SUMMARY:

• An accomplished IT Professional with More than 6 years of experience as a Business Analyst in all phases of Software Development Life Cycle with solid understanding of Business Requirement Gathering, Business Process Workflow and Business Process Modeling.
•  Experience in Business Analysis, systems operations and systems analysis in the Healthcare, Medical Management, Insurance, Finance, Banking, IT/Service/Product, etc. environments. 
• Good understanding of health care industry, Claims Management process, Medicaid and Medicare Services.
• Proficient in all phases of Requirement Management, including gathering, analyzing, detailing, and tracking requirements.
• Worked with a client relationship focus to ensure full awareness of client business workflow, strategy, issues, requirement, and tools. 
• Experience in conducting GAP analysis, SWOT analysis, User Acceptance Testing (UAT), Impact analysis, Risk analysis and mitigation plan. 
• Involved in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation to assure that all aspects of a Project are in Compliance with the Business Requirements.
• Proven ability to analyze complex problems, identify risks and develop effective solutions to improve productivity, reduce cost and track progress through all phases of SDLC
• Strong experience in all phases of Software Development Lifecycle (SDLC) using Waterfall, Agile/Scrum, RUP (Rational Unified Process) and Software Testing Life Cycle (STLC).
• Expert in analyzing, elicitation and management of requirements. Highly experienced in creating Business Requirement Document (BRD) and Functional Requirement Specifications (FRS) document.
• Facilitated one on one interviews, Joint Requirement Planning (JRP) and Joint Application development (JAD) sessions
• Experienced in methodologies like Agile, Waterfall Model and Data Modeling; Creating Process mapping, Use Cases, Sequence diagrams, Activity diagrams
• Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements.
• Used SQL on TOAD to upload catalog updates
• Executed advanced level SQL queries to verify data integrity of the databases.
• Excellent knowledge and hands on experience with SSRS reporting systems.
• Experience with Trizetto's Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, and Utilization Management.
• Scheduled meetings and reinforced business analysis with developers, system analysts and testers to collaborate rescore allocation and project completion using MS Project.
• Have worked with SAS (Statistical Analysis System) Integrated system, particularly in the modules w.r.t. Data Analysis, Performance and Risk Management.

PROFESSIONAL EXPERIENCE:

Confidential,TX

Business Analyst

Responsibilities:

• Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
• Responsible for gathering the functional requirements for the health benefit claims receiving and processing system.
• Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD) and the Functional Requirement Document (FRD) using Rational Requisite Pro.
• Involved in Requirement Scoping and analyzing high priority requirement. Conducted sign - off meetings with IT teams to lock down the requirements.
• Created high-level Use Cases from Business Requirements and created UML diagrams like Use Case and Activity diagrams using MS-Visio.
• Involved in creating Business Flow Diagrams, Dataflow diagrams, UML Activity diagrams, Sequence diagrams, and USE cases diagrams using MS VISIO. 
• Conducting meetings with Subject Matter Experts (SME's) to understand the workflow of the business and their application processes. 
• Assisted the Project Manager in developing, tracking and managing the project triple constraint; schedule, cost, resources and scope using MS Project 
• Analysis of all the projects of past related to the functionality and come to one conclusion and then write the business scenarios for testing team. 
• Conducted JAD sessions to allow different stakeholders to communicate their perspectives with each other, resolve any issues and come to an agreement quickly.
• Tracked stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Involved with the Quality Assurance Team to develop and design test plan and test cases.
• Executed test cases and test scripts for manual and automation testing. Defects are raised in the HP Quality Center/HP ALM for logging, tracking and reporting bugs in the application.
• Conducted User Acceptance Testing (UAT) of the application with the QA team.
• Performed testing of the health benefit claims receiving and processing system to ensure that the system adheres to project standards, performance criteria, and functional specifications.

Environment: MS Office Tools, Windows XP, Facets, MS Project, SharePoint 2007, MS-PowerPoint, SQL, Agile framework

Confidential,RI

Business Analyst

Responsibilities:

• Conducted sessions with subject matter experts across teams in the United States and United Kingdom to understand their current Insurance Accounting and Reporting Systems.
• Analyzed the current insurance accounting and reporting systems and provided the management with key findings in People, Process and Technology.
• Conducted and facilitated many joint requirements, planning and brainstorming sessions with the business to understand their needs for the future global expansion.
• Defined frameworks for the application development and created Business Requirement Documents.
• Provided Confidential with a comparative analysis of the software products available in the market.
• Conducted Gap Analysis to provide Impact Assessment on various departments across the enterprise.
• Provided Confidential with a detailed project level road map in order to implement the new Insurance Accounting System.
• Conducted root cause analysis and implemented new business processes by defining data flows.
• Interacted with the Policy, Claims and Reinsurance departments.
• Devised business processes to eliminate the manual effort and automate the claims settlement process.
• Logged in issues in Share Point and assigned them to the necessary individuals.
• Used Rational tools such as RequisitePro for managing the requirements, Clear Quest for defect tracking and Rational Rose for documenting use case Modeling.
• Facilitated the User Acceptance Test.
• Developed the training material and Standard Operating Procedures (SOPs).

Environment: Rational tools (Rose/RequisitePro/Clear Quest), RUP, MicroSoft.Net, JAVA, Oracle, MS Word/PowerPoint/Excel/Project/Visio/SharePoint, Windows XP, UNIX.

Confidential,TX

Benefit Advisor

Responsibilities:

• Attend to all the customer calls, setting up appointment for enrollment, Fulfill customers’ needs and enrolling the customers in various health plans and schemes pertaining to their health care needs.

  Educating the customers about HRA with their benefit.

• Used consultative skills to assess the client's needs, determined the best insurance plan and assessed appropriate eligibility. 
• Effectively communicated costs and benefits of Medicare and Healthcare insurance plan via the telephone
• Perform daily researches and analysis of claims issues, verification, validation, reconciliation, routing and logging of patient claims, coding using Medicare for Medical Necessity and other Third Party insurance, Process a minimum of 10-15 claims per day and accounts for all claims in assigned batches. 
• Interpreted and applied varying guidelines across multiple insurance carriers to applicant-specific health scenarios.
• Making sure the customer understand difference between HRA and HSA.
• Assisting them in their transition.
• Providing customer service with clear and crisp communication and product knowledge.