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Business analyst / Pharmacy Benefit Management Resume

Jacksonville, FL

SUMMARY:

  • Highly motivated and result oriented with 8 years of industry experience as a Sr. Business Analyst with Guidewire CalimsCenter / Prorperty & Casualty Reinsurance / Insurance industry.
  • Strong organizational, communication, leadership, planning and vendor management skills.
  • Excellent knowledge of industry standard methodologies like Software Development Life Cycle (SDLC), Project Life Cycle, Rational Unified Process (RUP) and Capability Maturity Models (CMM).
  • Experience in conducting Gap Analysis, and documenting AS - IS and TO-BE business processes.
  • Excellent Analytical skills to understand the business process and Functionality, Requirements and to translate them to system requirement specifications. Developing functional specifications for business process refinement and automation, data modeling, system architecture, conducting feasibility studies, scope.
  • Diverse experience in Property and Casualty, Underwriting, Guidewire, Rating, Reinsurance and Life Insurance.
  • Strong experience in Data Analysis, Data Modeling, Data Mapping, Data Profiling, Data Migration, Data Conversion, Data Quality, Data Governance, Data Integration and Metadata Management Services and Configuration Management.
  • Excellent Business writing skills in creating Business Requirements Document (BRD), Use Case Specifications, Functional Specifications, and Systems Requirements Specification (SRS).
  • Expertise in co-coordinating between Top Management, Program Managers, Project Managers, Systems Developers and Business Sponsors for project implementation.
  • Excellent Team player works in conjunction with testing, development and other teams in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects.
  • Experienced in SQL Server Reporting Service (SSRS), Executing Queries and Running Stored Procedures.
  • Managed the implementation of ImageRight (a paperless solution) for the Reinsurance Claims Division -- oversaw and planned the "Go Live" process training.
  • Expert in the Property, Casualty, Annuities, Disability, and Supplemental Insurance policies include administration, sales, customization, Claims, pensions and CMS.
  • Experience in facilitating Joint Requirement Planning (JRP) sessions with Business User Groups, conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.
  • Worked extensively with Guidewire software including ClaimsCenter, Claims administration, building center.
  • Extensive experience in developing Use Cases, creating Screen Mockups, conducting Gap Analysis and Impact Analysis, SWOT analysis, Cost Benefit Analysis, Risk Analysis.
  • Effective at conducting meetings and brainstorming sessions.
  • In depth knowledge Rational Unified Process (RUP) methodology, Use Cases, Software Development Life Cycle (SDLC) processes, Object Oriented Analysis and Design (OOA/D).

TECHNICAL SKILLS:

Programming Languages: C, C++, HTML, XML, SQL, JAVA

Data Base: MS Access, Oracle (SQL Series), DB2Project Management: Microsoft Project, Microsoft Office, OLAP Crystal Report

Operating Systems: MS-DOS, Windows95/98/NT/2000/XP, Apple McIntosh, Linux

Software: MS Office Suite(Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes

Performance Testing Tools: Virtual User Generator, Load Runner

Processes/Technologies: Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint 2007, Agile, Scrum.

Automation Tools: Requisite Pro, Win runner, QTP, Test Director, Quality Center

PROFESSIONAL EXPERIENCE:

Confidential, Atlanta, GA

Sr Business Analyst

Responsibilities:

  • Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose.
  • Utilize the guidelines and artifacts of the Agile Methodology to develop a detailed imple-mentation process FirstBest UMS PolicyCenter Integration during different iterations and phases in Software Development Life Cycle (SDLC).
  • Develop and maintain strong relationships with surety underwriters and oversee a book of contract and commercial Surety business within defined territory to capture business re-quirements.
  • Created Requirement description document to include the business requirements, technical requirements, non-functional requirements and error handling based on the analysis performed while creating the Process flows.
  • Elicited, documented, modeled, validated and prioritized functional and non-functional requirements using interviews, data analysis.
  • Prepared Business and Functional specification document related to Data Mapping, Data manipulation and enhancement of existing document by gathering information from vari-ous levels of users.
  • Responsible for investigation, analyzing, and managing all necessary underwrit-ing/accounting/work flow issues, within framework of Surety policies and procedures.
  • Performed Integration testing, System testing, Regression testing and Performance testing of BillingCenter and Payment manager in Guidewire application based on the business requirements using LISA.
  • Worked closely with Rating team in identifying rating gaps versus UW guidelines.
  • Designed Rating architecture that allows system to auto quote based on Underwriter guide-line.
  • Responsible for preparing Commercial Surety Rating Specifications.
  • Gathered Product Backlog on the traditional Billing system and newly integrated BillingCenter and carefully elaborated application enhancement specifications detailing in scope/out of scope items, as-is/to-be process maps and critical test scenarios.
  • Work closely with production underwriters to review commercial Surety insurance renewal and new business opportunities to ensure proper risk identification, analysis and assessment and the development and growth of a profitable portfolio of business.
  • Frequently used Requirements Traceability Matrix (RTM) for identifying and tracing the lin-kages among PolicyCenter and BillingCenter.
  • Involved in Data validation in both front end and back end risk management reference center.
  • Frequently used Requirements Traceability Matrix (RTM) for identifying and tracing the linkages among BillingCenter.
  • Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
  • Interacting closely with functional teams and end users on critical issues
  • Created use case scenarios and documented work flow and business process using Rational Rose
  • Involved in project management using MS Project
  • Assigned tasks among development team, monitored and tracked progress of project fol-lowing Agile methodology.
  • Examined various bottlenecks and points for automation to streamline the policy processing, underwriting and pre- and post-sales process.
  • Worked on Requirement Change Management System in Rational Requisite Pro
  • Documented requirements associated change requests with requirements and connected requirements with Use cases.
  • Created screen mock-ups and performed User Acceptance Testing to ensure they met all design requirements.
  • Project initiative was also to replace the legacy Claims Case management system, ACES Mainframe 3270, with a customized version of the JAVA-based, Guidewire application, Claim Center 3.1, implementing the Agile/SCRUM methodology.

Confidential,Trenton, NJ

Sr. Business Analyst

Responsibilities:

  • Working with integration requirement with Docs and Forms, Claims, Rating, Customer Data Hub, Risk Report, Portfolio management, Policy Service, Analytical systems and defining rules and requirements for online Sales portal.
  • Performed the role of a primary Intermediary between the Subject Matter Experts, business user and technical SME's to identify the business needs, Business Rules, Business Processes & Interface Specifications for the New Claims module and Claims Assignment Module.
  • Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose.
  • Performed routine checks on Property and casualty loan litigation and negotiation processing activities as well as received reports from team members on selected Claims applications.
  • Utilize the guidelines and artifacts of the Agile Methodology to develop a detailed implementation process Guidewire ClaimsCenter Integration during different iterations and phases in Software Development Life Cycle (SDLC).
  • Prepared Business and Functional specification document related to Data Mapping, Data manipulation and enhancement of existing document by gathering information from various levels of users.
  • Garnered technical prowess on Change Management by performing Impact Analysis for Change Requests obtained during Claims processing lifecycle.
  • Performed the requirements elicitation, analysis and impact analysis, and documented the functional, non-functional, data and report requirements for Customer Registration, Quote, Rating and Premium Calculation, New Business, Endorsements, Renewals, Miscellaneous Adjustments, Billing, Payments and Claims
  • Prepared requirements document for Commercial Auto, Crime, Worker's Compensation, Umbrella, Business Owners Policy, Commercial Output Policy, and Commercial Property Package.
  • Worked on Commercial lines Property and Casualty Insurance including both policy and claims processing and reinsurance.
  • 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.
  • Regular updates of Forms, Tables in Underwriting and Claims System as per the IRDA Regulations of Insurance and Reinsurance business.
  • Greatly reduced number of errors previously found by client prior to StoneRiver Claims combining illustration & underwriting/new business systems under one account manager and one business analyst.
  • Conducted current state study which included data collection methodologies, data quality and dataintegration problems, data storage and infrastructure related issues.
  • Worked on Guidewire BillingCenter with the Personal line, Test Definition workshop, Test Strategy, Test Planning using Insurance Test Framework for Guidewire.
  • Work closely with production underwriters to review commercial property insurance renewal and new business opportunities to ensure proper risk identification, analysis and assessment and the development and growth of a profitable portfolio of business.
  • Captured requirements for for Guidewire BillingCenter application.
  • Performed custom data conversions and developed custom software for risk management applications including commercial insurance, life insurance, etc, tracking. Perform all data field mappings.
  • Diverse experience in Property and Casualty, Underwriting, Guidewire, Rating, Reinsurance and Life Insurance.
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
  • Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
  • Created and validated business process models using techniques such as system flow diagrams context diagrams, data flow diagrams, activity diagrams, that include modeling of all the activities of the business from the conceptual to procedural level.
  • Managed General Liability, Commercial Property, Commercial Package, Commercial Auto and Workers Compensation policy lines
  • Interacting closely with functional teams and end users on critical issues
  • Created use case scenarios and documented work flow and business process using Rational Rose
  • Involved in project management using MS Project
  • Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
  • Worked on the commercial property and casualty domain and made specific changes to the same for the smooth flow of the process.
  • Electronically and manually relate dwelling fire, umbrella, boat owners, inland marine and mobile home polices as requested.
  • Examined various bottlenecks and points for automation to streamline the Claims processing, underwriting and pre- and post-sales process.
  • Worked on Requirement Change Management System in Rational Requisite Pro
  • Documented requirements associated change requests with requirements and connected requirements with Use cases.
  • Wrote test cases and test scripts for the User Acceptance Testing
  • Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
  • Created Test plans, Test Cases, Test Scenarios as per the specs for data warehouse testing as well as web testing.
  • Worked on Guidewire Auto Policies on Submission/ Policy Changes/ Renewals/ Cancelation.
  • Created screen mock-ups and performed User Acceptance Testing to ensure they met all design requirements.
  • Used Requisite Pro for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level
  • Used Rational Clear case for version control
  • Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Claims Management Systems, Payables/Receivables and Claims processing.
  • Performing Web Testing, User Interface Testing, Negative Testing, Positive testing, User Acceptance Testing and Baseline Testing.

