SUMMARY

• 12+ years of experience as a Systems /Business Analyst in IT Industry, with strong knowledge in Software Development Life Cycle methodologies like Agile, Scrum, and Waterfall models.
• Insurance experience includes Personal Property Casualty and Commercial Automobile Product knowledge, Commercial Property Casualty, Group and Life Insurance Systems, Health Insurance, Auto Insurance Homeowner Insurance, etc.
• Proficient in Business Requirement Gathering, Business Process Flow, Functional Process Flow, Business Process Modeling, Business Process Re - engineering, Business Change Management, Transaction Processing, Documenting Enhancement Requests with a keen awareness of developer needs & end-users and able to deal with clients efficiently.
• Experienced in the creation of industry-standard documents such as BRDs, FRDs, User Stories, and Use Case specs.
• Adept at creating and transforming business requirements into functional requirements and designing business models using UML diagrams - Context, Use Case, Sequence, Activity diagrams, MS Visio.
• Expertise in analyzing business requirements & processes through document analysis, interviews, workshops, & workflow analysis.
• Develop business architecture using requirements such as scope, processes, alternatives, and risks.
• Analyze client's business requirements and processes through document analysis, interviews, workshops, and workflow analysis
• Liaise between business and technical personnel to ensure a mutual understanding of processes and applications.
• Participate in developing strategies to improve API development life cycle and governance processes.
• Excellent experience in Claims Processing and Claims Pricing.
• Strong knowledge of IKA claim processing and validations of claims.
• Developed Data transformation maps to /from CVS, XML, X12, EDI FACTS, and flat file in Spec builder Most common transaction includes EDI 835,834,837,270,271.
• Strong Knowledge in Guidewire Claim Center, Claims Transaction, Configurations, Exposure, Reserve, Recovery and Checks.
• Develop and disseminate written guidance for multiple federal child nutrition programs to ensure compliance with federal, State, and local policies, rule, guidance, and regulations.
• Validated Backward and forward Mapping for ICD9- IDC10 and logged when I found a bug in it.
• Strong experience in Application Design (Prototyping, Screen Mock-ups), wireframes, UI design
• Modeling, ELT Design, Analysis, Development, Testing, Performance Tuning, Implementation, Troubleshooting, and error handling in the field of Data Warehousing in ELT process using ODI.
• Validate the Data transformation from source to target for Master Data.
• Strong knowledge of SQL, data analysis, and data validation using SQL and Oracle Data Integrators.
• Excellent verbal/written communication skills & strong analytical abilities to perform well both independently & as a team player.
• Strong knowledge of JIRA, Rally and have work experience in Hadoop application like Pig and Hive

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Responsibilities:

• Gathered sessions on large, complex programs and projects using methodologies such as JAD, JAR, SCRUM, etc., to define, analyze, and document business needs and requirements in support of strategic initiatives.
• Collaborated across multiple business units ensuring that all parties get the best possible outcomes for Company and its members and providers.
• Documented functional and non-functional business needs and requirements, ensured requirements are usable, specific and testable, and in alignment to business goals and overall business architecture.
• Assists in defining Acceptance Test Criteria, tracing back to documented business requirements.
• Created and updates complex as-is and future state business workflows to enable the documentation of business process needs and production of requirements for all related business, and operational systems critical to the project or program.
• Conducted requirement gathering session with stake holders and IT team and creating BRD based on new requirements, Data source and inclusive/Exclusive criteria.
• Made recommendations for solutions or improvements that can be accomplished through new process or technology, or alternative uses of existing processes or technology.
• Researched and analyzed data in support of business functions, process knowledge, and systems requirements.
• Tracked maintenance of business need and requirements to ensure they are not attenuated or discarded during the execution and delivery phases.
• Supported the Project Manager by providing more detailed project objectives; clear structured, and useable requirements; tradeoff analysis; requirement feasibility; and risk analysis to improve the execution of the project plan.
• Mentioned other Solutions Analysts and Business Analysts to strengthen Company's solution and business analysis capability.
• Defined and follows best practices for the organization based on BABOK or other authoritative bodies of knowledge.
• Conducted analysis in support of the entire ePMO.

