We provide IT Staff Augmentation Services!

Sr. Qa Analyst Resume

Basking Ridge New, JerseY

PROFESSIONAL SUMMARY:

  • 8 years of Software Testing and Quality assurance of Client/Server and Web based applications focused on Manual and Automated Testing of GUI and functional aspects of the Client - Server and Web based Applications
  • Experienced with testing Facets.
  • Experienced with TriZetto Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management, Enrolment and Billing
  • Proficient with Testing methodologies, Test Matrices and Traceability Matrix.
  • Good working knowledge in Enrollment, Billing, Claims, CMS regulation, HIPAA regulations, ACA regulations, EDI 834 enrollment and 837 claims transactions for health care industries.
  • Proficient in analyzing the BRS (Business Requirement spec), SRS (System requirement spec) and FRS (Functional requirement spec) for preparing and documenting test plans/test rules, test cases and executing test cases for both manual and automation testing.
  • Extensive experience in Functional testing, Integration testing, Regression testing, User Acceptance Testing (UAT), GUI testing, Back-end testing and Ad-hoc testing, System Testing.
  • Strong Knowledge of all aspects of the Agile methodology of SDLC Good Knowledge in Healthcare Transaction, EDI HIPAA X12 transactions (837,835,834,270/271,276/277) Inbound and Outbound 837 Institutional, Professional, Dental and Pharmacy Claims.
  • Experience in EDI testing and Inbound/Outbound Claims testing.
  • Expertise in Test Process, Test Scenarios, Test Scripts, Test Case Designing and Defect Tracking.
  • Experience maintaining Test Cases, Scenarios and Requirements in Quality Center.
  • Experience in Testing HIPAA X 12 4010/5010.
  • Involved in Smoke Testing, Integration Testing, System Testing, Regression Testing, User Acceptance Testing(UAT), GUI Testing, Performance and Database Testing, Production Validation and Audit.
  • Clear understanding of Medicare and Medicaid benefits as well as business processing.
  • Experience executing manual test cases and doing Adhoc testing, Black Box and White Box testing.
  • Experience in uploading test cases from MS Excel to Quality Center.
  • Experience with healthcare systems, Medicaid with prime focus on claims adjudication, Provider Eligibility and Prior authorization.
  • Experience in an Agile Methodologies with Scrum.
  • Proficient in manual and automated testing of applications on Windows and Unix environment
  • Very good experience in Back-End Testing using SQL on UNIX and Windows platform to validate the consistency of data.
  • Extensive experience in testing Facets applications mainly in Provider, Group, Subscriber/Family, membership and billing.
  • Experienced working with 5010 transactions changes analysis, design and migration strategy
  • Strong knowledge of MMIS (Medicaid Management Information System), and healthcare reforms like the Patient Protection and Affordable Care Act (PPACA).
  • Developed Test cases for and automated and executed them using Quality Center 10, HP ALM and Quick Test Pro
  • Experience in developing SQL statements and queries for Oracle Sybase and
  • Extensively used Quality Center to write Test Cases and for reporting. All the Scripts are maintained using Quality Center/ALM.
  • Extensively uploaded test cases from MS Excel, MS Word to Quality Center.
  • Experienced in Bug Tracking System and Process.

SOFTWARE SKILLS:

Testing Tools: Quality Centre10, HP ALM, Bugzilla, Quick Test Pro, Rational Clear Quest, CTP, Rally, Omega

Databases: Oracle, MS Access,DB2,PL/SQL

Languages: C++, Java, .Net

GUIs: Facets 5.01/4.71/4.51 , Sales Force

Operating Systems: Windows, Linux, Unix, Android and Sun Solaris

Packages: MS Office, MS Project, Lotus notes

PROFESSIONAL EXPERIENCE:

Confidential, Basking Ridge, New Jersey

Sr. QA Analyst

Responsibilities:

