SUMMARY:

• 6 years of total professional experience in Quality Assurance testing with web - based and standalone applications, with complete life cycle development of software projects.
• Extensive experience in testing client/server, Internet and intranet applications developed using J2EE Technologies and .NET Technologies.
• Highly skilled in creating and executing Manual and Automated test cases.
• Proficient in developing Test Plans, Test Strategy, Test Cases, Defect tracking and Defect metrics.
• Specialized in system study and testing Healthcare and Insurance applications developed on various technologies such as Facets, QNXT, J2EE, JSP, Java, SharePoint, VB.Net, Oracle and SQL Server on Windows NT/2000/XP and UNIX environments.
• Expertise in various testing methodologies like Black box testing,
• Experience in all types of testing including Functional, Integration, System, Regression, Positive, Negative, Database, Sanity and User Acceptance testing.
• Expert in HIPAA Transactions testing and in-depth knowledge of HIPAA framework (Health Insurance Portability Accountability Act) rules for ANSI X12 messages 837P/I, 835, 276/277, 270/271, 278, TA1 and 997 in 4010A1 Standards.
• Solid understanding of Membership, Claims Processing, Billing, Benefit/Eligibility, Authorization/Referrals, COB, and have experience in HIPAA standards and corresponding EDI transactions.
• Knowledge in different Databases like MS SQL Server, Oracle 10G/9i/8i.
• Good experience in PL/SQL.
• Experienced in interfacing with development teams to report bugs and track issues until resolution.
• Tested the HIPAA EDI transactions 834, 837/835, 276/277, 270/271 according to the requirement test scenarios.
• Experienced in performing Quality Assurance duties in an Agile Project Environment.
• Participated in QA Team meetings and walkthroughs.

TECHNICAL SKILLS:

Programming Languages: C, C++, Java, VB.NET, ASP.NET, VB 6.0

Operating Systems: Windows NT 4.0/XP/2000/ME/95/98, HP-UNIX, Linux

RDBMS: SQL Server 2000, MS Access 2000, Oracle 9i

Servers: IIS 5.0, Web sphere6.0, Windows 2000 Advanced Server

Scripting Languages: TSL, 4Test scripts, JavaScript, VBScript, Shell

Networking: TCP/IP, UDP, SOAP

Version Control: Visual Source Safe, PVCS Version Manager, MS SharePoint

Test Tools / Defect: QTP, Quality Center, SOAP UI, Rational Clear Quest

PROFESSIONAL EXPERIENCE:

Confidential, SFO, CA

EDI QA Analyst

Responsibilities:

• Defined the test criteria, project schedules and base lined the Test Plan with the help of project meetings and walkthroughs.
• Involved in testing HIPAA EDI Transactions.
• Expert level skill in Extraction, Transformation and Loading (ETL) in SQL Server database.
• Completed 5010 Gap Analysis and Impact Assessments on Business process, Application and EDI Transaction process for upgrade from 4010A1 to new 5010 HIPAA EDI X12 electronic formats.
• Extensively involved in Database testing by writing SQL Queries to extract data from various database tables for testing purpose.
• Analyzing 4010 and 5010 gaps and impacts across all transactions, system interfaces, applications and business processes.
• Tested the pricing and benefits configuration in Facets
• Tested the claims flow (Medical and Hospital) in Facets.
• Validated DRG codes, Procedure codes, capitation, Accumulators in Facets.
• Validated the claims status and overrides in Facets.
• Developed required SQL scripts for database testing using SQL and PL/SQL. Extensive experience in Database Testing on Oracle and SQL servers.
• Tested the COB (Coordination of Benefits) in Facets.
• Worked with claims batch process, external claims and Pended claims in Facets.
• Tested the enrollment of members in Facets
• Experienced in other RDBMS like Oracle (SQL, PL/SQL, Forms, and Reports).
• Tested the class, plan, products, group and sub-groups in Facets
• Tested the eligibility inquiry and enrollment in Facets
• Tested the subscriber and Member enrollment in Facets and association with class, plan and product.
• Created ETL test data for all ETL mapping rules to test the functionality of the Informatica Mapping
• Tested the ETL Informatica mappings and other ETL Processes (Data Warehouse Testing).
• Tested the COB carrier functionality and eligibility functionality in Facets.
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
• Worked with SQL server and functions to test the database integrity.
• Work on Logical Data Requirements and Physical Data Mapping for the Forward Data Cache a new Data Model designed for EDI transactions (270/271,276/277, 834 and 837) to cater to the new 5010 federal govt. mandated regulations.
• Tested the Web portals for Members/Providers.
• Worked with XML/SOAP/WSDL Web Services.
• Adhered data transition of the enrollment process, COB, Claim Status and Eligibility as per the EDI standard 834, 835, 837, 277 and 271.
• Worked with EDI transactions 837 - Claims and 835 Remittances and validated the claims.
• Tested and processed Institutional, Professional and Dental claims using EDI 837 I/P/D Transactions.
• Extensively worked on EDI 837I, 837P, 837D X12 file creations.
• Involved in EDI 834 (Enrollment) Testing.
• Validated the data coming from EDI/X 12 4010/5010 (837, 835) interfaces.
• Worked on EDI 270/271 for Eligibility Inquire and Response and 276/277 for Claims status.
• Worked with X12 /EDI transactions and validated the specifications/mapping for 837 transactions for Institutional and professional claims and 835 responses.
• All the test scenarios which have been satisfied with the functionality are moved to automation testing using QTP.
• Created tasks and workflows in the Task Manager and Workflow Designer respectively provided with Workflow Manager of Informatica.
• Performed data validation testing after the ETL process using Informatica.
• Tested the Cognos/BI reports.
• Tracked and Managed Defects using Quality Center.
• Backend testing of the DB by writing PL/SQL queries to test the integrity of the application and Oracle databases using TOAD.
• Used Visio for business analysis.
• Responsible for collecting and analyzing the test metrics and then submitting the reports keeping track of the status and progress of the testing effort.

