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Business Analyst Resume

Boston, MA


  • Nine years of experience in Business Analysis with expertise in gathering Business and IT requirements, conducting Gap Analysis during Requirement Gathering, Use Cases and writing Test Plans and developing database schemas based on logical models.
  • Health Insurance Background – Specifically related to collecting requirements, documenting and representing the business, Use Cases, Business process improvements, etc.
  • Adequate knowledge in Health Administration – Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans)
  • Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
  • Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
  • Proficient in MS Office Excel (pivot tables, vlookups, hlookups, macro), Access, PowerPoint, Visio.
  • Experienced with Medicare and Healthcare Insurance; as well as Medical Standards (HIPAA and HL7)
  • Extensive knowledge of, Software Development Processes, Design Patterns, Structured (SAD) and Object-Oriented Analysis and Design (OOAD) and UML.
  • Knowledge of 837, 835, 277, 270, 271, NCPDP, 4010, 5010 and ICD-9/ICD-10.
  • Highly skilled in documenting business and technical requirements along with UI wireframes.
  • Knowledge of electronic (HIPAA X12 standards-270, 271, 275, 276, 277, 278, 835, 837, and 997) and paper claim forms such as UB04, HCFA-1500, CMS1500, etc
  • Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
  • Have gained understanding and experience on data acquisition, data integration and data aggregation including experience working with data-feeds which included market data and internal feeds.
  • Extensive experience in writing Use Cases and UML diagrams.


Programming Languages: C,C++,C#,VC++,VB,VB.NET,C#.NET, ASP.NET, Java, SQL, PLSQL

Operating Systems: UNIX, Windows 95/98/NT/2000/XP, Linux.

Databases: MS Access, MySQL, SQL Server, Oracle, Teradata, DB2, Sybase

Application Servers: IBM Websphere, ATG Dynamo, BEA WebLogic.

Internet: HTML, XML, VBScript, ASP, JavaScript, JSP, J2EE.

Automation Tools: MS Visio, Rational Rose, Rational ClearCase, Rational RequisitePro, Documentum

Bug Tracking Tools : Mercury TestDirector, Rational ClearQuest

Utility Tools: MS Office Suite, MS Project, TOAD, Adobe Photoshop

Reporting Tools: Crystal Reports, SQL Server Reports (SSRS )

Data warehousing Tools : Informatica, Business Objects, Cognos, Erwin

Testing Tools: Quick TestPro (QTP), TestDirector, WinRunner, LoadRunner

Professional Experience:

Confidential, Boston, MA

Business Analyst

Confidential is a leading integrated communications provider offering voice and data services to small and medium sized businesses. The focus of the Project was to upgrade Confidential ’s IVR system by developing an application in Siebel Call Centre. This system would allow better call tracking and reduce customer response time.


  • Analyzed Business Requirements performed gap analysis and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
  • Scoped, analyzed, designed, tested, implemented a call center IVR/Genesys Voice Platform VoiceXML application to handle customer service calls
  • Captured and made executive presentations of the issues and risks inherent in as-is process for review by senior management. It included strategic recommendations for process improvements (re-modeling of Call Center) to enhance Member satisfaction leading to Member retention.
  • Involved in Performance Measurement to develop measurable indicators that can be systematically tracked to assess progress made in achieving predetermined goals.
  • Worked on a Java based web application used by the call center associates developed by Chordiant, on Java code base using the J2EE architecture.
  • Functioning also as a Voice Response Unit analyst by supporting the Genesys Call Center application.
  • Directed/Instructed/Maintained all call Center activities via consolidated reports from technical and managerial staff.
  • Trained End-users and customer service agents on the CRM (Customer Relationship Management)

Confidential, Milwaukee, WI

Business Analyst

Confidential Claims and Reporting software package promoted for automated reporting in health care facilities. In the formal SDLC environment and object oriented platform, automated reporting with secure data archiving of patient history and tracking. Information Management system has direct interface with the hospital management in additions. The claims and insurance details were processed at the health care facility for preferred insurance company. Project was implemented in accordance with the HIPPA guidelines.