Confidential, Jacksonville, FL

Business Analyst /Guidewire

Responsibilities:

  • Design Visio process flowcharts for the enhanced Customer Complaint Handling System. Prioritize documentation schedule for multiple projects.
  • Provide data workflow, including legacy system profiling, mapping of data, documentation of business rule validations, and reconciliation of historical Claims data for an enterprise integration of Guidewire BillingCenter.
  • Worked as Test Automation Architect on the GuideWire Core BillingCenter & PolicyCenter for Both Commercial Lines and Personal Lines.
  • Acted as primary liaison between the client departments and the Information systems IT department to perform analysis, review, and estimation of client requests, prepared and reviewed requirements and client documentation for Personal Lines Property and Casualty business.
  • Conducted functional and technical requirement gathering sessions with Stakeholders, Underwriting Managers and Operations Analysts for the Policy, Claims and Point-of-sale related modules.
  • Developed mapping spreadsheets for ETL team with source to target data mapping with physical naming standards, data types, volumetric, domain definitions, Transformation Rules and corporate metadata definitions.
  • Managing workers compensation claims and determining compensability. Develop and managing Claims resolution.
  • Expertly performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the proposed system for Treaty and Facultative Reinsurance.
  • Provide support across different domain areas such as Auto Assignment, Payments, Claims Documentation, and Appointment Logs, Auto Estimations, Fire Claims etc.
  • Proactively collaborating with business users and the IT technical team to analyze information needs and requirements to deliver the following artifacts as needed: Functional requirements, Business Requirements Document (BRD), Use Cases, Screen and Interface designs.
  • Created complex integration diagrams (Sequence, Component & Activity) to visualize Business Process and their interaction with interfacing systems.
  • Wrote Business Cases for the Stakeholders to understand the functioning of the new Underwriting System.
  • Provide direction for developers within the Commercial Lines Property and Casualty rating, rules, and coverage form by creating specific algorithm logic based on a specific line of business rules.
  • Eliciting requirements from business users, through interviews, document analysis, JAD sessions, business process descriptions, use cases, scenarios, and task and workflow analysis.
  • Created test plans and test cases for implementation testing of Guidewire BillingCenter.
  • Documenting business rules updates in policy, assumed, retro and accounting modules ofreinsurance system.
  • Involved in testing/implementing insurance Billing applications using Guidewire BillingCenter Product.
  • Senior level SQL query skills (Oracle and TSQL) in analysing and validating SSIS ETL database data ware house processes.
  • Conducted Joint Application Development (JAD) sessions with IT teams to identify changes, and participated in Stakeholder Meetings to communicate the same
  • Responsibility to identify new commercial insurance program opportunities for reinsurance partners.
  • Created Business Context Diagrams, Business Process Diagrams, Activity Diagrams, Sequence Diagrams using UML methodology.
  • Additionally, worked with the PMO to Create, Baseline and manage other projects within the Smart Grid Initiative
  • Responsible for making data model, Use Case Diagrams and Class Diagrams using UML.
  • Researched problem items and made the necessary adjustments to avoid buy-ins.
  • Created Use Cases, Workflows, and Screen Shots for the Application.
  • Responsible for gathering requirement for Data Warehouse for Umbrella insurance reports module.
  • Developed the business and functional requirement specification describing and prioritizing of the requirements.
  • Researched and processed complicated excess reinsurance claims.
  • Prepare graphical depictions of use cases (activity diagrams, system context diagrams, sequence diagrams, use case diagrams, wire frames/mockup screens, etc.).
  • Followed top down, leveled technique for building Business Process Models
  • Identified and documented issues, risk and gaps, their descriptions, their impact and provided recommendation and alternatives to develop the application to meet the user requirements
  • Performed Sanity testing, System testing, Functional testing, Integration testing, Web testing, and GUI testing.

