SUMMARY

• Having 9+ years of professional experience in IT Software in the field Software testing& quality with proficiency in mainframe, web, Client server and manual testing.
• Extensively worked with Claims Processing (Professional Claims, Institutional Claims, Dental Vision and Hearing Claims) and EDI Business Process.
• Involved in analysis, and executing the Test Cases.
• Good Experience working with Confidential - NPS system.
• Good Experience working with Confidential - Applications such as - HIQK, HRBK, HRRK, HURK, HSSK, TPOL and EFDE.
• Good Experience working with CPL(Central Product Library) system.
• Very Good Understanding of Provider System and Pricing.
• Very good Knowledge of the PDM - to Write/Update the CSR’s.
• Good interaction with developers, managers and team members to coordinate job tasks
• Demonstrated ability to work as a team player as well as an Individual.
• Extensively involved in Unit Testing, System Testing, Integration Testing, User Acceptance Testing, Regression Testing
• Strong problem solving capabilities with Good communication skills with a proven track record of success.
• Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) Standards.
• Extensively worked with Claims Processing (Professional Claims, Institutional Claims, Dental Vision and Hearing Claims) and EDI Business Process.
• Experience with EDI and Good Knowledge of Gentran and MQ series.
• Excellent knowledge of Confidential claims systems.

TECHNICAL SKILLS

Testing Skills: Manual Testing and Mainframe

Operating System: Windows98/2000/NT/XP,OS/390,AS400,Vision Plus

Languages: C,HTML,SQL

Data Base: Oracle 9i

Mainframe Technologies: EDI

RUP - Technologies: Rational Rose, Rational Robot, Clear Quest

Products: EFDE,SCRIPTING

PROFESSIONAL EXPERIENCE

Confidential

UAT Tester

Responsibilities:

• Performed Testing on the CPL system - creation of test claim data on CPL and involved in preparing test case documents and test plan documents.
• Conducted UAT testing for multiple projects on CPL system.
• Validated benefit inventories for multiple projects with the CPL front end plan configurator and Benefit Query.
• Documented the results in the test case templateand logged the defects in Clear quest, retested and closed the defects after defect fix by CPL development team.
• Extensive knowledge of CPL front end system and attended daily defect calls.

Environment: CPL Plan configurator, CPL Benefit Query.

Confidential

Test Specialist

Responsibilities:

• Performed entire Testing on the NPS system - creation of test claim data and involved in preparing test case documents
• Conducted Baseline, Regression and parallel testing for ICD9 and ICD10 claims using HIQK, HEHK, HRBK, HBEK
• Analyzed current particulars, sub-particulars, and column coding that could potentially impact to the current code
• Documented the results in the approved templateand issue log
• Extensive knowledge of HIQK, HEHK, HRRK, HURK, HRBK, TPOL, HBEK, Benefit file Mnemonics, Procedure and Diagnosis Files

Environment:  NPS, HRBK, HIQK, HEHK, TPOL, HURK, HBEK

Confidential

Test Lead

Responsibilities:

• Involved in Analysis of the Requirements documents
• Participated in the meetings with the ICD10 Test team.
• Involved in System Integration Testing.
• Extensively worked with the test team.

Environment: & Tools: Confidential - HIQK, HEHK

Confidential

Test Specialist

Responsibilities:

• Involved in Analysis of the Requirements documents
• Performed entire Testing on the NPS system – from preparation of test case documents.
• Extracted / Tested in Model Office with test data
• Conducted testing for Benefit changes - based on the Benefits provided in the form of BIF’s, NAEGS.
• Documented the results in the approved Test Grid template

Environment: & Tools: Confidential – NPS, Benefit File – HRBK, HIQK, HEHK, TPOL, EFDE, HZMK, HRRK

Confidential

Systems Analyst

Responsibilities:

• Involved in Analysis of the Requirements documents
• Performed entire Testing on the NPS system – from preparation of test case documents, identification and documentation of the functional test scenarios, creation of test claim data and involved in preparing test case documents
• Conducted regression testing for ICD9 claims using HIQK, HEHK, HRBK
• Conducted Test cases for Specific scenarios – test ICD9 claim with ICD9 qualifier DTT/PCT/SXG/DXT in the benefit constructs- Limit string and particular/sub particular/Fee/Accum/PFT
• Conducted Test cases for Specific scenarios – test ICD9 claim with ICD10 qualifier T7T/P7T/X7T/S7T/N7T in the benefit constructs- Limit string and particular/sub particular/Fee/Accum/PFT
• Analyzed current particulars, sub-particulars, and column coding that could potentially impact to the current code
• Part of the testing team for the ICD10 testing for numerous Groups
• Documented the results in the approved template
• Worked with the CMA- Data Baseand Extracted / Tested in Model Office with test data
• Extensive knowledge of HIQK, HEHK, HRRK, HURK, HRBK, TPOL, Benefit file Mnemonics, Procedure and Diagnosis Files

Environment: Confidential, NPS, HRBK, HIQK, HEHK, TPOL, HURK, Lotus Notes, Windows, MS Word, Excel, MS Access

Confidential

Benefit File Testing

Responsibilities:

• Developed the New Group implementation testing grid of 300 scenario’s Grid.
• Involved in Analysis of the Requirements documents
• Performed entire Testing on the NPS system – from preparation of test case documents
• Conducted over 300 Test cases for Specific scenarios – such as Mental Health, Substance Abuse, Outpatient and Inpatient and other Categories Testing.
• Created Model Office contracts through TPOL system and also created Test claim data through the eFDE application
• Extracted / Tested in Model Office with test data
• Conducted testing for Benefit changes - based on the Benefits provided in the form of BIF’s NAEGS.
• Documented the results in the approved Test Grid template

Environment: & Tools: Confidential – NPS, Benefit File – HRBK, HIQK, HEHK,TPOL,EFDE

Confidential

Benefit File Testing

Responsibilities:

• Worked with the Business team from Confidential AND Well Point to work on the Requirements.
• Developed the New Group implementation 335 scenario’s Grid.
• Involved in Analysis of the Requirements documents
• Performed entire Testing on the NPS system – from preparation of test case documents
• Conducted over 335 Test cases for Specific scenarios – such as Mental Health, Substance Abuse, Outpatient and Inpatient and other Categories Testing.
• Conducted testing for Benefit changes - based on the BPD’S of the Well Point work with the 400 Column Coding.
• Documented the results in the approved Test Grid template
• Created Model Office contracts through TPOL system and also created Test claim data through the eFDE application
• Extracted / Tested in Model Office with test data
• Extensive knowledge of HIQK, HEHK, HRRK, HURK, HRBK, TPOL, Benefit file Mnemonics, Procedure and Diagnosis Files

Environment: & Tools: Confidential – NPS, Benefit File – HRBK, HIQK, HEHK,TPOL,EFDE