  • Designing the Business Requirements Document and working with system developers to ensure that the requirements are effectively communicated and well understood.
  • Working within a growing knowledge of X12 4010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
  • Written Business Requirements Documents (SRD), including Functional and Non-Functional requirements.
  • Captured and made executive presentations of the issues and risks inherent in as-is process for review by senior management. It included strategic recommendations for process improvements (re-modeling of Call Center) to enhance Member satisfaction leading to Member retention.
  • Prepared User Acceptance Testing test plans and conducted UAT Testing. Also prepared user reference documentation.
  • UAT testing performed along with call center managers to make sure that application meets their requirements.
  • Worked with the development team during the Design, Build and Test phase of system projects to clarify system requirements as required.
  • Established traceability matrix using Rational Requisite Pro to trace completeness of requirements in different SDLC stages.
  • Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
  • Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
  • The HIPAA component efforts included mapping and gap analysis of legacy claims formats, CMS 1500 and UB92 to 837P and 837I.
  • Assisted quality assurance team to functional-test the new HL7 interfaces always keeping in mind HL7 and HIPAA guidelines, and coordinated user acceptance testing using derived test data
  • Prepared the functional test cases and performed the functional testing of the application using mock and live data at the back end.
  • Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
  • Used JAD sessions, and one-on-one meetings to identify business and System Requirements, and documented using Use Case Modeling, Process Flow diagrams and documentation.
  • Worked on EDI transaction 835 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
  • Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
  • Managed and organized requirement coverage, Test Case Management and Defect Management using Mercury Quality Center.
  • Wrote Test Cases in Mercury Quality center that would test various Test scenarios.
  • Clarified QA team issues and reviewed test plans and test scripts developed by QA team to make sure that all requirements will be covered in scripts and tested properly.
  • Prepared PowerPoint slides of all the outcomes with the focus on defects and presented to the team of Business Analyst
  • Worked with SQL queries using MS Access for data manipulations.

Environment: Windows XP professional, MS Office suite, MS Project, ReqPro, UNIX/Oracle Platform, XML, OOAD, Oracle Pl/SQL, MS Visio, RUP 2002, Rational Rose 2002, Rational Clear Quest 2002, Enterprise Architect, Rational Requisite Pro.

Confidential, Towson, MD

Business Analyst

Confidential, a part of Emdeon Business Services, is a leading provider of healthcare data management, analytics, decision support, process automation and related information technology and innovative business intelligence solutions that help governmental and commercial healthcare payers improve patient outcomes, enhance market position and reduce costs. Confidential serves commercial and government clients, from large health plans, major managed care organizations and global pharmaceutical organizations to leading federal agencies and contractors in supporting the claims-processing demands of Medicare contractors, The Centers for Medicare and Medicaid Services (CMS), and various state and federal agencies. Worked on some challenging CMS projects for Medicare including DME Medicare Administrative Contractor (DMAC) Migration for Beneficiaries, National Provider Identifier (NPI) implementation, and X837 Co-ordination of Benefits (COB) crossover claims


  • Worked with development team during technical design to maximize test support and Involved in Test Inspection and executed the test scripts for Connectivity to backend and positive and negative testing.
  • Prepared Test plans which includes an introduction, various test strategies, test schedules, QA teams role, test deliverables, etc.
  • Used Test Director to detect defects, communicate to the developers and tracking the defects.
  • Participate in the assessments of various technical design sessions to provide details during the development process and assure those detailed technical specifications match the business’ functional specifications
  • Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
  • Designed and developed Project document templates based on SDLC methodology
  • Created DTS Packages for migration of data between MS SQL Server database and other databases like MS Access, MS Excel and Flat Files.
  • Created the SQL scripts for demonstrating the prototypes and for verifying the result sets
  • Produced UML Activity diagrams with defined swim lanes using MS Visio as part of claims process analysis
  • Responsible writing Test Plans, Test Cases and Test Scripts using manual and automated testing tools from Rational and Mercury Interactive such as test Director, Winrunner.
  • Involved in creation and execution of manual test cases in Mercury Test Director and automated Test Cases in QTP and analyzed the Test Results.
  • Wrote Test Cases in MS Excel for user registration, access to training material, and activity log-in, reviewed the test cases and finalized
  • Created User Acceptance Test Plan and coordinated UAT for the site redesign project
  • Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
  • Provided clear and concise documentation regarding requirements management plans, Functional Requirements, supplemental Requirements, Test Plans and Test Cases.
  • Used Rational Rose to designed and develop Use Cases Scenarios, Use Cases Models, Activity Diagrams, Sequence Diagrams, State chart diagrams, OOAD using UML
  • Responsible for writing Test cases to cover overall quality assurance using Test Director
  • Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
  • Performed Unit Testing and User Acceptance testing (UAT) and documented detailed results.