Confidential

Business Analyst/Product Owner

Responsibilities:

• Working for a technical BA. The primary role will be understanding the types of insurance coverages that the various business units are selling and understanding how those coveragesplug into the ecosystem for the backend data operations ecosystem.
• Working on the source systems and sending that data (XML or JSON message structures are necessary).
• Gathered business Requirements using various Elicitation Techniques such as Interviews, Brain storming sessions, JAD Sessions with Focus Groups and more for Claim Database Upgrade to Guidewire Insurance Suite.
• Guidewire Claim Center is used for design to manage the process of Reporting, Verifying, and Making payments on claims against a policy.
• Extensively interacted with the designers, developers to ensure functional implementation of business requirements and QA Team in executing Test Plans, Test Scenarios and Test Cases for Claim Center Module using Guidewire
• Working closely with Business, Product Management, and development engineers to understand Guidewire Claim Center features, performing Gap analysis to identify features, gathering, and analyzing business requirements
• Created cross system data flow diagrams and flowcharts to depict the integration dependency of other applications with Guidewire Claim Center.
• Engage with developers where those data elements are (example: Xpath, tell developers how to find something). Working on relational databases (they are in a NoSQL data lake) and comfortable picking technical tools and understanding the JSON and XML structures of Data elements.
• Working with stakeholders for requirements gathering, engaging with PM’s, non-IT product compliance organizations.
• Working with Dev team performing ELT process. Writing the user stories and follow-up end-to-end process and validation before moving to UAT and PROD.
• Write the test plans for different scenarios execute them and validate. Engage in daily standup meetings and provide updates to PM daily.
• Validate the Data on daily basis in Marklogic during the transformation from Guidewire to ML.
• Creating claims in Guidewire for different scenarios for test plan and validating the same in Marklogic data lake stagging and Final.

Confidential

Business Analyst

Responsibilities:

• Performed Vendor management support - aids in creating external vendor reporting; responsible for auditing monthly vendor invoices; supports management, as needed, in budget and forecasting exercises
• Maintains and creates KPI reporting for the department on a daily/Monthly and Quarterly basis.
• Involved in IVR replacement project, directly working with business and steak holder.
• Gathered and analyzed business requirements for GW Claim Center by conducting interviews with business users and customized the application accordingly
• Worked on claims center (Guidewire) to create claims with different scenarios for testing prospective in Dev and UAT as per test cases requirements.
• Conducting JAD sessions and gathering high-level business and technical requirements.
• Conduct daily standup meeting with onsite/offshore and monitors the progress of the project.
• Engage with business team/ solution architect team and gathering information regarding modification/update and creation of new PEGA cases.
• Summarizes lengthy reports for all lines of business monthly.
• Responsible for initial review of complex analysis performed by other team members by serving as the second set of eyes on high visibility projects
• Supports more senior team members in intensive technical analysis

Confidential, Richmond, VA

Claims Business Analyst / Production Support Team

Responsibilities:

• Performed ongoing quality assurance to ensure accuracy and consistency of output in the IKA system for many clients (BSBC OF MI, BCBS OF AR, BCBS NEBRASKA, BCBS HPHC, CODUENT, TOTAL HEALTH CARE, SCAN and XEROX.
• Acted as BA Product Support team member of Confidential, BCBS initiative to combine a local and national claims processing system into one single platform
• Loaded and maintained Health Care s and Riders in Document Database.
• Plan and conduct requirements elicitation and develop a proposed statement of work. Elicit, analyze, document, validate and communicate requirements with stakeholders.
• Weekly performed/validate Check run procedures for MI BCBS & AR BCBS and Generate Report & upload in Jira ticket.
• Performed initial analysis for Claims Defect/Service Request created by Clients in IKA system as Part of Product support team.
• Create the IC tickets and provide a complete walk through to Developers regarding defects with actual behavior and expected behaviors for the client requirements.
• Engaged with client-facing meetings and provide updates on the issue daily.
• Facilitate the daily scrum meeting with onsite /offshore Dev/QA teams and find the progress and daily updates for all defects/service requests, discuss the roadblocks and dependencies on other teams to find the solutions.
• Wrote SQL queries to validate data.
• Generated reports and performed data validation in IKA for BCBS.
• Implemented and maintained account benefit updates in the system as part of National Health Care Reform mandates.
• Researched, defined, and analyzed changes to both state and federal laws affecting the Medicaid Management Information System (MMIS) for Texas Medicaid account.
• Served as a project management analyst on multiple initiatives involving maintenance and systems changes for HIPAA implementation and quarterly code load.
• Researched and gathered detailed requirements and translated it into proposed systems system enhancements.
• Completed system documentation, researched system requirements, participated in system testing and verification for HIPAA implementation.
• Acts as liaison between the users and the IT development team to determine and deliver the most effective solution for development and implementation including preparing detailed business requirements documents.
• Provided post-implementation support and performed root cause analysis and fixed post-implementation issues.

