SUMMARY:

• 7+ years of diverse experience in Information Technology with emphasis on Business Analysis, EDI Quality Assurance, Manual, Functional testing, System Testing of Web and Client/Server based applications in Healthcare Insurance industry.
• In depth knowledge of the Business process development using Software Development Lifecycle (SDLC) Waterfall, AGILE and Testing using Software Testing Lifecycle (STLC).
• Highly skilled in System Integration Testing (SIT) and User Acceptance Testing (UAT) using black box techniques.
• Specialized experience in Healthcare Insurance domain.
• Good Knowledge in Healthcare Transactions, EDI HIPAA X12 Transactions(837, 835, 834, 270/271, 276/277)Inbound and Outbound 837 Institutional and Professional Claims.
• Possess strong knowledge of Healthcare Terminology and extensive experience working on healthcare projects.
• Profound understanding of insurance policies and proven experience with HIPPA 4010, 5010 EDI X12 transaction codes such as 270/271 (inquire/response healthcare benefits), 276/277 (Claim status), 278 (Services Review/Authorization Transaction), 834 (Benefit Enrollment), 820 (Payment/remittance advice), 837 (Claim).
• Broader understanding of EDIX12 837 transaction system and routines.
• Processing mechanism of 10 & 5010) transactions, custom mappings, segments & translators etc.
• Proficient in HIPAA& inbound claim load jobs, 835/837 related outbound jobs.
• Worked on healthcare standards such as HIPAA Compliance and ICD 9 standards.
• Proficient in Defect tracking and reporting tools like Clear Quest, Mercury Quality Center/ALM and Test Director.
• Experience in working with databases such as SQL Server, MS Access, Oracle, Sybase, and writing SQL queries for Back - end Testing.
• Excellent Problem Solving and Analytical skills, quick learner and capable to perform well under pressure.
• Maintain excellent communication skills in working with both technical and non-technical team members.
• Able to work in a multi-team environment with people from diverse cultural backgrounds.

PROFESSIONAL EXPERIENCE:

Confidential, Hartford CT

QA Analyst/EDI Analyst

Responsibilities:

• Mapped EDI 837, 835, 834 files from legacy system to the new system to facilitate the claims adjudication process.
• Prepared Knowledge Transfer and Business Process Documents containing the features and use of each module of a product.
• Defined project scope and assisted the project manager in creating the business case and project plan.
• Analyzed and synthesized results from Joint Application Development (JAD), proposed alternative tasks and transformed those into Business Requirement Document (BRD).
• Developed business flow diagrams, Activity/State diagrams and Sequence diagrams using MS Visio so that developers and other stakeholders can understand the business process.
• Performed GAP analysis of 5010 EDI transaction using implementation guide to identify the changes in segments and data elements
• Actively analyzed current business processes Claims, Recipient eligibility and enrollment.
• Involved in Claim Validation process for all the business fields ( Commercial, Medicare and Medicaid)
• Well acquainted with every phase of Validation Life Cycle (VLC) and Software Development Life Cycle (SDLC).
• Prepared Validation Summary Report to provide a summary of the validation activities.
• Conducted the training sessions for new team.
• Used Ultra Edit to extract data for member data mapping.
• Created sample claims using Claim Creation Tool.
• Co-ordinated with Project Manager, Business and Subject Matter Experts (SME’s) to complete testing and validation activities.
• Co-ordinated with Offshore testing team, Data analytics team and Business team.

