SUMMARY

• Highly reliable, strategic, and innovative business professional acclaimed for excellent judgment and decision making skills as a team lead and scrum master, focused towards achieving goals with excellent analytical, administrative and technical skills, competent to work in challenging environments.
• 8 years of robust experience in the field of Information Systems with emphasis on Business Process Reengineering, System development and Implementation in Healthcare, Insurance, Medicare, Medicaid domains.
• Extensive experience in eliciting project requirements, which include requirement gathering, requirement rating/analysis and prioritizing requirements.
• Excellent Business writing skills in documenting Business Requirements Document, Functional Requirements Specification, Systems Requirements Specification, Requirements Traceability Matrix and Lessons learned document.
• Extensive experience in using SDLC including Waterfall, Agile Scrum and RUP in performing analysis of requirements, designing, planning and execution along with DMAIC based on the SIX Sigma framework.
• Aptitude for analyzing, testing, identifying errors, error logging, and designing solutions.
• Fast learner with ability to rapidly assimilate new technologies, concepts and processes and successfully adapt them to the projects and operations.
• Created business rules, business vision document and business glossary.
• Proficient with SQL 2005/ 2008 Join, Update , Business Intelligence tools SSIS, Crystal reports , Data Warehousing, stored procedures, indexes, and ETL processes.
• Meticulously maintained work flow using out-of-the-box or custom designed SharePoint 2010.
• Profound experience in custom designing templates, PowerPoint presentations and content writing.
• Proficient in creating UML diagrams: Use Cases, Sequence Diagrams and Activity Diagrams.
• Hands on experience in processing PPO, HMO, POS, Medicare parts A, B, C D and Medicaid insurance data and claims.
• Having good working knowledge on SAP.
• Worked with HIPAA 4010/5010, HL7 transactions such as 837, 835, 834, 276, 277, 270 and 271 and EDI transactions combined with XML to provide ubiquitous connectivity and interoperability.
• Expertise in Electronic Medical Records, ICD-9/ICD-10/CPT-4, HCPCS codes.
• Phenomenal knowledge in Object Oriented Analytical Design OOAD , Data Modeling, Mapping, Design and implementation of RACI charts.
• Validated Test Plans by meeting with quality leads and helping them with discrepancy management
• Extensive experience in the Implementation, Integration and Development of marketing strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Excellent communication, client relationship and customer service skills. Responsible, self-motivated and organized. Excellent written and verbal skills.

Technical Expertise

Project Summary

Confidential

Project manager / Senior Business Systems Analyst

• HP had a contract with Kentucky State Medicaid to implement Kynect which is Kentucky's Health Insurance Connection, to provide for healthcare for American households with low income and resources. The Patient Protection and Affordable care Act PPACA increased the Medicaid minimum eligibility level to cover for most Americans with household income up to 133 percent of the federal poverty level.
• This project was highly focused on analyzing the employees' workflow and designing the intranet system that would enable employees to create access and update newly eligible Medicaid enrollees' profiles and assign them to Managed Care Organizations MCO , maintaining the load balance.

Responsibilities:

• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS and HIPAA Regulations.
• Coordinated with PM and also had step up to manage the project, create templates for Project Technologies, Methodologies, Budget, Time factor, Risk register, MS project timeline, Project mile stones, WBS, Critical path analysis.
• Analyzed business needs and developed use case stories and facilitated JAD sessions.
• Catered to resolving queries from data analysts, client representatives, marketing, and other IT analyst in the product promotion division.
• Analyzed and wrote test scripts based on functional requirements documents FRD.
• Used process and data modeling techniques for the EDI transactions.
• Implemented Service-Oriented Architecture SOA for linking business and computational resources on demand to achieve the desired results for service consumers and used WSDL and SOAP.
• Developed Wireframes using Visio and Mockup Screens to ensure an intuitive interface.
• Used TOAD for writing SQL queries to perform data analysis.
• Analyzed, validated employer behavioral data and generated Reports/ Dashboards with different Analytic Views Drill-Down / Dynamic, Cascading Style Sheets, Pivot Table, Chart, Column Selector, Tabular with global and local Filters .
• Configured and stored artifacts in MS Share Point 2010.
• Executed business process analysis As-Is system To-Be systems.
• Worked extensively with Physical Layer, Business Layer and Presentation Layer.
• Proficient in Remedy Service Request Management SRM and Action Request System ARS .
• Prepared Documentation for OBIEE Repositories and Dashboards designs, test results and standard operating procedures SOP .
• Worked extensively on marketing analytics, generating reports on the customer satisfaction, product promotion, and call center analytic functions for Medicaid enrollment and presented the results to the project manager.
• Managed security privileges for subject area and dashboards according to user requirements.
• Performed regression, functional testing, stress testing, load testing, performance testing, user interface testing, User Acceptance and system testing to validate and map functionalities.
• Identified timelines for the different kinds of testing to be performed and estimated the risks involved.

