- Working with functional teams in an agile environment, analyse factors and components of systems and processes to manage interrelationships and facilitate change. Detects inefficiencies or conflicts in systems and processes and helps to identify effective improvements.
- Reviewed existing IT processes in ServiceNow to identify areas of improvements & enhancements.
- Implement and configure new ITSM platform ServiceNow.
- Involved in preparing Test Plan and defined the testing approach, resources and timelines in agile environment.
- Interacted with other team members and participated in daily scrum meeting to make sure the all team members are on the same page.
- Prepared Test Cases based on business requirements and business rules for HIPAA EDI Transaction 834, 837, 835.
- Wrote Test Cases in Excel based on Technical and Functional Specifications and upload them in ALM.
- Maintained Requirement Traceability Matrix (RTM) to make sure that test plans were written for all the requirements.
- Defined structured testing methodology and standard testing procedures.
- Created and maintained templates such as: Project Progress Report, Test Plans, Requirements. Traceability Matrix, Test Scripts, Test Calendars, Testing Issues.
- Extensive use of Jira for test execution, defect tracking and QA related reports creation.
- Facilitates communications between customers, SME's and Technical staff. Participate in various testing functions (i.e. string and acceptance tests) to verify that results are correct.
- Analysed the system for the effectiveness of the E- commerce operations.
- Help manage the overall content of websites through CMS systems.
- Assisted in creating wireframes for web interface with the GUI design team.
- Analysed data and created class diagrams and ER diagrams for designing databases.
- Determined project scope and engineering requirements, estimated schedules, tracked item completion, certified milestones and maintained project documentation and corporate e-commerce web site Testing.
- Planned and defined Use Cases created Use Case diagrams, Scenarios and Use Case Narratives using the UML methodologies.
- Migrated Data from MS Excel to SQL Server Reporting Service Using DTS and SQL loader utilities.
Confidential, Warren, NJ
- Analyzed operating procedures and policies on an ongoing basis and recommended and implemented improvement plans where appropriate.
- Worked on Commercial Lines Property and Casualty Insurance including both policy and claim processing and reinsurance
- Held regular JAD meetings with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed, and issues were resolved beforehand.
- As a functional consultant, implemented Guidewire Policy Center through an Agile Scrum development model
- Experience in commercial Property and Casualty, Commercial Lines and Personal Lines Insurance, Underwriting, Rating and Guidewire experience with national carriers.
- Developed Data Flow Diagrams and Data mapping agreement, illustrating the flow of data from the front-end Guidewire Billing Center and Claim Center into the Application Database Tables.
- Understood core processes of the departments to provide input on re-engineering or streamlining opportunities
- Analyze, review and consult on Worker's Compensation Cases, bodily injury and other commerce of the most serious and complex nature requiring investigation, liability evaluation, commercial property damage evaluation, and negotiation.
- Incorporated Agile (Scrum) methodology to create BRD, FSDs using MS Visio and MS Word
- Worked on an application that took care of online account services which included Bill paying, checking the bill history, changing customer profile, ordering auto insurance ID cards
- Did extensive data analysis and prepared test plan for Data validation team and Confirm that all test scripts and results have been documented and presented to business stakeholders
- After the completion of BRD, conducted BRD Quality Review (QR) sessions with the entire stakeholders including business, testers, and developers.
- Experience in configuration on Guidewire claim Center including working on UI and Business, Data model.
- Prepared requirements document for Commercial Auto, Inland Marine, Crime, Worker's Compensation, Umbrella, Business Owners Policy, Commercial Output Policy, and Commercial Property Package.
- Involved in Code Reviews, System Testing and UAT followed by production verification, post production testing and validation.
- Monitored EDI Eligibility/Inquiry/Response (270/271) transactions via reports generated by the developers.
- Worked on solving the errors of EDI 834 load to Facets through MMS.
- Identify, communicate and resolve findings with the account teams in the various regions
- Created designs for various business rules to support claim payout transactions
- Facilitated Focus Group Meetings and (JAD) Sessions to adequately access business needs
- Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro
- Acted as a liaison between the account teams in the various regions and the lenders
- Used MS Project to schedule deadlines, resources, and facilities
- Wrote business and functional requirements
Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), SQL, AGILE, SWOT analysis, HP ALM.
Confidential, Woodland Hills, CA
- Analysis of business requirements and system requirements of the client and also for Property and casualty modules
- Gathered requirements, organized team meetings requirements from business users such as insurance policy managers, generated business process models, & use-case models, and created system requirements document & functional requirements document (FRD).
- Technically competent in Workers Compensation Case Management including complex claims, disputes, Regulatory matters, common law and litigated claims
- Developed a file of ACORD Forms used as the standards in all Property and Casualty markets, for both Personal and Commercial Lines of Business.
- Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile
- Involved in QA and testing procedures introduced into teams for both COTS and Legacy Systems.
- Align design and technical requirements with COTS reporting database.
- Worked on Insurance tools like Guidewire (Policy center, Claim center and Billing center). Excellent knowledge of various policy administration & industry standard tools such as Guidewire Policy Center, Duck Creek and ACORD standards with insurance laws, regulations and company policies
- Worked extensively to write Use Cases and do the Process flows for the Worker's Compensation package
- Developed and managed the formal SDLC implementation using the Lean/Agile Methodology.
- Responsible to Track, Document, Capture, Manage and Communicate the Requirements using Requirement Traceability Matrix (RTM) which helped in controlling numerous artifacts produced by the teams across the deliverables for a project
- Created Detailed Use Cases for the Web interface applications, Screen Mockup's for the project.
- Conducting JAD Sessions to resolve open issues, change requests so that the application meets the system requirements and dead lines
- Maintained business and technical specifications for the submission of Medicaid EDI X12 837 and NCPDP formatted Encounter Claims.
- Created Source to target data mapping documents identifying key data elements and prepared Data Flow Diagrams
- Extensively used tools such as Rational Rose, Rational Requisite Pro, UML, MS Visio, MS Project, MS Office, MS Access
- Responsible for managing the documented system requirements and Requirements Traceability Matrix.
- Used Guidewire for Claim Center (claim lifecycle), Policy Center (policy lifecycle), and Billing Center (invoicing and payment lifecycle).
- Followed the UML based methods using Microsoft Visio to create: Use Cases Diagrams, Activity Diagrams, State Chart Diagrams, Sequence Diagrams and Collaboration Diagrams.
- Responsible for providing analytical support in the Design, Development and Implementation of Project.
Environment: Rational Enterprise Suite (Rose, ClearCase, ClearQuest), RUP, MS Office, MS Access, SQL, SQL Server, Oracle, MS Project, Project Management.