SUMMARY

• Highly skilled Benefit configuration business Analyst and Software QA Analyst with 6+ years of progressively responsible project experience, seeks business analyst position to drive through business and bring improvements in the process.
• Experience in coding and testing of health care application involving Client benefit changes, claims processing, coverage determination, appeal processing for Medicare, Medicaid and other commercial health programs.
• Strong domain knowledge in Health Care, Banking and Insurance, Claims Adjudication System, Pharmacy Benefit management (PBM) system, Benefit Configuration, Membership, Provider and Billing related application .
• Expertise in Software Development Life Cycle (SDLC), Software Testing Life cycle (STLC), Methodologies and Test processes, Business analysis and documentation.
• Proficient in GUI testing of Web based and Client - Server applications
• Experienced in Develop Test Scenarios and execution of Test plan, Defect tracking and Reporting
• Good knowledge in diverse industries such as e-commerce, Insurance, Finance, Retail, mobile application
• Good knowledge in Analyzing and developing Requirement Document and preparing Traceability matrix
• Knowledge in working with Web Services using SOAP UI, JMeter tool to validate XML request and response using different methods.
• Experienced with testing tools such as HP Quality Center, ALM, Quick Test Pro(QTP) and UFT, Load Runner testing client/server and web based applications
• Good experience in Automated testing Tools UFT, QTP, Load Runner, Quality Center, JIRA.
• Knowledge in regression testing, data driven testing, UAT (User acceptance testing), Integration testing, Unit Testing, Smoke testing, Functional testing, Performance Testing etc.
• Good knowledge in back end testing of Oracle & SQL Server databases to check the Integrity of data
• Knowledge in Validation Source and Target database in ETL process
• Working experience in Mobile application testing
• Experienced working on an Agile team environments
• Knowledge in UNIX / Linux, FTP ( file transfer protocol ), Executing shell scripts
• Proven ability to support multiple projects under Tight Deadlines often with competing priorities and complexities
• Excellent verbal and written communication skills and highly effective in interfacing across business and technical groups.
• Experienced in working in onshore/offshore model and teams located across different geographical locations.

TECHNICAL SKILLS

Tools: & Languages: Quality Center, JIRA, Load Runner, UFT, QTP, ALM, EZ Query++,EZTest, Soap UI, As-400, File-Aid, Toad Data point, JMeter, Putty, Selenium Visual Basic, JAVA, Testing Script Language (TSL), VB Script, SQL, PL/SQL, (T-SQL)

Data Base: SQL Server, MS Access, Oracle via Toad Data point

Business Area: Claims, PBM, HIPAA 5010, Membership, Provider, Benefit Configuration, EDI ICD-10 code, HCPCS and CPT codes, Utilization Management, Member Pricing, Patient Pay system.

Business Applications: Salesforce, AS-400,MS Word, Excel, Outlook, PowerPoint, Visio, Lotus Notes, MedHOK, Clinical Authorization System (CAS,) Enterprise Systems, Pharmacy Online Processing Systems (POPS), Citrix, SAP

Operating Systems: Windows 98/NT, Windows 2007& 2010 Windows XP, Mainframes and UNIX, VMware

Web Services: SOAP, RESTFul, SaopUI Tool, XML

PROFESSIONAL EXPERIENCE

Confidential, Cranston, RI

QA Tester

Responsibilities:

• Create to test scenarios, test plan, and Test cases.
• Performed Functional, Regression, Smoke testing
• Validated and test by crosschecking data in backend
• Execute test cases in Jama and track the defect in Jira.
• Working as a UAT(alfa testing) tester in preproduction
• UAT (beta testing)in production environment with stake holder
• Translation testing in both Spanish and Portuguese in CRM software
• Intersystem / External Interface testing
• Involve to find out bad (invalid) data in DHS data base and clear them from production environment.
• Communicate among different stake holders and member to release application to the production
• Involve to create daily status report to the client on day-to-day basis.

Environment: JAMA/JIRA,IBM CICS ADABAS, COBOL and Natural programming languages on an MVS/ZOS platform, Excel, Access, MS Outlook, Oracle

Confidential, Lincoln, RI

QA

Responsibilities:

• Worked in Agile environment, attended daily stand up meetings, SCRUM meetings.
• Business requirements development and reviews(User Stories) with Account manager, Team lead, and coder
• Developed test scenarios/test cases based on user stories
• Written test scenarios, test cases, testbed generation and raise defects
• Performed Smoke testing, Functional, Regression, Sanity testing, Smoke Testing and User Acceptance Testing.
• Performed Functional on AS-400 system to check the real life Adjudication at pharmacy working as per SLA
• Performed system testing for pharmacy requirement
• Validated tests by crosschecking data in backend
• Performed Regression testing
• Communicated with Pharmacist team to resolve the issues about drugs(NDC,GPI, UM etc)through SFDC
• Participated in defect management activities through identifying, logging and re-testing using Salesforce
• Participated defect triage meetings and assigned severity and priority to defects based on risk assessment and worked with developers to resolve issues.
• Coordinated and work with offshore team to provide them information as per their requirements and activities

Environment: As-400, Excel, Access, MS Outlook, Windows, Salesforce (SFDC), EZ Query++

Confidential, Shrewsbury, MA

QA Tester

Responsibilities:

• Worked on preparing test strategy, test plan, and Test cases.
• Involved in system requirement analysis phase to ensure requirements adequately cover users prospective.
• Involved in Functional, Regression, Sanity Testing, Smoke Testing, Integration testing and User Acceptance Testing.
• Involved in writing automated test scripts using UFT to support regression testing and functionality of the application
• Learned application business requirements, technical specification and installation guidelines.
• Developed test scripts to automate process of testing in Soap UI.
• Participate and executed test cases for major program modules.
• Performance and Load testing of web applications using Load Runner.
• Performed usability, GUI, Functionality and regression testing of the new builds.
• Identified application defects to minimize number of steps to reproduce the problem.
• Performed browser (IE, Firefox, Chrome, Safari) and platform (Windows 7/Vista/ XP) compatibility testing in virtual machine environment.
• Worked on HP ALM to write manual test cases, executed them and Logged defect on both ALM and JIRA.
• Involved in Understanding user stories in each sprint and creating scenarios in each sprint.
• Providing daily status report to client on day-to-day basis.
• Worked in Agile based environment working from sprint to sprint.

Environment: JIRA, HP ALM, UFT, Soap UI, Load Runner, SQL Server, Visual studio 2010, Oracle, PL/SQL, C++, Java, VB, VB Script, UNIX, Excel macros, and Windows NT/2000

Confidential, Lincoln, RI

Appeals Representative

Responsibilities:

• Reviewed incoming requests and determined the nature of the appeal for Medicare part D member.
• Channeled misdirected requests to the appropriate department.
• Researched in member benefits and check claim history in different systems (MedHOK, PeopleSafe, CAS & As400) to validate the incoming appeal request.
• Processed member appeals and initiated claims overrides as necessary following CMS guidelines.
• Maintained internal provider database updates Atena for billing and mailing addresses based on correct NPI numbers during provider letter generation process.
• Communicated with physicians, pharmacists or other external agency to complete appeal review process

Confidential, Lincoln, RI

Prior Authorization Representative

Responsibilities:

• Received inbound Prior Authorization requests via phone/fax from members, providers and pharmacies to review and respond.
• Communicated with providers and pharmacies to clarify details and resolve issues and complete member coverage determination.
• Followed CMS guidelines using CAS and AS 400 system to process Medicare part D prescription drug requests.
• Processed claims in PBM system and ensured authorizations are accepted on critical cases to meet SLA.