Environment: Microsoft Active Directory, XML, MS SQL Server 2005, MS SharePoint, MS Visio, Windows Server 2000, Oracle 10g Windows NT , MS Excel, UNIX, OBIEE, Remedy, Testing, Windows XP, 7 Environment.

Confidential

Sr. Business Systems Analyst / Project Manager

• Wea Trust provides group health insurance programs for public school employees and their families. It is one of the state's largest health insurers and brings innovation and thoughtful care to cover for both short and long term disability. WEA- MedPlus plan covers for Medicare eligible public sector retirees and their spouses.
• The objective of this project was to design an automated claims adjudication process, which could validate the claims by correlating the data input with the database, determine the accurate prices using the price application and batch process the claims to make decisions of claim payment or denial.

Responsibilities:

• Defined the scope and dependencies and implemented business rules, organized user meetings, gathered business requirements and specifications and documented them.
• Involved in the meeting with Business Process Owners, SME Subject Matter Experts and store users for Requirement gathering in Definition Stage.
• Responsible for project management, Business process mapping and design.
• Prepared Cost Benefit Analysis report, Gap report and Feasibility reports.
• Worked with the Waterfall methodology, and was responsible for developing use cases, project plans and documentation at every phase.
• Conducted the FRS reviews and walkover meetings with architects, developers and stakeholders.
• Well versed with HIPAA 4010/5010, ICD 9/ICD 10 and privacy and security.
• Worked extensively with EDI transactions: 837, 835, 834, 820, 270, 271, 276, 277, and 278to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Documented the BRD and SRS and validated the test plans, test cases and test scripts and prepared Requirements Traceability Matrix.
• Created workflow diagrams to better demonstrate the claims processes adopted in the paper, online and EDI transactions.
• Ensured that transaction sets, segments, and data elements are all used at the same version/release level of HL7 and ASC X12 standards.
• Created Process Flow Diagrams, Use Case Diagrams, Activity Diagrams and Sequence Diagrams UML using MS Visio.
• Performed UAT based on Requirements Document and error logged using HP Quality Center.
• Maintained Traceability Matrix in Excel.
• Built Business model and established relationships Foreign Keys Physical Logical between tables.
• Performed extensive data modeling to differentiate between the OLTP and Data Warehouse data models.
• Environment: HP Quality Center, MS Project 2004, MS excel, MS Word, MS Visio, MS .NET, AJAX, DB2, MS FrontPage, MS Power Point.

Confidential

Sr. Business Systems Analyst

• Confidential. has been a leading provider of medical image and information products and technologies for acquiring, processing, managing and storing diagnostic images and related data.
• This project was to develop Fujifilm's Synapse Cardiovascular system, which is a customizable tool to suit the needs of the customers healthcare facilities . This tool gave providers the opportunity to correlate data pertaining to the cardio vascular department and the diagnostic tests required for determining cardiovascular risk, diagnosing diseases and monitor the treatment.

Responsibilities:

• Facilitated user meetings, gathered Business requirements specifications for the Data-warehouse design.
• Planned and defined system requirements to Use Case, Use Case Scenario and Use Case Narrative using Rational Rose.
• Assisted UI/UX team in translating client graphical requirements to reality by creating static prototypes such as Mockup Screens and wireframes, as well as dynamic prototypes using HTML and CSS.
• Used the guidelines and artifacts of the Rational Unified Process RUP to strategize the Implementation in different iterations and phases Inception, Elaboration, Construction and Transition .
• Performed Risk Analysis meetings with the project manager, technical team, management and product marketing team. As a result, we assessed, identified and prioritized risks and designed solutions to minimize them.
• Applied Erwin, Rational Rose and Power designer for modeling tools.
• Interfaced with internal clients and technical vendors on new feature requirements.
• Manual testing of GUI, Field Validation, Functionality and UI/UX application reviews.
• Created Dashboards by embedding reports and providing intuitive drilldowns and links to exploit the full benefit of Analytics.
• Worked with project management tools like MS Project 2010 and Liquid Planner, that help implement the Change Management, Content Management and Configuration Management effectively based on impact analysis using Rational Clear Case.
• Prepared Business Process Models BPM that includes modeling of all the activities of the business from the conceptual to procedural level.
• Worked extensively with the QA team for designing Test Plan and Test Cases for UAT.
• Performed manual testing to verify the functionality of the application and reported any defects using Clear Quest.
• Created stub data to check the functionalities.
• Created formula's for Crystal Report and stored it on the Crystal Repository to be used across the organization.

Environment: Rational Rose, Rational Clear Case, Rational Clear Quest, MS Office Suite PowerPoint, Visio , MS Project, Broadcast agent server, Erwin 3.5.2, IIS Webserver, DB2, SQL, Oracle 9i, Mercury Test Director, Informatica Power Center 6.x/7.x.

Confidential

Senior Executive

Tata AIG Health Insurance has several plans including MediPrime, Wellsurance Executive, Wellsurance Family, Wellsurance Woman, Critical Illness Policy, MediPlus and MediSenior. With these range if insurance policies, they take care of the unforeseen needs of enrollees.

Responsibilities:

• Conducted Planning and deployment using SharePoint, which involved Workflows, Lists and Libraries.
• Identified the system requirements for the entire Distribution Operations department.
• Raised the system requirements in coordination with MIS team.
• Was responsible for managing the project and came up with work breakdown structure and business process mapping.
• Performed all the UAT testing.
• Regularly managed and upgraded the system and tested the product updates and new product setup.
• Managed commission payouts monitored proper flow timely generation of accurate commission to all the channel partners.
• Responsible for appointment and termination of Business Associates.
• Assigned advisors to the appropriate Business Associates.
• Addressed the various queries raised by the sales managers and the BA managers.
• Addressed the commission related queries relating to BA's to all branches.
• Sent regular MIS updates on various appointment and assignments to all the zones.
• Licensed advisors as per the guidelines of IRDA.
• Checked the Contract Maintenance criteria of all the Business Associates month wise.

Business Analyst

Confidential Insurance offers complete range of general insurance for motor, home, accident health, travel, property and casualty. This project was to increase the percentage of growth and customer retention, design discounts and special programs to increase the sale of insurance policies. This information was extracted from different OLTP applications using Informatica and was transformed into a Data-mart.

Responsibilities:

• Designer tools were used to design the source definition, target definition and transformations to build mappings.
• Used Source Analyzer and Warehouse Designer to import the source and target database schemas, and the mapping designer to map source to the target.
• Used Transformation Developer to create the joiner, filters, router, Expression and aggregation transformations that are used in mappings.
• Created Workflows, Dimensions, Facts Mappings.
• Taking the Backup of Repository on regular intervals depending on the amount of work done.

Environment: Informatica 7.1, Oracle 9i, SQL Server 2000/2005, SQL, PL/SQL, Erwin, UNIX, EDI transactions.

Confidential

Executive

The family plans offered by Apollo Group include Easy Health Standard, Easy Health Exclusive and Easy Health Premium. The project was to create benefits determination software, handle the backlogs in claims processing, and enhance the overall customer experience.

Responsibilities:

• Document the functional and technical requirements for the eligibility determination software.
• Business development by coordinating with all the insurance companies.
• Handled the corporate clients.
• Efficiently handled claims processing mainly in the form of EDI transactions.
• Addressed the queries of all the employees of the corporate clients.
• Updated the float fund details to HO by coordinating with the Insurance Companies.
• Handled corporate clients independently with excellent people skills and problem solving skills.
• Helped clients benefit from cash-less hospitalization on a daily basis.
• Worked efficiently under tight time constraints and high stress level.
• Was able to multi task between the different roles.
• Used a balanced and strategic view leading to a pragmatic result-oriented approach.
• Collaborated with the entire team and was responsible for team orientation.
• Set high standards and displayed the passion for excellence.
• Displayed excellence in creativity, analytical ability and optimistic thinking and adaptability to handle new situations or problems.