SUMMARY

• Extensive experience in Software Development Life Cycle (SDLC) and Project Life Cycle working asQuality Assurance Analyst mainly inInsurance, Healthcare.
• Excellent skills in writing Test Plans and Test Cases
• Extensive experience in testing Client/Server and Web - based Applications
• Expertise in Automated testing tools such as WinRunner and QTP
• Expertise in Bug reporting tools such as Test Director and Quality Centre
• 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 teh consistency of data
• Experienced working wif x12 version 5010 transactions changes analysis, design and migration strategy.
• Profound understanding of insurance policies like HMO and PPO and proven experience wif HIPPA 4010 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim status), 834(Benefit enrolment), 835(Payment/remittance advice), 837(Health care claim).
• Maintained Test Matrix and Requirement Traceability Matrix.
• Performed ICD9 to ICD10 impact analysis.
• Experience wif HIPAA compliance and Healthcare systems, Claims, Enrolment, Eligibility verification for Members and Providers, benefits setup, and backend payment cycle.
• Experience providing primary analysis for business processes running on teh EDI (Electronic Data Interchange) standard.
• Experience wif CPT and ICD 9 encoding for defining proper disease codes on Claims and to identify diagnoses, symptoms, conditions, problems, complaints or other reason(s) for teh encounter/visit.
• Good understanding of POS system, Medical Claim processing, Health Care plans, HIPAA, PPO, Retails. Experience wif healthcare system, Medicaid and wif prime focus on claims adjudication, provider, eligibility and prior authorization.
• Highly analytical in developing teh methods and measures to meet requirements and solve any issues dat arise during teh project.
• Experienced wif various Business Analysis SDLC Methodologies, such as RAD, RUP, JAD, and Spiral Methodologies.
• Knowledge of 837, 835, 277, 270, 271, NCPDP, 4010, 5010 and ICD-9/ICD-10.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Experience in conducting/facilitating Focus Groups Sessions, Stakeholder Interviews, Joint Application Development (JAD) and Joint Requirement Planning (JRP) Sessions for effective requirement gathering.
• Good understanding of POS system, Medical Claim processing, Health Care plans, HIPAA, PPO, COPAY, Retails. Experience wif healthcare system, Medicaid and wif prime focus on claims adjudication, provider, eligibility and prior authorization.
• Strong hands on ability to use SQL in RDBMS (SQL Server, Oracle) for verifying source data preparation and assisting of data design input and trouble-shooting. Strong noledge of Business Intelligence, Data Warehousing and Business Architecture.
• Expertise in Gray Box, Functional Testing, Structural Testing, White Box Testing, Black Box Testing, Unit Testing, System Integration Testing, System Testing, Regression Testing, Load Testing, Stress Testing, Volume Testing and User Acceptance Testing.
• Expertise in using Quality Center and TestDirector to write test cases, test procedures, test execution and for reporting and defect logging.

TECHNICAL SKILLS

• RUP
• UML
• SDLC
• Agile
• Waterfall
• QA
• MS Access
• SQL Server
• MySQL
• PL/SQL
• Oracle DBA
• Java
• Windows 98/2000/XP basic UNIX
• HTML basic DHTML basic XML
• MS Office Suite-Excel Macros
• MS Project
• MS Visio
• Adobe Photoshop
• Flash
• Rational- Rational Rose
• Clear Quest
• Requisite Pro
• CaliberRM
• Omniture
• Crystal Reports various NIKU products
• C
• C++
• SharePoint
• Docushare
• BASIC
• Intermediate level-Visual Basic

PROFESSIONAL EXPERIENCE

Confidential - Rockville, MD

Quality Analyst

Responsibilities:

• Developed Test Cases bases on Requirement Specifications and Design Documents.
• Responsible for modification and executing of teh Test Scripts.
• Involved in testing QNXT Member, Provider, Claims Processing, Utilization Management, Accumulators, Contracts and Benefits.
• Involved in manual claims Adjudication process.
• Creating, Approving and Modifying PA in both Portal and QNXT.
• Involved in Adding Contracts to teh Provider in QNXT and associating Providers in Portal while creating claims.
• Involved in processing Claims, EE, and CM Subsystem as part of UAT.
• Involved in Functional, Integration, and Regression testing of teh application.
• Processed Medical claims and applied edits to teh claims for testing purposes
• Tested teh HIPPA EDI 834, transactions according to test scenarios and verify teh data on different modules.
• Worked in utilization management module for to create and test PA.
• Involved in uploading and processing of EDI 834 in Portal.
• Coordinated wif offshore people and updated teh tasks to manager.
• Worked wif stakeholders in UAT environment to ensure Business requirements are tested properly
• Logged defects in Clear quest and worked wif teh developers to resolve any issues.
• Conducted Regression Test for teh fixes of teh application
• Used RMT for running teh tasks like uploading, modifying, executing and taking logs accordingly
• Updated status report on weekly Basis and submitted to teh team prior to weekly meeting
• Participated actively in conference calls, project meetings and delivered input.