Environment: Trizetto Facets 4.71/4.81, SharePoint, ASP.NET, VB.NET, EDIFECS Transaction Manager, EDIFECS SPEC BUILDER, EDI 5010/4010, ETL, Cognos, Informatica, Quick Test Pro 11.0, HP Quality Center 11.0, ALM, UNIX, XML, SQL, PL/SQL, Oracle.

Confidential, Providence, RI

EDI/ QA Tester

Responsibilities:

• Developed use cases, project plans and helped manage scope.
• Worked with TriZettos Facets Application Groups: Claims Processing, Customer Service, Guided Benefit Configuration, Medical Plan, Medical Provider Agreement, NetworX, Pricing Profile, Provider, Subscriber/Member, Utilization Management, Workflow Configuration.
• Worked with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 834, 835 and proprietary format files and Reports development.
• Run the SQL queries to fetch test data and backend (database) testing to validate the database.
• Worked with Database and XML messaging technologies.
• Tested the pricing and benefits configuration in Facets
• Tested the claims flow (Medical and Hospital) in Facets.
• Validated DRG codes, Procedure codes, capitation, Accumulators in Facets.
• Validated the claims status and overrides in Facets.
• Tested the COB (Coordination of Benefits) in Facets.
• Tested the enrollment of members in Facets
• Creating xml files to upload data to the database application.
• Used SQL tools like TOAD to run SQL queries and validate the data.
• Tested the class, plan, products, group and sub-groups in Facets
• Tested the eligibility inquiry and enrollment in Facets
• Adhered data transition of the enrollment process, COB, Claim Status and Eligibility as per the HIPAA standards.
• Worked with EDI transactions 837 - Claims and 835 Remittances and validated the claims in Facets.
• Tested and processed Institutional, Professional and Dental claims using EDI 837 I/P/D Transactions.
• Tested the ETL applications and ETL Process using Informatica.
• Wrote stored procedures and triggers in PL/SQL for managing consistency and referential integrity across data mart.
• Extensively worked on EDI 837I, 837P, 837D X12 file creations.
• Involved in EDI 834 (Enrollment) Testing.
• Validated the data coming from EDI/X12 (837, 835) interfaces.
• Worked on EDI 270/271 for Eligibility Inquire and Response and 276/277 for Claims status.
• Coordinated the upgrade of Transaction Sets 270, 271, 837 (I, P, D), 835 to HIPAA compliance.
• Extensive experience in Database Testing on Oracle and SQL servers.
• Work closely with EDI to ensure accuracy in data transmissions and shared processes. Transaction sets processed (837 (I, P, D), 997, 835, 271, 834).
• Analysis of inbound and outbound interfaces and extensions to Erisco Facets claims processing system.
• Created Test scripts for verifying the Informatica process as part of the Enterprise Data Warehouse.
• Tested the Data warehouse (ETL) applications using ETL tool Informatica.
• Assisted in building a business analysis process model using Rational Rose and Visio. Produced Visual models for the application using Rational Rose and created Use Cases, State diagrams, Sequence Diagrams and Activity Diagrams.
• Played a key role in the planning, testing, and implementation of system enhancements and conversions.
• Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
• Facilitated weekly meetings with the review teams to continuously improve the QA process for the application development.
• Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents.
• Conducted walkthroughs with the end users and stakeholders to gather the modification requests from the user to upgrade or change the business specification for the product.
• Performed Code Testing, Migration and Validation per SDLC standards.
• Created Test Scripts, Test Plans, Validation Plans and Testing Metrics Reports.
• Performed Functional, Integration and Regression Testing using QTP.
• Used SOAP UI to perform the test automation of Web Services.
• Analyzed data and created reports using T-SQL queries for all issued Action Items.
• Performed GUI testing, Integration testing, Regression testing, Ad -hoc testing, Negative testing, End to End testing, Load testing, User Acceptance testing.
• Wrote Test Scenarios, Test cases in excel sheet and imported them to Quality Center.
• Logged defects in Quality Center, re-tested defects, analyzed defect with Users and Developers.
• Involved in both automated and manual testing
• Involved in writing the positive and negative test cases.
• Played a key role in the planning, testing, and implementation of system enhancements and conversions.
• Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
• Analyzed the requirements corresponding to coding the insurance rules in various processes.
• Facilitated weekly meetings with the review teams to continuously improve the QA process for the application development.
• Conducted walkthroughs with the end users and stakeholders to gather the modification requests from the user to upgrade or change the business specification for the product.
• Followed a structured approach to organize requirements into logical groupings of essential business process, business rules and information needs.
• Assisted with product evaluation, product customization and system integration.