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, OOAD, Rational Rose, Cognos, Rational Requisite Pro, MS Office, SQL Server, MS Project, MS FrontPage 2003, MS Access, Oracle.

Confidential, Huntsville, AL

Business Analyst

Responsible for systems and applications start-up of FCHP a hospital-based community health plan (payer). Responsible for the Claims Adjudication System; Managed Care application training for all departments; administration of control files, formulary, provider demographic, provider payment, enrollee maintenance, benefit configuration (Claims Systems Processing,) fee schedules, capitation schedules, data warehouse, on-line pharmacy (over 200 pharmacies) claim and benefit troubleshooting, ID cards, and system generated Plan correspondence design and maintenance.


  • Interaction with underwriters to understand multiple data points. Prepared data flow diagrams using MS Visio for better clarity and to ensure documented process
  • Researched the existing client processes and guided the team in aligning with the HIPAA rules and regulations for the systems for all the EDI transaction sets.
  • Responsible for business system analysis of customizing the BPS Risk Management product with involvement through the whole SDLC
  • Wrote Test Plans in MS Word for Manual Testing, Business Testing, Integration Testing, Performance Testing, Regression Testing & reviewed their consistency with the business requirements.
  • Used MS Visio for Process modeling, Process mapping and Business Process flow diagrams.
  • Gather final requirement and draft the BRD and Business Data Flow Diagrams
  • Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access.
  • Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
  • Conducted and Managed JAD sessions with SMEs and Business departments, for planning and Requirements Gathering.
  • Developing Test Plan with a Test Strategy for the System testing. Instrumental in creating design and frame work for automation.
  • Rational ClearCase was used to manage all the changes and change requests in the projects. Worked with QA team with the aid of ClearQuest for the bug tracking and Mercury Test Director for Test Case Management.
  • Wrote Test plan and Test cases for the Integration testing and system testing.
  • Create and maintain requirements, test cases and defects in Mercury Quality Center
  • Develop change management procedures for implementing requirement changes and/or enhancements and consistently tracked the requirements status throughout the project life cycle.
  • Translated Business processes into Informatica Mappings for building Data marts
  • Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
  • Involved in manual testing and UAT with the development team and QA team.

Environment: Rational Rose, Clear Quest, Microsoft Project, Requisite Pro, Erwin, ReqPro, Microsoft Visio, Microsoft Office suite, Business Objects, ETL, Oracle Pl/SQL, OOAD, Enterprise Architect, Windows

Confidential, Columbus, OH

Business Analyst

Confidential, through its operating group Confidential, is a leading provider of short-term post-acute medical care and rehabilitation and long-term skilled nursing care as well as leading in hospice and home health care. The project involved streamlining and enhancement of the legacy claim management system to meet the needs for the next decade by enhancing our ability to automate and streamline claims processing and other administrative functions and to provide access to quality health services to members and provide responsive services to network health care providers and reducing costs to state partners. The application under testing automates an Insurance and Pharmacy Claims Process from the time a customer enters a claim to the time when the claim is either approved or denied.