Confidential,Hartford, CT

Business Analyst / Guidewire

Responsibilities:

  • Gathered business requirements through interviews, surveys, and observing from account managers and UI (User Interface) of the existing Portfolio Risk Management System.
  • Acted as a liaison between client and internal Developers to design software applications for Commercial Line Insurance such as Workers Compensation, Commercial Property, General Liability and Commercial Auto.
  • Worked on Commercial lines Property and Casualty Insurance including both policy and claims processing and reinsurance.
  • Worked as a Personal line of Property and Casualty Expert for interface to Insurer Business Partner on all facets of system design.
  • Involved in designing logical and physical Data models and wrote Business and technical metadata as well as prepared source to target data mappings documents in excels.
  • Understood and articulated business requirements from user interviews and then translated those requirements into functional and technical specifications.
  • Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Claims Management Systems, Payables/Receivables and Claims processing.
  • Prepared requirements document for Commercial Auto, Inland Marine, Crime, Worker’s Compensation, Umbrella, Business Owners Policy, Commercial Output Policy, and Commercial Property Package.
  • Involved in the creation for Manual Raters for One Shield Personal Lines homeowners product.
  • Worked with other Business Analysts on integration requirements with Guidewire ClaimsCenter.
  • Gathered business requirement for Property and Casualty related to Exposure Rating Model and completed on time.
  • Facilitated the User Acceptance Testing (UAT) with Pega System Administrators and Business Users, documented any issues or defects and eventually got sign off from the right parties.
  • In addition, we also provide comprehensive solutions for our P&C commercial lines customers through our Insurity unit.
  • Worked on data modeling and produced data mapping and data definition documentation.
  • Review and editing full system requirements documents, working with design and QA team to plan for full development of new commercial P&C insurance Claims issuance, rating and financial systems and enhancements.
  • Developed and facilitated reinsurance training for field claims professionals.
  • Completed the Inception phase for ClaimsCenter and the project plan for all onfiguration and integration needed.
  • Conducted Joint Requirements Planning (JRP) sessions with management, SME’s (Subject Matter Expertise), vendors, users and other stakeholders for open and pending issues to develop specifications.
  • Implement and maintain Property & Casualty (e.g. bug-fix, data integration, version release) systems of assigned customers.
  • Developed departmental reporting process for tracking monthly reinsurance claims activity.
  • Designed Use Cases, Use Case diagrams, Class diagrams, Activity diagrams, Sequence diagrams in UML methodology using Rational Rose.
  • Worked in mainframe environment and used SQL to query various reporting databases.
  • Involved in Joint Application Development (JAD) sessions with the IT Group.
  • Held group meetings, walkthroughs and supervised/trained other analysts.
  • Responsible for creating Bordereau report on a monthly basis for reinsurance broker.
  • Developed and maintained relationships with clients on all on-going projects.
  • Involved in writing Test Cases and developing strategies with Quality Assurance group to implement them. Efficiently responded to client inquiries and resolved discrepancies. Identified, prioritized, tested and proved essential business functions to assure compliance with vendor and internal auditing.
  • Participated in System Testing along with testers. Conducted UAT with the business.
  • Collaborated with Quality Assurance Analyst in Rational Clear Quest to track defects and used Rational Clear Case to maintain consistency in the builds.