Environment: Facets 4.31/4.71, Oracle, MS Word, Windows XP, Jira, SQL, PL/SQL, Oracle, VB.NET, HTML, Mercury Quality Center 9.2, XML Spy, SOAP, SOAP UI, Web Services.

Confidential, Dublin, OH

QA Analyst

Responsibilities:

• Analyzed and defined testable requirements created and implemented test plans.
• Developed Test Cases/Conditions for manual and Automation testing of the above Applications and Reports.
• Gathered requirements from the users and analyzed the requirements.
• Involved in performing functional, application, integration, system, and regression Testing.
• Developed the Test Data for different Groups
• Communicated with development team to ensure testing issues are resolved
• Performed Screen Navigation Test to ensure that the links are established as per the documentation provided.
• Prepared and executed different SQL Queries against the Oracle and Sybase Database.
• Verified and Validated the Rates Calculations and Rate Renewal Calculations for different Products and benefits by Preparing and executing different SQL Scripts.
• Validate EDI Claim Process according to HIPAA compliance.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• Developed SQL scripts to supplement the ETL process and to verify on final target data.
• Created reports that included a general overview, open bugs, new bugs and enhancement requests. Entered new bugs and maintained the current status of those bugs.
• Responsible to work on Medicaid Management Information System which includes two divisions: HIPAA compliance and Maintenance units division and Claim processing division
• Maintained Test Matrix and Requirements Traceability Matrix. Performed Gap Analysis on the same
• Performed System testing, Integration testing and Usability testing in Quick Test Pro by inserting various check points necessary for HIPAA and Medicaid standards.
• Involved in testing web testing with automated tool SOAPUI.
• Developed data structures, ETL business rules, and associated metadata after implementation
• Performed Compatibility Testing against different browsers and versions.
• Used Quality Center for reporting defects.
• Used Quality Center to enter and Report defects for Rate Quote Remediation
• Prepared Application Testing Metrics Reports using MS Project.
• Prepared and submit the weekly test status reports to QA Lead and Manager
• Followed and Implemented the SDLC to improve the Testing Process and Efforts.
• Coordinated with the Business users, BA’s and Testers in order to perform UAT Testing.
• Interacted with Business users and BA’s regarding the Requirement Issues.
• Involved in Weekly Testing Status meetings with Testing Team and Weekly Rate Quote Task force meeting with Business Users and Developers.

Environment: HIPPA, EDI, Rate Quote System, Rate Quote Remediation, Mass Transfer, Quality Center, QTP, UNIX, Shell Scripts, Java, J2EE, Web sphere, Web Logic, TIBCO, MQ Series, PowerBuilder, ETL,, Visual Basic, MS-Windows, MS Project 2003, Sybase, Oracle, SQL Plus, Access, SOAP, XML, SQL, .NET