Environment: RUP,UML,SDLC,Agile,Waterfsll,QA,MS OfficeSuite-ExcelMacros,MS Project,MS Visio,Adobe Photoshop,Flash,Rational Rational Rose,ClearQuest,ASP.NET, VB.NET, QNXT, DB2, Oracle, SQL, QNXT, UNIX,Requisite Pro,Caliber RM,Omniture,Crystal Reports,various NIKU products,C,C++,Sharepoint,Docushare,BASIC and Intermediate level-Visual Basic among others.

Confidential, Blue Bell, PA

Quality Analyst

Responsibilities:

• Worked wif Business Analyst and QA Lead in reviewing and analysing teh business requirements Documents and functional requirements.
• Importedpre-existing Microsoft Word and Excel-basedrequirements and testsfor analysis in MQC.
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 834, 276/277, 270/271, 837/835.
• Tested all HIPAA transactions for multi version support (4010 and 5010) and validating teh database to file elements.
• AnalysedHIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers, subscribers and other related entities.
• ICD 9- ICD 10 Conversion Analysis - Worked in teh analysis of teh ICD 9 - ICD10 codes.
• Wrote teh test cases from use cases and FRD for ICD9 - ICD10 upgrade.
• Verified teh test cases after teh codes changes in different tables associate wif ICD9 - ICD10 changes.
• Uploaded teh diagnosis codes, procedure codes to teh related tables in test environment to verify teh changes related to ICD9 - ICD10 changes.
• Modified teh existing claims wif new ICD10 codes and ran through teh changes to ensure dat claims are getting paid as expected.
• Verified teh fields length & character which was impacted by ICD9 - ICD10 changes.
• Maintaining noledge of Medicare and Medicaid rules and regulations pertaining to teh Facets configuration and evaluating teh impact of proposed changes in rules and regulations.
• Involved in FACETS Implementation, involved end-to-end testing of FACETS Billing, Enrollment Claim Processing and Subscriber/Member module.
• Set claim processing data for different Facets Module.
• Performed Positive and Negative Testing Manually
• Actively participated in walkthroughsand enhancement meetings
• Maintained Test Matrix and Requirement Traceability Matrix
• Performed Gap Analysis
• Performed Security Testing on teh application
• Tested user interface and navigation controls of teh application using QTP.
• Experiences working in ANSI x12 837-835 EDI Transaction.
• Validate teh date from EDI transaction.
• Tested teh HIPPA EDI 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify teh data on different modules.

Environment: UML, RUP, Microsoft Office Suite, Microsoft Visio, Unix, Documentum, Windows NT/XP, Oracle, SQL, SQL Server, Sybase, VBScript, C#. DOORS, C++, NET, ASP.NET, Business Objects, TestDirector,FACETS 4.41/4.51

Confidential, Washington DC

Quality Analyst

Responsibilities:

• Involved in writing Test Plan and making sure dat teh development process is according to teh requirements
• Involved in Back End Testing by extracting flat files from teh server, which were generated by a Batch process to verify data against expected results.
• Maintaining noledge of Medicare and Medicaid rules and regulations pertaining to teh Facets configuration and evaluating teh impact of proposed changes in rules and regulations.
• Involved in FACETS Implementation, involved end-to-end testing of FACETS Billing, Enrolment, Claimsprocessing and Subscriber/Member module.
• Set claim processing data for different Facets Module.
• Reviewed test assignments, developed test plans and scripts, and conducted test as assigned.
• Used Microsoft excels to write test case and exported to Quality Centre.
• ValidateEDI Claim Process according to HIPAA compliance.
• Involved in testing HIPAA Database, which incorporates all teh HIPAA (Health Insurance Portability and Accountability Act) transaction sets
• Validated teh translated HIPAA files wif teh proprietary CCR (Common Claim Record) implementations
• Tested data to check HIPPA- eligible & participation check for individual coverage
• Involved in creating test scripts and test data files for teh HIPAA transaction based on teh ANSI X12N HIPAA standards.
• Conducted result analysis and interacted wif developers to resolve bugs
• Assisted in UAT (User acceptance testing) testing.
• Performed Smoke Testing.
• Perform Integration Testing.
• Performed regression, system testing and end-to-end testing of teh application.
• Involved in GUI and functional testing of teh application
• Created Complex SQL Scripts and embedded them into Unix Shell Scripts to perform teh back end testing.
• Tested and validated teh database tables using SQL queries and Stored Procedures and performed Data Validation and Data Integration.
• Documented problems found during test using Quality Centre and communicated recorded problems to teh responsible QA or development personnel.
• Participated in Status Review Meetings.

