PROFESSIONAL SUMMARY

• 15 years of experience in IT industry with 9 years at Client site in United States.
• Over 8 years of experience as a Business Analyst Architect and system design, successfully implemented complex projects as per schedule and within budget.
• Very good in Functional knowledge in healthcare insurance, member enrollment and billing, claim processing and Financial systems at USA and is responsible to resolve issues received by client by managing the team.
• Possess good knowledge of Customer information processing and call center
• Consistently demonstrated capabilities to manage and successfully analyze complex requirement and deliver.
• Conduct JAD, scrum meetings, perform brainstorming and strategy sessions, build use cases.
• Shows strong project management skills with SDLC methodology.
• Has good knowledge of Agile process and Lean Management Techniques.
• Good at Planning & Leading Teams to meet the targets as per schedule, thereby build the strong motivated & focused team
• Has good experience in leading & managing the teams of size from 5 to 20 members
• Proficient in Drafting Work plans, Deriving WBS, Resource Plans, WBS Estimates Project Schedules, Risk Assessments.
• Experience includes preparing the project plan using MS Project.
• Has a very excellent analytical capability and communication skills.
• Proficient knowledge in management of full project life cycle; concept through implementation and always ready to take ownership of projects.
• Preparing project management methodologies and techniques
• Develop project plans, share information such as project objectives, technologies, systems, information specifications, schedules, funding, and staffing
• Manage project execution to ensure adherence to budget, schedule, quality and scope and identify risks.
• Manage multiple projects and possess out of box thinking capabilities.
• Communicate effectively across cross - functional teams
• Provided designs and architect solutions.
• Participate in every phase, provide testing recommendation and root cause analysis.
• Understands Supply chain management and operation principals
• Effectively prepared business flow diagrams and made presentations to senior management
• Responsible for overall delivery of the project
• Majorly involved in the communication with all the Stakeholders within the project and Co-ordinate
• Schedule and facilitate meetings.
• Excellent knowledge of healthcare industry, specializing claims processing

TECHNICAL SKILLS

Operating Systems: OS/400, MS-Windows 95/98/NT/7, Mainframe

Languages: RPGLE, RPG/400, COBOL ILE, CLLE, CL/400, COBOL, VB 6.0, VB.Net, C, JAVA

Databases: UDB DB2/400, SQL Server 2000, VSAM, IMS DBMicrosoft Access

GUI/CUI: VB 6.0, CICS, IMS DC

Development: SDA, RLU, Query/400, SQL/400, Crystal Reports XI, JAVA Change Management: ACMS (Aldon Change Management System), Changeman, Expeditor, Easytrieve, VSS 6.0, CRMTT, HPSM

Business Products: VisionPlus, PowerMHS, ITSS, Microsoft Office 2010

Tools: CRMTT, BMRS, Visual Explain, MQ SeriesDBMON, Hawkeye, HP Quality Center 9.2/ALM, VSS, MS Visio, MS Word, MS Excel, MS Project, Sharepoint, Web service, tableau, microstrategy, crystal reports, Bugzilla, Service Now

Domain Knowledge: Healthcare Insurance Claims processing and FinancialCredit Card Management System, Property Insurance

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Environment: COBOL ILE, RPL ILE, AS/400 iseries, DB2UDB, JAVA, web service, Oracle

Responsibilities:

• Document and analyze the current application configuration and processes; Present new design solution and provide workflow recommendations for improvements
• Perform risk analysis
• Quality assurance and release support
• Out of 300 Change Request, prioritization and coordination with teams to build a delivery plan
• Requirement Gathering & Preparing Business Requirement Documents
• Project tracking and providing direction to team member as needed
• Perform Knowledge transfer and documentations
• Perform production issue analysis and resolution
• OS Upgrade and provide expert opinion

Confidential

Business Analyst

Environment: C#, VB.Net, COBOL, Oracle 10, Toad, SQL Developer, MS Project, Unix, Windows, Tableau

Responsibilities:

• Document and analyze the current application configuration and processes; Present new architecture workflow recommendations for improvements
• Perform financial risk analysis and fraud of as per CA 4840 regulation
• Quality assurance of the ITSS application upgrade through software testing
• Verify member billing and accuracy of customer information from SAP system
• Analyze the Security management plan for San Diego and create a schedule to implement plan
• Conduct research on Confidential contract, value-add services, resource model and present in a PowerPoint format
• Requirement Gathering & Preparing Business Requirement Documents
• Perform risk analysis and mitigation as part of risk management
• Project tracking and providing direction to team member as needed

Confidential

Business Analyst

Environment: COBOL/ILE, RPGLE, ILE CL, SQL/400, Jwalk, DB2/400,ACMS, MQ series, Hawkeye, Crystal Report XI, ROBOT, Connect Direct, PVCS, MS Project, Microstrategy, BPCS,OS/400 (V7R1), AS/400-iseries, JAVA, JAVA beans, Application Server, web service, mainframe, changeman, JCL

Responsibilities:

• Code Editing Upgrade for ClaimsXten: Responsible for providing design solutions and successful implementation of this project. For Clinical code editing, a adapter established to make asynchronous call during claim Adjudication to ClaimsXten application in XML format. The response and appropriate savings should apply on the claim. Online user are not expected to be hit by performance.
• HIPAA 5010 and ICD10: As a compliance project, organization wide initiative was to restructure the architecture. This program was multi phase projects involving large number of trading partners. It consists of 837-inbound, 837-outbound, 276/277 and 835 transactions. Also upgrade application for ICD-10.
• “Coordination of Benefits”: Project objective was to allow Coordination of Benefits (COB) correctly in adjudication when member has other insurance.
• “Serbanes-Oxley (SOX) implementation”: Confidential has agreed to meet Sarbanes-Oxley compliance in 2007. With this compliance all payments and invoices should balance. Changes were to add strict balancing criteria in every module and tighten the grip on money inflow-outflow within different departments interfacing with General Ledger system.
• “System Health”: Confidential had large amount of data (in Terrabytes) and maintaining the data in the AS400 system was costly. The cost effective solution is to migrate old data the low cost application under System Health.
• “Claim Check 8.5 upgrade”: Worked as team lead. The existing adjudication process was using Third party software for the ‘Claim Check’ (version 5.0) processing. Confidential had decided to use the upgraded 8.5 software version than existing 8.5. This has demanded Adjudication to make necessary changes and provide setup for new configurations.
• “Cost Containment”: Cost Containment is the customer initiative to achieve more savings on claim processing and external partners. This project also initiated steps modularize adjudication programs. As part of this project, I developed new technique called Logical Mapping Process (LMP), this has shown tremendous positive results.
• “Refund Adjustment”: Refund Application is the special processing application developed by third party. Front end of this application is built on JAVA and main process in done in AS/400. This application processes billing refund and adjustment requests received from business, customers or different vendors.

Confidential

Associate Consultant

Environment: COBOL, DB2, VSAM, Change man, Easytrieve, Vision Plus, Mainframe

Responsibilities:

• Communicate with Onsite and Offshore team leads
• Understand delinquencies and credit risk
• Requirement Gathering and Analysis
• Prepared specification document, code, review and unit test
• Responsible for Integration testing

Confidential

Programmer Analyst

Environment: RPG/400, COBOL ILE, DB2/400, SDA, RLU, OS/400

Responsibilities:

• Requirement Analysis
• Prepared specification document, code, review and unit test

Confidential

Programmer Analyst

Environment: COBOL, DB2, Change man, Mainframe

Responsibilities:

• Understand and implement Supply Chain principals
• Perform Impact Analysis
• Preparation of Program Specifications
• Coding, Review and Unit Testing