Confidential

Business/System Analyst

Responsibilities:

• Defined program & project goals, objectives, products, services, constraints, assumptions, risks & facilitated processes by working with the project team, sponsor, & stakeholders to baseline scope of work & enable the development of the plan.
• Documented risks, issues, & dependencies as required weekly & sent a communication via email with necessary updates.
• Supported in the successful delivery of IT projects for the organization including reservation engine upgrades, web application development, and POS systems.
• Conducted JAD sessions and user interviews at both in-house and client locations, gathering and analyzing requirements using Rationale tools.
• Assisted Project Teams in preparing Functional and Non-Functional Requirement documentation.
• Performed Gap Analysis by identifying existing technologies documenting the enhancements to meet the end state requirements. Also responsible for writing Functional Requirement Specifications (FRS).
• Managed and documented risks, change requests, and issues and escalated when required.
• Functioned as the primary liaison between the business line and the technical areas throughout the project cycle.
• Created UML Diagrams including Use Case Diagrams, Activity Diagrams, Data Flow Diagrams (DFDs), Web Page Mock-Ups while defining the Business Process Model.
• Performed Feasibility, Adaptability, and Risk Analysis to identify the business-critical and high-risk areas of the application.
• Involved in documenting customization requirements, business rules and data migration requirements for the Implementation of Guidewire Claim Center and Policy Center.
• Involved in the implementation of Guidewire Claim Center for Commercial LOB like Worker's Comp & Commercial Auto and Policy Center for Personal Auto LOB.
• Involved in the meeting with Business Process Owners, SME (Subject Matter Experts), and store users for Requirement gathering in Definition Stage.
• Developed Test Strategy and Test Plan to ensure that test cases reflect user needs for functional, performance, and usability, and security requirements.
• Extracted key progress metrics for the entire team, Drive risk and issues process. Maintained program-wide approaches, plans, policies, and procedures and provided Program Management Support.
• Maintained an understanding of the business plans of competitors and of the industry in general.
• Creating claims in Guidewire for different scenarios for test plan and validation.

Confidential, Richmond, Virginia

System Analyst/Business Analyst

Responsibilities:

• Worked in data warehousing and analytic concepts, Data sourcing, Reporting, and extraction methods and standards.
• Worked in multiple teams and followed both Waterfall and Agile SDLC processes across teams.
• Data analysis and appropriate query languages such as Teradata SQL.
• Covered a wide range of business knowledge of health insurance and data subject Area.
• Captured meeting minutes, stored, and share for every meeting they facilitate.
• Analyzed and documented technical detailed response to business requirements.
• Responsible for all data profiling required to support technical requirements and data mapping.
• Changed to Edward data models are managed and cornered by the advert model management process.
• Worked with HIPAA EDI 834 form received from various Vendors, Partners, and Producers invalidating the data in Stage Environments Test running the formats and conducting issue analysis.
• Worked with HIPAA EDI 837, 835, files for data validation, and create data mapping and ETL process requirements for loading data into EDI.
• Performed validation of EDI 271, 835, and 837 Professional and Institutional format files according to EDI FECS engine.
• Worked with the Data Architecture team to ensure the data model solution meets the requirements.
• The developed robust requirement to sport new and enhanced BI solution in the form of DataMart’s analytical applications and Reporting.
• Conducted source to target mapping for all data foundations and data exchange efforts.
• Claims Processing and Claims Pricing while using Edward from source to target.
• Explore each Tab in a mapping template and fill out all appropriate tabs for the project.
• Review the mapping with the execution team like developers /Testers who provide feedback to ensure the mapping contains enough information to proceed with their efforts.
• Updated and posted a document to the Edwards lights on production folder when a project goes into UAT.
• Used the most current Target metadata spreadsheet, delivered by the data architect, to front-load their mapping documents with Target information. This spreadsheet should contain the most current tables and column of Advertiser tables and column of Edward Target tables.
• Played a significant role in the contribution, review, and approval of SIT test plans.
• Participated in reviewing SIT test results and assist with resolve issues as necessary.
• Work with a cross-functional team to help resolve any issue raised during the warranty period.