  • Created test plans and test cases for enrollment, eligibility and claims in ALM.
  • Worked on the E2E testing team specializing on Claims and TPL Claims.
  • Also worked on verticals like Member Management, Portals.
  • Worked on 834’s EDI files in Ultraedit and processed them into Electronic Enrollment in Facets through Omega interface.
  • Worked on Daily reports of effectuation 834 against outgoing 834s.
  • Validating the EDI data to rebuild 834 that were errors out by compiling on HIPPA Compliance check.
  • Ingest of all inbound 834 and outbound 834 into EDI repository tool daily.
  • Created 837 I/P/D/V EDI files and load to the facets through batch process.
  • Validated the benefits and business rules are applying correctly.
  • Analyzed the different portals like individual, Providers and SMA that the Member Details and claims are populating correctly.
  • Validated the claims on different modules like Supplemental mapping, Dental Benefits, Fee Schedules and Subrogation claims.
  • Develop SQL queries that validate business requirements and source to target mapping within the data warehouse.
  • Worked on Integration workflow displaying interaction with other systems consisting of MMIS (Medicaid Management Information System), Medicare Claims Processing Systems and other Healthcare Systems at State, Federal level as well as Third Party Companies.
  • Worked for maintaining dual eligibilities for members with Medicaid and Medicare with support of the Medicaid Management Information System (MMIS).
  • Validated the following 835 (Health Care Claims payment) 834 (Enrollment/Dis-enrollment to a health plan).
  • Performing quality assurance functions covering the full software development life cycle, including development and implementation of test plans, test infrastructure and project plans.
  • Follow the department software development life cycle (SDLC) and adhere to standards and best practices in the department
  • Worked in both Waterfall and Agile methodologies.
  • Attended in bug review meetings, Status reporting meeting.

Confidential, Basking Ridge, New Jersey

Sr. QA Analyst

Responsibilities:

  • Worked on creating application and processed those in the back end to validate the Applications are picked for the Mass health Benefits.
  • Experience with scenarios like addition of dependents, change of member details like SSN, First Name, Last Name and address change like Zipcode, street address and city name.
  • Performed GUI Testing and Back end testing.
  • Worked on different modules like the Failure to Reconcile (FTR) and Periodic Data Matching (PDM) as the part of the HIX project.
  • Validated the new features deployed for the MA HIX.
  • Validating Periodic Data Matching will pick up and re-determine members of tax households whose FTR Override time clocks expired at predefined intervals.
  • Develop SQL queries that validate business requirements and source to target mapping within the data warehouse.
  • Worked on Integration workflow displaying HIX interaction with other systems consisting of MMIS (Medicaid Management Information System), Medicare Claims Processing Systems and other Healthcare Systems at State, Federal level as well as Third Party Companies.
  • Engaging in refining Reporting on front-end on metrics aspect from MMIS and HIX for executive review.
  • Performing quality assurance functions covering the full software development life cycle, including development and implementation of test plans, test infrastructure and project plans.
  • Follow the department software development life cycle (SDLC) and adhere to standards and best practices in the department
  • Involved closely with Customers, product teams to understand the scope of new features, develop Test plans, Test Strategies and test cases.
  • Worked in both Waterfall and Agile methodologies.
  • Attended in bug review meetings.
  • Tested security test and audit test for this particular system. Performed Black Box, functional testing, end to end testing for world points system.

Confidential

QA Analyst

Responsibilities:

  • Wrote test cases based on different deliverables such as PRD, CSD, and TTD for the finalized claim files (FCF), Intertele processing systems, EOB, and Intertele processing reporting.
  • Worked on both user acceptance testing (UAT), system integrations testing (SIT) and end to end testing.
  • Worked on enrolling subscribers using TCAM tool to generate the claims for subscribers.
  • Transferred the claims to the IKA claim processing system to adjudicate the claims using Facets.
  • Verify the connectivity testing between ABCBS, IKA and the plan connextion (PX) with all data and naming convention.
  • Validated 750 fields in the IKA FCF file together with IKA UI and lay out specification provided by the ABCBS.
  • Created data set, generation data groups (GDG) and job control language (JCL) in the main frame to execute EOB jobs for IKA
  • IKA medical claims
  • VSP vision claims
  • Local dental claims
  • Validated the EOB raw file in different enrollments of IKA claim processing system like stage, G- region, and H- region.
  • Validated the EOB pdf file generated by the printing shop with the template approved by the CMS.
  • Attended daily defect triage meeting, daily score card meeting, weekly test execution status report meeting and ITS claims & ITS report status meeting.

