SUMMARY:

• 6 + years of experience in Business Analysis, Requirements Management, Design, Development and testing in health care and health insurances related assignments and also as system analyst in pharmaceutical related assignments for drug compliance and testing with FDA, Insurance & Property and Casualty (P&C).
• Hands on experience in integrated Claims Management applications for various insurance product lines. knowledge of Business Requirement Document (BRD), Business Process re - engineering, Business Requirements gathering & Functional Requirement document (FRD), Process Flows, Process Modeling, Use Case Modeling and related technical processes.
• Possess outstanding client interaction and relationship management skills.
• Experience on e commerce business development skills, with hedge funds,equity and shares
• Proficiency in RUP (Rational Unified Process) and Unified Modeling Language (UML), applied RUP concepts and have created UML artifacts like Context Diagrams, Event List, Process Maps, Use Cases and analysis models like waterfall and agile, conducted JAD sessions independently if required.
• Good Acumen and Intellectual in Claims reporting claims processing lifecycle from Insurers unique Identifiers number to Subject matter expert (SME) for the claims reports on functions and other statistics reports.
• Experience in developing UML use case diagrams, work flow diagrams, data flow diagrams, flowcharts, screen mockups and report prototypes. using tools like Rational Rose, MS Project, MS Excel, MS Word and MS Visio
• Experience on CTMS (Clinical Trails Management System )
• Involved in reviewing and sign off requirements for Business Intelligence Reporting in Seibel (tool of CRM )
• User Clintrace for data collection, assessment, evaluating the actions on the existing drugs on clinical trials while following the compliance systems of drug safety surveillance board’s regulations and HIPAA regulations required for pharmaceutical companies to conduct trails.
• Prepared project process tracking document to identify testing deliverables.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams and UML
• Good knowledge of HHS(Health and human services) laws, HIPAA laws and Guidelines related to electronic data transfer system by Depart of health human services (DHHS) and health Insurances business, (Fundamentals of health Insurances, Insurance operations, Insurance Contracts, Loss Exposure and Risk Management),Medicaid, HMOs, PPOs, Medical, FDA policies, ISO, Six Sigma, and Capability Maturity Model (CMM), HL-7(Health level seven). Extensive Managed Care and Health Care systems domain experience and Pharmacy claims processing.
• Good knowledge in Drug safety system implementation such as SAS, ARIS-G, and Clint race
• Good Knowledge on EPIC Interface systems record system.
• Experience in designing Labs, Radiology, Emergency, ICU health care systems.
• Incredible knowledge of Software Development Life Cycle (SDLC) with thorough understanding of various phases like Requirements Analysis, Design, Development and Testing
• Experience in Data manipulation & Data query on RDBMS(Relational and database management system ) SAS, and SPSS(Statistical Package for the Social Sciences).
• Practiced in developing and maintaining systems documentation such as design specifications, description of application operations, methodology documentation using MS Visio.
• Self-starter and hands on problem solver with outstanding communication skills capable of delivering in a dynamic and demanding work environment.
• Excellent presentation and communication skills combined with a proficiency in problem abstraction, business modeling, interpersonal, leadership skills, and ability to work in a cross functional team.
• Familiarity working with Business Objects, Data Modeling, Data mapping, Designer and Central Management Console.
• Ability to perform independently on reports and analysis tools such as Siebel analytics, crystal reports with the requirements.
• In detail knowledge on facets data model for claims arbitration and claims reimbursement.
• Worked on the process improvement tools to manage more productivity with the same staff count
• Analyzed existing policy procedure and revenue to in corporate it into the new system with improved automation and efficiency, implement new technology projects and the scripts are tested.
• Packages designed to support HCS requirements for claims such as CPT (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) coding

TECHNICAL SKILLS:

Business Analysis: Requisite Pro, MS Visio, MS Project 2010, UML

Programming Languages: HTML, XML

Database: Microsoft Access, MS-SQL Server

Operating Systems: Windows XP, Windows vista & 7

Methodologies: RUP, Water Fall, UML and Agile

Microsoft office suite: Microsoft Access, Microsoft project, Microsoft Visio, Excel, Power point And Microsoft Outlook

PROFESSIONAL EXPERIENCE:

Confidential

Responsibilities:

• Use Cases and analysis models like waterfall and agile, conducted JADsessions independently if required.
• Good Acumen and Intellectual in Claims reporting claims processing lifecycle from Insurers unique Identifiers number to Subject matter expert(SME) for the claims reports on functions and other statistics reports.
• Experience in developingUML use case diagrams, work flow diagrams, data flow diagrams, flowcharts, screen mockups and report prototypes. using tools like Rational Rose, MS Project, MS Excel, MS Word and MS Visio
• Experience on CTMS (Clinical Trails Management System )
• Experience as a Clinical Data Analyst on CDMS (clinical data management systems),
• Good knowledge of HHS(Health and human services)laws, HIPAA laws and Guidelines related to electronic data transfer system by Depart of health human services (DHHS) and health Insurances business, (Fundamentals of health Insurances, Insurance operations, Insurance Contracts, Loss Exposure and Risk Management),Medicaid, HMOs, PPOs, Medical, FDA policies, ISO, Six Sigma, and Capability Maturity Model (CMM), HL-7(Health level seven). Extensive Managed Care and Health Care systems domain experience and Pharmacy claims processing.
• Good knowledge in Drug safety system implementation such as SAS, ARIS-G, and Clint race
• Good Knowledge on EPIC Interface systems record system.
• Experience in designing Labs, Radiology, Emergency, ICU health care systems.
• Incredible knowledge of Software Development Life Cycle(SDLC) with thorough understanding of various phases like Requirements Analysis, Design, Development and Testing
• Experience in Data manipulation & Data query on RDBMS(Relational and database management system ) SAS, and SPSS(Statistical Package for the SocialSciences).
• Practiced in developing and maintaining systems documentation such as design specifications, description of application operations, methodology documentation using MS Visio.
• Self-starter and hands on problem solver with outstanding communication skills capable of delivering in a dynamic and demanding work environment.