Environment: J2EE technology, Test Director, Windows 2000 Advanced Server, XML, UNIX / Oracle Platform, MS Visio, RUP 2002, Rational RequisitePro

Confidential, Northbrook, IL

Quality Analyst

Responsibilities:

• Analyzed clients systems and business processes.
• Prepared teh Test Plan and Test Cases based on teh functional specifications
• Tested User Interface and navigation controls of teh application using WinRunner
• Inserted Checkpoints to check for standard properties of an object using WinRunner
• Tested teh properties of teh tables by inserting table checkpoints using WinRunner
• Conducted Back-End and regression testing during teh various phases of teh application
• Participated in walkthroughs and project meetings
• Inserted Transaction Points to test for performance and Rendezvous Points to emulate heavy load on server
• Created Projects using Test Director Administrator
• Investigated Software bugs and interacted wif developers to resolve technical issues using Test Director
• Involved in all stages of testing teh Auto & Home Insurance application.
• Responsible for testing teh Quote & Purchase for both Auto and Home Property Insurance of teh customers.
• Conducted user interviews, gatheird requirements, analyzed teh requirements by using Rational Rose, Visio and Requisite pro - RUP
• Established a Business Analysis methodology around teh Rational Unified Process.
• Developed UML Use Cases using Rational Rose and developed a detailed project plan wif emphasis on deliverables.
• Researched teh various steps in teh lifecycle and tan constructed teh system in a way dat teh high-risk customers would be easily identified and monitored.
• Streamlined clerical work processes and mapped tan into teh new system.
• Developed project plans and managed project scope.
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology
• Track and manage all Change Requests, using Rational ClearQuest.
• Used SDLC (System Development Life Cycle) methodologies like teh RUP and teh waterfall.
• Coordinating and Developing QA activities.
• Conducted presentations of teh QA test results wif analysis to teh stakeholders and users and documented modifications and requirements.
• Responsible for creating teh Business Process Model for teh Global New Account Opening utilizing teh BPM methodology and notations.
• Conducted UAT; facilitated discussion between business team and QA team on determine teh test requirements and pass/fail criteria; documented and reported user feedbacks to management team.
• Involved in Inception Phase and prepared vision statement and initial data models dat contain Business Requirement Documents and supporting a document dat contains teh essential business elements and detailed definitions.
• Designed and Customized data models for Data warehouse
• Worked extensively wif MS Excel and MS access
• Assisted in building a Business Analysis Process Model using Rational Rose and Visio.
• Performed extensive Requirement analysis and developed use cases and workflows.
• Implement and maintain Property &Casualty (e.g. bug-fix, data integration, version release) systems of assigned customers.

Environment: UML, RUP, Mainframes, COBOL, JCL, Db2, Oracle, Rose, MS Word, MS Excel, MS Visio,LoadRunner, WinRunner.

Confidential, New York, NY

Quality Assurance Analyst

Responsibilities:

• Verified various transactions according to HIPAA rules (834) and EDI X12 standards.
• Captured and re-engineered transactions wif legacy systems for Medicare/Medicaid members (MMIS); Enrollment-834, Health Plan Premium-820, Eligibility Transaction (270/271), Claims (837), Claim Status Report and Response (276/277), and Remittance (835).
• Analyzed and identified issues in claims, encounters and remittance advice process flow.
• Formulated detailed Test Plan, Test Cases and Testing Procedures, which included Test Cases/Scripts, capturing Test Results and capturing and resolving Test Anomalies.
• Performed configuration/ compatibility and user interface testing manually.
• Have experience designing and writing training manual templates, design formatting, project planning and writing technical documents.
• Performed automated testing using WinRunner.
• Performed Data Driven Testing using WinRunner.
• Conducted GUI/Usability Testing and Black Box Testing according to specifications.
• Involved in writing complex SQL queries to check teh data integrity
• Ensure dat products and changes are fully documented.
• Analysing and documenting detailed program information working and interacting wif software developers and members of various other dependent departments
• Analysing User and Functional requirements to point out gaps between used SQL queries to extract teh data from teh database.
• Performed Smoke and Sanity testing.
• Performed Positive and Negative Testing
• Performed Security testing and Backend testing Manually.
• Participated in conducting System testing and End-to-End testing Manually.
• Extensive UAT Testing Manually.
• Performed Usability and Integration testing Manually.
• Used Quality Centre for bug tracking and reporting, also followed up wif development team to verify bug fixes, and update bug status.
• Documented bugs found out during teh process of testing.

Environment: s: MS SQL Server, UML, Mercury Quality Center, MSOffice Tools, MS Outlook.