  • Involved in all phases of software development life cycle in RUP framework.
  • Analyzed, documented, and managed all project requirements and changes to requirements throughout the software development lifecycle using RequisitePro.
  • Involved in technical design/analysis indicating the input data sets, sorting and merging techniques to get the required report.
  • Created test cases and scenarios for Unit, Regression, Integration as well as Back-end, GUI and Black box testing.
  • Assisted to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
  • Elicit the Requirements through various activities such as interviewing, brainstorming, conceptual prototyping
  • Responsible for building a Business Analysis Process Model using Rational Rose and Visio.
  • Participated in UAT and worked with Mercury Quality Center for bug and defect tracking.
  • Conducted user interviews, attended JAD (Joint Application Development) sessions, and documented analysis in requirement gathering.
  • Created advanced Excel reporting models via the use of VLOOKUP statements and Pivot tables
  • Assisted the project manager in preparing the project schedules, milestone tracking, resource allocation using MS project.

Environment: Rational Rose, Requisite Pro, Rational Clear Case, Feasibility Analysis, Risk Analysis and Gap Analysis, RUP, UML, SQL, MS-Office, MS Project, MS Visio

Confidential, Jacksonville, FL

Business Analyst

Confidential is a leading health care payer serving more than six million subscribers in the FL area. Extensively worked on the Modules like EDI Gateway and Claims Processing application group which enables to record, process, track and run inquiries on hospital and medical claims, Customer Service group of applications allows you to administer and channel inquiries about practitioners and facilities. The inquiries for the Members are entered through the EDI system using 270/271 and 276/277 transactions. Claims are entered through the 837 transactions. Working as a test specialist, my responsibilities included analyzing the requirements, ANSI Implementation guides and testing the EDI jobs to ensure compliance and correctness.


  • Requirement Gathering and Analysis, understanding functional needs, creating Technical Business Requirement Document. Developed Use Cases, Use Case Diagrams, Activity Diagrams, and other UML artifacts. The project utilized a RUP-inspired methodology.
  • Drafted Business Requirements Documents, Business Requirement Specifications, Business Work Flow Diagram, Use Case Diagram, Data Flow Diagram, Cross Functional Diagram to represent Business requirements.
  • Troubleshooted file transmission problems and assisted customers in a call center environment with EDI and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation guides (837P, 837I, 837D, 270/271).
  • Directed/Instructed/Maintained all call Center activities via consolidated reports from technical and managerial staff.
  • Prepared Business requirements Documents (SRD) and got sign off to be used by the developers.
  • Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
  • Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
  • Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
  • Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
  • Worked on Claims Processing per Medicaid Management Information Systems (MMIS) 42 CFR 433.
  • Facilitated user acceptance testing and test strategies with Information Systems Group.
  • Came up with test cases from the requirements, validated/exercised those test cases in form of integration and regression tests. Used Test Director to map the requirements with test cases (automated/manual), used QTP for automated testing.
  • Manually verified the validity of the failed test cases. Performed Positive, Negative and Black box testing on the application
  • Analysed the business and functional requirements of the application and developed detailed test plans, test cases in Test Director.
  • Developed Test cases for manual testing and automated them using Win Runner, Silk, Load Runner, Silk performer and QTP.
  • Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
  • Migrated Data from MS Excel to SQL Server Reporting Service Using DTS and SQL loader utilities.
  • Gathered user requirements for new reports through JAD/JAR sessions, which eliminated duplicate and obsolete data and provided a uniform reporting environment across the multiple trading desks.
  • Checked all messages/transactions for compliance with ANSI X12 4010 formats including 270 Eligibility/Benefit Inquiry, 271 Eligibility/Benefit Information, 276 Claim Status Request, 277 Claim Status Response, 834 Benefit Enrollment, 835 Remittance Advice.
  • Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
  • Participated in documenting the requirements those were critical to the business process and used those requirements in system design based on a Use Cases, Use Case Diagrams and Activity Diagrams.
  • Authored test plans, test cases for various test scenarios and helped testing team to better understand the test scripts.
  • Performed task decomposition, delegated tasks and monitored project milestones using MS Project.
  • Worked extensively with Microsoft Excel (Macros, VLOOKUPS, and Pivot Tables). Proficient Microsoft Word, PowerPoint, Access and Lotus Notes.

Environment: MS Office, MS Visio, Rational Requisite Pro, Rational Rose, Rational Clear Case, Rational Clear Quest, Quality Centre, ReqPro, RUP Methodology, Oracle Pl/SQL, OOAD, MS Project,

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