Confidential, DC

QA Analyst

Responsibilities:

• Draft High-Level Test Scenarios, Test Cases, Test Scripts, execute test scripts Manually as well as through UFT to analyze outcomes according to the business rules/requirements.
• Coordinate detailed E2E Test Cases and design steps walk-through and ensure sign-off by stakeholders.
• Setup/prepare target test environment such as getting access to the required tools/applications as well as the locations.
• Experience with test setup, defect management and maintenance in HP Quality Center/ALM.
• Produce daily and weekly testing status reports and communicate to management.
• Identify project applications and business areas to be involved in testing.
• Import test cases to and from MS Excel, MS Word to and from Mercury Quality Center/ALM.
• Participate in weekly meetings with the management team and walk-throughs.
• Test applications; document the results and bugs, including documentation of information useful in the debugging process.
• Perform back-end testing to validate the data using SQL queries
• Generate the test execution report in Mercury Quality Center/ALM to be reviewed by the QA Manager and development team.
• Design DatabaseQueries to support reporting and analysis using MS Access.
• Write SQL queries and perform Back-End Testing for data validation to check the data integrity during migration from back-end to Front-end.
• Perform Requirement Traceability by setting automatic alerts for tracing changes in the requirements and system maintenance.

Confidential, Dayton, OH

Business Analyst

Responsibilities:

• Healthcare applications interoperability testing for applications interconnected through Biztalk server orchistrations.
• Configured product to meet client technical and operational requirements
• Assisted Project Manager by creating project charter, scope and schedule.
• Used Jira for tracking Bugs.
• Worked in tandem with other teams of BAs, developers and testers throughout the entire development life cycle to manage requirements and build the final business requirements document.
• Created Traceability Matrix to validate and track the client requirements, test cases and the defects.
• Responsible for creating documentation, plans and presentations for all levels of leadership, including senior executives.
• Design and documented test cases and scenarios as per the applications requirements.
• Performed requirement analysis, went through all the use cases and workflows Analyzed the business requirements and technical specifications

Confidential, Virginia Beach, VA

QA Analyst

Responsibilities:

• Involved in all phases of Software Test Lifecycle activities.
• Responsible for Manual as well as Automation Testing.
• Automated test scenarios for GUI, Functionality and performed Data Driven Testing on the application inserting different data in excel sheet using
• Conducted Functionality Testing during various phases of the application using QTP
• Responsible for user acceptance testing, functional testing and regression testing
• Developed SQL Queries in SQL server as per the request from the business team.
• Wrote SQL queries in TOAD to perform Backend testing.
• Managed IVR quality assurance (QA) which included the creation and documentation of test scenarios, test cases, scripts, testing, UAT and perform internal QA activities on IVR releases.
• Extensively involved in managing defects using Clear Quest and interacted with the DEV Team in resolving critical and high-risk defects.
• Assisted in development and tested new software products usingIBM Rational Test Suite.

Confidential, Richmond, VA

QA Analyst

Responsibilities:

• Analyze business requirements and functional specs by performing requirement and design walkthroughs with business users and business/system analysts respectively.
• Worked on different modules of EZEnroll, Web based application to validate new members are able to create the account profilewith their Username/Password, Providers are able to select different claims based on their needs, claim submission process, claim review process, claim processing workflow, claim approval confirmation workflow.
• Imported test cases from MS Excel, MS Word to Mercury Quality Center.
• Imported test cases from Mercury Quality Center to MS Excel or MS Word.
• Backend Testing using SQL Scripts.
• Participated in weekly meeting with the management team and walkthroughs
• Tested applications and documented results and bugs including documentation of information useful in the debugging process
• Performed back-end testing to validate the data using SQL queries
• Generated the test execution report in Mercury Quality Center to be reviewed by the QA Manager and development team.

TECHNICAL SKILLS:

Testing and Bug Reporting: HP Quality Center/ALM, JIRA, Team Foundation Server (TFS)

Automation Tools: QTP/UFT, N-Gen Validator, 83x File Generator

Programming Languages: SQL, VB Script

RDBMS: MS SQL Server, Oracle, MS Access, DB2

Web Technologies: HTML and XML

Operating Systems: Windows XP/7/NT/2000/98, UNIX, AS/400

MS Office Tools: Word, Excel, PowerPoint and Visio.

Web Browsers: Internet Explorer, Netscape Navigator/Communicator, MS Lync 2010, Mozilla Firefox

Methodologies: Agile, Waterfall

Other Tools: Encoder Pro (OPTUM), ScanPlus, ClarEDI, Tidal, Trello, Aqua Data Studio, Visual Studio