Confidential,PA

Business Analyst / Pharmacy Benefit Management

Responsibilities :

  • Help create requirements and enhancements with business stakeholders, SME's, and de-velopers. Elicit, define, document, and manage all requirements to create BRD. SRP and obtain stakeholder approval.
  • Conduct in-person/ online interview sessions with various stake holders to solicit their visions/ requirements about the opportunity/ initiative at hand.
  • Analyzing the internal and external processes, dependencies, interfaces and mapping them to specific business needs, objectives and desired functionalities.
  • Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
  • Experienced in conducting requirement analysis, use case design, designing test plans and developed database schemas based on the logical models.
  • Experienced in conducting User Acceptance Testing and coordinating with the UAT par-ticipants to get the change requirements.
  • Strong communication skills when working with developers, project managers, subject-matter experts, stakeholders, system implementers, and application end-users.
  • Dedicated self-motivator with the abilities to multitask, provide thorough analysis of da-ta, and problem solve.
  • A team player with strong experience in leadership, organizational, verbal and written communication skills & working with culturally diverse teams as well as offshore-onsite teams.

Confidential,Louisville, KY

Business Analyst

Responsibilities :

  • Responsible for rating multi-line policies. Manual rated Property, Liability, Auto and Workers Compensation policies. Conducted training classes for Auto and Workers compensation rating.
  • Responsible for elaborating Billing Center configuration user story such as Invoicing rules, Delinquencies, Claims Cancellation, Automated disbursements, Claims Rewrites, Claims Reinstatements, Billing Parameters, Fees, and Payment distribution rules, etc
  • Responsible for elaborating Billing Center integration user stories such as Integration to Agency Management system, Process commission payment via Enterprise Payment Services, Integration to commission management center, BC to PC custom integrations, etc.
  • Writing user stories for Business Process Flow, System Integration Testing based on the Configuration requirements of Guidewire Policy Center for Personal Auto LOB.
  • Analyzed standard industry practices of back office applications of Insurance Company, underwriting and claims administration with the help of Subject Matter Expert.
  • Speaking customers with inquiries and changes to homeowners and automobile insurance policies via telephone or written correspondence.
  • Worked on Guidewire Policy Center for Policy creation and maintenance using different Policy Transactions for Auto and Property (including Homeowners).
  • Worked with the business users and product owners to modify/add requirements to address multiple enhancements that are needed to fix any issues with previously implemented functionality in Billing Center
  • Analyzed scope of the Edge project was to create a Web-based application for agents to submit and maintain commercial insurance claims.
  • Marketed and sold personal auto, home, umbrella, and related property and casualty insurance coverage.
  • Design and Develop application flow as per business requirement
  • Participated in backlog grooming sessions to identify user stories for future sprints. Analyzed the backlog in order to place all user stories in most effective and accurate sequence
  • Conduct demo/conference pilot sessions to present both custom and Out of the box Billing Center functionality to business
  • Create process flowcharts for various issues in Billing Center functionality and help perform gap analysis
  • Conduct Agile Scrum Meetings to review the day to day progress when Scrum Master is out of office
  • Worked with the Billing Representatives team on various customizations on the Billing Screen
  • Participate in requirement walkthroughs with the Dev and QA teams with the aim to develop testing strategies and test plans such that test cases reflect user needs
  • Assist the QA team by reviewing test cases and clarifying requirements to ensure complete coverage of requirements
  • Execute smoke testing and review results to ensure the major functionality is working as per the requirements.

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