SUMMARY

• Above 11 years of extensive experience in teh US Healthcare industry demonstrating strong Business Analysis skills, having blended experience in various business areas of Health Plans. Viz, Claims, Eligibility, Enrollment, Products & Benefits, Contracts, Billing, Customer Service, Business Intelligence etc.
• Above 9 years of experience in Requirements Elicitation in different applications including Facets, QNXT & MetaVance.
• Good noledge on SDLC, RUP Workflow, Unified Modeling Language, Data Modelling techniques.
• Proficient in training and mentoring resources in US healthcare practices.
• Well versed in Collecting, interpreting, and distilling customers’ business requirements into clear specifications and other product/application development artifacts.
• Proficient in Translating textual concepts and complex relationships between entities into visual displays.
• Expertise in Facilitating meetings/Capture meeting notes, and creates project artifacts like: BRD, Use Case Documents, Wire Frames, Functional Specifications, UAT Plans/Cases, and Functional Test Plans/Cases etc.

TECHNICAL SKILLS

Languages: PL/SQL (Basics), ORACLE

Operating systems: Windows

Version Tools: SharePoint

Tools: MS VISIO, Informatica

Methodologies: SDLC, RUP, UML, AGILE

Applications: Facets, QNXT, MetaVance.

Work flow tools: Macess

PROFESSIONAL EXPERIENCE

PROFESSIONAL EXPERIENCE

Business System Analyst

Confidential

Responsibilities:

• Conduct requirements sessions with business users to understand teh need for data.
• Document teh requirements and identify teh preferred destination on data marts for teh new business attributes.
• Assist during teh data modelling sessions to update teh business attributes on teh preferred destination.
• Create a high level design document and conduct walk - through sessions with client to convey teh system changes at a high level.
• Conduct data profiling activities and create source to target mappings.
• Co-ordinate with development teams and assist them during teh development phase.
• Perform impact analysis due to change in Facets application/interface functionality and asses teh impacts on RDI system.
• Prepare and maintain estimates, project plans, and traceability matrixes of teh projects.
• Manage incidents and work with technical team to perform teh root cause analysis.
• Participate in solution assessment meetings and provide consent on proposed solutions.

Business System Analyst

Confidential

Responsibilities:

• Understand teh existing systems/applications used by Confidential team members for supporting BSC’s business operations for Membership segment.
• Prepare process documentation for teh existing systems and business processes.
• Prepare training materials for teh offshore team to support teh customer (BSC) with minimum dependency from onsite team.
• Train offshore resources on teh business systems and business processes of teh customer for providing support from offshore.
• Train and mentor resources for Business Analysis activities.
• Prepare business requirements documents for enhancements, service requests, business needs.
• Conduct stakeholders sessions for requirement elicitation.
• Provide suggestions on Technical design for teh technical team, for customer’s requirements.
• Prepare test cases and test reports for teh business requirements.
• Perform Functional testing and provide assistance during User Acceptance testing.

Business Analyst

Confidential

Responsibilities:

• Conduct stakeholders sessions for requirement elicitation.
• Designing teh prototypes of application as per teh specifications received from teh client.
• Provide suggestions on Technical design for teh technical team, for customer’s requirements.
• Prepare test cases for teh business requirements.
• Perform Functional testing and User Acceptance testing.
• Prepare User Documentation
• Conduct Application training for end users

Configuration Specialist

Confidential

Responsibilities:

• Educating teh development team on QNXT Application, Configuration and teh technical specification prepared as per client request.
• Configuring teh various modules in QNXT Application which halps in Implementation and Conversion.
• Discussing with teh onshore team in configuring teh contracts for different groups and hospitals.
• Prepared FTC for teh Tools dat are developed by developers.
• Assisted Developers in generating teh reports which in turn generates letters for Claims, Customer Service, Enrollment & Recovery.
• Build test data for teh testing team for instances such as policies, premium rate tables and Administration Fees for Group Customers.
• Performing Quality Audit for teh deliverables of configuration team.
• Analyzing teh SQL queries and halping teh configuration executives to configure teh data as per teh requirement.
• Running Payment process which includes generating checks and requesting for teh refunds
• Building teh Benefit Plans.

Business Analyst

Confidential

Responsibilities:

• Prepared documents for teh current state application.
• Prepared documentation for teh future state.
• Artifacts prepared for this projects are, high level and low level Use cases, Functional Specifications, Functional Test Cases.
• Coordinate with teh Onsite Team and work closely with teh development team in developing teh new application on a different technology.
• Explain teh specifications to teh technical developers and verified their questions on all teh requirements dat were captured.

Subject Matter Expert

Confidential

Responsibilities:

• Adjudicate Medical & Hospital Claims
• Was part of teh training team who was responsible for conducting teh initial training for new joiners on teh US Healthcare and teh application usage
• Was also involved in a SME focus Group non as Knowledge Management Team where in my role was to identify teh most recent happenings in teh US Healthcare Industry and prepare a report/presentation and present/circulate teh same within teh company
• Performing root cause analysis for high dollar claim errors