Confidential, City of Sunrise, FL

Systems Analyst/Business Analyst

Responsibilities:

• Followed Agile throughout SDLC and worked in Scrum teams.
• Wrote Epics and User Stories to capture requirements. Participated in Daily Stand Up and Sprint Planning calls.
• Defined and implemented Data Warehouse requirements and administered Data Warehouse requirements and needs.
• Responsibilities included source system analysis, data transformation, loading, validation for data marts, operational data store, and data warehouse.
• Prepared high level and detailed Business Requirement Documents (BRD) and Functional Requirement Documents (FRD) and created interactive prototypes.
• Applied UML notations and methodology in developing models that accurately represent the business process and workflows and clearly communicate them to the stakeholders.
• Conducted requirement sessions and successfully translating those requirements into Use Cases and GUI wireframes.
• Responsible for creating a business process and workflow documentation using BPMN standards.
• Performed Data Analysis and Data Profiling using SQL queries.
• Wrote queries in Teradata for business elements on various dimensions according to business logic.
• Wrote test scripts for User Acceptance Testing (UAT).

Confidential, Eden Prairie, MN

Systems Analyst/Business Analyst

Responsibilities:

• Worked with the business users on Identifying the Healthcare Reform 3R's (Reinsurance program, Risk corridors, Risk-adjustment program) (PBM procedures) requirement and created the Functional specification for the same
• Created the Source to Target Mapping Document based upon the Business Rules to map the fields from Source System to the Target System UDW.
• Gathered requirements and modeled the data warehouse and the underlying transactional database.
• Created mapping and workflow to load the data from the external source to the Data Warehouse.
• Created BPMN Process Flow diagrams using MS Visio.
• Performed tuning and optimization of SQL queries using Teradata Explain.
• Worked on Agile SDLC during the project phase, performed the role of the team member in Scrum Meetings.
• Used UML Methodology to define the Context Diagram, Data Flow Diagrams (DFD), and Sequence Diagram
• Converted Business Requirements to the Functional Specification and Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Performed data quality analysis using SQL skills
• Documented Test Plans containing test scripts, test cases, and expected results for the User Acceptance Testing (UAT). Help Business Users during UAT testing Phase

Confidential, Troy, MI

Systems Analyst

Responsibilities:

• Gathered requirements from Business Owners, stakeholders, Data Governance Team, and the subject matter experts through meetings to understand the needs of the system.
• Gathered requirements for the transition of the project from a legacy system to the new data warehouse environment.
• Analyzed User Requirement Document, Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS).
• Proficient in preparing User Stories, Use Cases, Business Process Models by BPMN Framework, and Prototypes.
• Expertise in facilitating and conducting Joint Application Development (JAD) sessions with Business Clients to identify business rules, functional and non-functional requirements.
• Created functional flow diagrams, context diagrams, and other high-level diagrams for documenting the functionality of separate modules using MS-Visio and UML.
• Used SQL Queries to validate data in multiple sources and created data mapping document between existing data sources and proposed metadata
• Updated and remediate Teradata applications to reflect changing business data requirements.
• Designed and developed project document templates based on Agile/ Scrum methodology.

Confidential, Philadelphia, PA

Systems Analyst/Business Analyst

Responsibilities:

• Provide contract business analysis for a CRM initiative and in-house applications.
• Utilize Visio to model current and future state processes for the business areas affected by the CRM system replacement project.
• Facilitate requirement sessions with the business for the new CRM application.
• Responsible for creating a Request for Proposal to be delivered to the CRM solution providers.
• Create user stories and acceptance criteria for the re-platforming of a current system in preparation for grooming and refinement sessions.
• Conducted Use Case walkthroughs, and JAD sessions. various Use Case Diagrams, Sequence Diagrams, and Business Objects using MS Visio to describe Process Flow with PowerPoint Presentations.

Confidential, Morrisville, NC

Business Systems Analyst

Responsibilities:

• Involved in requirement gathering, understanding, and producing Business Requirement Document (BRD) and translating it into Functional Requirements (FRD) and Technical Requirement Documents (TRD).
• Documentation of Business and Functional Requirement Documents in compliance with FDA regulations
• Involved with subject matter experts in product markets and in providing vision and leadership to technology R&D efforts.
• Project managed scope and prioritization across workstreams across customer and R&D teams.
• Worked on business and technical requirements of user interface design to deliver a complete solution for all R&D initiatives.
• Facilitated JAD sessions with SMEs and Business Departments.
• Generated various Use Case Diagrams, Sequence Diagrams, and Business Objects using MS Visio to describe Process Flows with PowerPoint Presentations.