Environment: SQL,NASCO Mainframe,Facets,Ultra Edit 21.20,MS-WINDOWS,IKA Staging, IKA Test G, IKA Test H, Quality Center 10.0,11, TCAM, Rational Clear Quest, Windows, EOS, DN3 server

Confidential, Albuquerque, NM

QA Analyst

Responsibilities:

  • Executed Test Plans and Test Cases manually and automatically to verify the Functionality of the application against the expected results.
  • Worked in validating the loops of EDI transactions 834, 835 and 837.
  • Hands on experience working on complete end to end EDI claim lifecyle.
  • Extensive testing experience with Members enrollment, Member services, Premium billing, Provider management, Claims processing, Provider reimbursement and Claims adjudication.
  • Performed Gap Analysis, updated report layout and documented the changes.
  • Tested the Claims, Members, subscriber and Providers in Facets. Used Quality Center (HP ALM) for preparing the Test Plans and manual Test scripts.
  • Reported Defects using Quality Center (HP ALM).
  • Verifying the Member’s Eligibility and review information about the member’s benefits in FACETS.
  • Validated and worked on different loops and segments of 834 file.
  • Monitoring the defect life cycle, generating customized graphs and reports for the client, using Quality Center (HP ALM).
  • Used Quality Center (HP ALM) to record documenting information useful in debugging process, evaluating test data.
  • Experience in HIPAA 5010 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim status), 834(Benefit enrolment), 835(Payment, 837(Health care claim).
  • Performed Backend Testing by writing SQL statements to review the returned data to ensure that the correct data was retrieved for EDI transactions.
  • Worked on direct submissions to electronically submit enrolment (834) data.
  • Assisted with planning resources activities and monitor day-to-day progress, making adjustments as needed for the successful completion of tasks.
  • Worked in enrolling subscribers using Subscriber/ Family sub application of Subscriber/Member in FACETS.
  • Worked in creating claims electronically using batch jobs
  • Hands on Experience in creating groups using Groups sub application of Subscriber/member application of facets 5.01.
  • Performed manual testing of 834 enrolment file and 837 claims file in FACETS 5.01.
  • Worked on Medical plan application for different newly added Products using FACETS.

Confidential, Hartford, CT

QA Consultant

Responsibilities:

  • Worked on various releases of this project.
  • Involved in leading, guiding & monitoring the analysis, design, implementation & execution of test cases, procedures & suites.
  • Involved in Planning, monitoring and control of testing activities & tasks. Attended detailed design sessions with Client on EDI 276/277 Transactions and the 277 family (277 CA, 277U)
  • Hands on experience developing Test Plan, Test Requirements, Test Cases and detailed test cases in Quality center.
  • Involved in developing Functional Test Scripts from requirements to test the EDI X12 837, 835, 834, 276/277/277CA/277U Batch and Real Time Transactions.
  • Developed Scenarios for the Functional testing of processing Batch Transactions and LOB’s for Split claim prior to Member Validation.
  • Involved in testing Mainframe applications.
  • Performed manual and automation testing.
  • Experience in developing test cases for 5010 EDI transactions. Identified the scenarios based on business requirement and HIPAA compliance for each transaction such as 837, 835 and 276/277.
  • Performed the testing Analysis for the transition to EDI X12 5010.
  • Hands on experience testing 837 Claims for Billing and Payment, 834 Claims for Benefits Enrollment and 835 Claims for Pre-adjudication.
  • Involved in scheduling the test execution & then monitoring, measuring, controlling & reporting the test progress, the product quality status & test results.
  • Performed Web testing, Smoke, Functional, Regression, System Integration testing.
  • Analyzed the member/eligibility information on claim to that in FACETS.
  • Prepared and created Test cases/ Test data according to different requirements.
  • Worked extensively with Clear Quest for defect management.
  • Analyzed the inbound and outbound interfaces and extensions to Trizetto FACETS claims processing system.
  • Experience in System and UAT testing of the FACETS core application and custom modules as needed.
  • Claims validation in FACETS application which includes claims pending status, member status and Enrollment.
  • Analyzed error messages and investigated defects.
  • Along with the functionality testing of IBU, tested the functionality of Small Group Renewals as different users such as Underwriter, Producer, Managing Agent, Sales Representative, Internal User, Consumer, HPA, DBM as per requirements.
  • Interacted with Business Analysts and Developers to address quality problems.
  • Created & reviewed Requirement Validation Matrix.
  • Coordinated with planning team to complete all the projects within the release time.
  • Participated & organized meetings with other testers, developers, leads, managers & written meeting minutes.
  • Provided full UAT support to ensure that the business receives the support needed to adequately test the functionality & correct processing.
  • Involved in the Review of Requirements Specification with technical specialists of the application.
  • Involved in understanding the current business process and in defining scope of the project.

Environment: FACETS 4 .71, Rational Clear Quest 7.1.2.0, Mainframe, SQL Advantage, MS Access, SQL DBX, Sybase, HTML, XML Spy, Ultra Edit, WinScp, FTP Pro, Unix through Vitria, Connecture, MS Office.

Confidential, Danville, PA

QA Analyst

Responsibilities:

  • Responsible to insure that EDI Process is HIPAA (Health Insurance portability and Accountability) compliant and worked on ANSI X12 standards.
  • Analyzed URS & Functional Requirements Specifications to understand business rules of application.
  • Identified the scenarios based on business requirement and HIPAA compliance for each transaction such as 837(Claim) and 276/277 (Claim Status).
  • Developed all operational and technical flows using MS Visio and involved in the creation of Business Architecture Document to provide an overview of different aspects of the application.
  • Actively participated in creating requirements traceability matrices, Test Scenarios, Test scripts and Test Cases.
  • Experience with EDI transactions like EDI 834 (Benefit Enrollment and Maintenance), 276/277(Health Care Claim Status Request and Response), 835(Health Care Claim Payment/Advice) and 837 (Health Care Claim: Professional, Institutional and Dental).
  • Documented test cases corresponding to business requirements and other operating conditions.
  • Used RUP Methodology.
  • Created and executed scripts in QTP for Functionality testing.
  • Executed automated test cases in QTP through Quality Center and reported defects.
  • Responsible for back-end testing/database testing, which was done using SQL queries
  • Maintained and executed test cases and test scripts using Rational Clear Quest.
  • Reported the bugs, Email notifications to the developers using the Rational Clear Quest.
  • Provided Support services for Centers for Medicare and Medicaid Services (CMS)
  • Performed Data mapping, logical data modeling.
  • Created test plans and test cases for Mainframe application.
  • Used SQL queries to filter data within the database tables.
  • Involved in Data Selection for testing the EDI Load Process: backend process for loading and processing the data received through EDI and manual process as per Business Rules.
  • Preparation of Traceability matrix.
  • Participated in Testing using SQL queries on SQL Server tables and generating reports to ensure data integrity.
  • Performed UAT testing with client and supported all phases of testing with QA team and managers
  • Facilitated and co-coordinated all User Acceptance Testing activities

Environment: SQL, Quality Center, QTP, Windows, Mainframe, Excel, Outlook, PowerPoint and Word, MS Visio, Rational Unified Process (RUP), UML, Use Case Diagrams, MS Office.

Hire Now