SUMMARY

• Proven ability to work effectively with all levels in cross - functional and cross-cultural work environments. Team player and a self-starter with project planning and interpersonal skills, proven ability to work under pressure, prioritize and meet deadlines. Open to dynamic work environment and to learn new developments with ability to grasp and implement the same.
• Involved in multiple end to end IT projects that included activities like gathering and documenting requirements, business and system analysis, design, development, gap analysis and process re-engineering.
• My core competency includes: Ability to clearly identify stated and implicit business requirements, clear written and verbal communication to effectively translate into functional requirements for technology teams, guide technology teams to ensure timeline and accurate project deliverables.
• Worked in various health insurance companies and have implemented multiple projects in membership enrollment, pricing, underwriting.
• Safe Practitioner 4.5 Certified and expertise in Agile methodology.
• Some key project implementation includes:
• Using SDLC methodology for Small group and individual exchange plans from 2012, we implemented robust reconciliation process for 14 exchange states. Help scrum master to collaborate follow up calls and assist with daily stand up calls.
• Extensively worked on Conversion of data into consumer hub application, Individual and Small group exchange plan, Occupational Health, Healthcare Claims, Eligibility, HMO, Power MHS, CDHP, PPO Product plan, benefits and provider services of members. Well versed with Medical, Pharmacy, Dental and HSA/HRA product plan.
• Worked on critical security related requirements (secured access PHI data of member). Good knowledge of ICD9 Diagnosis Code.
• Strong Analytical and Technical skillset including
• Analyze and track core business requirement based upon scope of project and translate business requirements into functional requirements.
• Review and provide approval for Detailed business, technical requirements, technical design document.
• Strong Experience in defining and writing data mapping rules.
• Ability to work collaboratively with business SME’s, business analyst, testers, developers and other team members in complex projects and in the overall enhancement of software product quality.
• Working knowledge of Mainframe, SQL and DB2/QMF tool.
• Running SQL ‘select’ query using DB2/QMF tool and analyzing data and writing mapping rules.
• Extensively worked in web-based intranet application, create mockups and gather requirements for OLTP transaction.
• Provide business scenarios to create the test scripts and test plans from use cases.
• Led offshore Team and translate business knowledge to the team.

PROFESSIONAL EXPERIENCE

Confidential

Systems Analyst Advisor

Responsibilities:

• Worked on agile methodology for letter enhancement project where letter needs to have common format for Large group, Small Group and Individual business. Created mapping document for each business/per system (WGS, ISG, PSD). Worked with different systems POC to finalized design/mapping/requirements. Worked on letter field name for flat file covert to XML tag name for ISG/WGS/PSD system. Review and validate flat and XML file.
• Worked on Agile methodology to finalize Sprints backlog for each PI. Attend daily stand up calls with team and try to resolve other system impediments. Collaborated with Scrum master and schedule follow up call with teams and provide working solution for team members to expedite process.
• Use mainframe technology to view member data, table and file. Wrote SQL ‘Select’ query to view member data.
• Schedule meeting with business to get business requirements, clarifications and detail information regarding Individual CDHP plan enrollment for 2020. Provide clarification to developer, tester and other team members regarding requirements and design. Work closely with Technical lead, architect to finalized design as per requirements.
• Worked on ID card enhancement project where needs to eliminate ID card generation per state/per business/per product. Id card should generate as per business requirements and should stop generating ID card when it is not required.
• Worked on Individual and Small Group enrollment and eligibility reconciliation project since 2012 till to date. Created reconciliation process per state/per business. Worked with Exchange, business, ISG & WEM/E3 team members to finalized mapping and file layout.
• Worked on 834 enrollment file WCF ( Confidential common format) to add mapping rules for Individual business. Working knowledge on review WCF (834 enrollment file).
• Worked on Individual and Small group enrollment plan for on/Off exchange plan, created new exchange related tables and data in ISG system to identify exchange plans.
• Review business requirements, technical requirements, Functional Design document (FDD) and Technical Design Document (TDD), test scenarios and test cases. Worked closely with BA, Developer, business SME’s and tester to finalize all documents.

Environment: Windows 2000 platforms, Microsoft Office 2013, Mainframe, MS Visio, JIRA, Confluence, outlook 2013, Microsoft teams, WebEx and Lync Skype for meeting.

Confidential

Business System Analyst

Responsibilities:

• Worked with business SMEs and developer for creating Common Format File Spec, define the business rules, required key field, history data elements, relationship between data elements.
• Performed the gap analysis CF doc, cobol CF doc and ETL CF doc, documents the recommendations.
• Worked with SME’s, BSA’s, ETL team to create ACES source to target mapping document, documented mapping rule, transformation rule, default rule.
• Worked with ETL team to understand the basic require data elements to process the group and membership data. Analyze the data elements from three source system (CS90, STAR & WGS)
• Worked with business SME’s, BSA’s, Data Architecture, Data Stewards and Data Governor’s for the ACES required fields and created new business terms, definition and data model for WCC system.
• Performed Gap analysis between WGS s2t doc, CF doc and Data Dictionary document and make updates accordingly.
• Follow up with Payer, standard and Dental contract with Encoder Pro vendor and Confidential manager. Worked with Ingenix vendor to get Encoder Pro tool for Confidential associate. Schedule DEMO session and create user list and make sure everyone gets the access.

Confidential

Business Systems Analyst

Responsibilities:

• Review & document As-Is & To-Be Business Processes. Review and approve business use cases for the individual business conversion project. Facilitate JAD session with Clients - BOA, State of Oregon and external vendors - TriZetto and IBM to finalize the requirements. Work closely with Cash management, Finance and Membership Confidential SME’s to capture premium due and member eligibility requirements.
• Create PDM (Physical Data mapping) & LDR (Logical Data Requirement) for data extracts for file and report. Create new tables and fields in the Facets applications and provide business rules, mapping rules for the source and target tables. Analyze data into the MS Access, ODS (Operational Data Storage) database and EDW (Enterprise Data warehouse).
• Documented requirements using NACHA format (the National Automated Clearing House Association) to send file to the external Client. Work closely with external client, internal SME’s, developer, solution engineer and tester to finalize the requirements.
• Documented meeting minutes, requirements specifications (Base BIR and Design BIR), process flow diagrams and stored artifacts on the Livelink. Documented guidelines to access set up for SQL navigator, Sybase and other internal applications. Provide training and guidance to newly join. Act as liaison between business, developer and tester.
• Facilitate JAD session between the different teams to identify the requirements gap. Re-distribute the work effort between teams and project. Review the other project requirements and identify dependencies, duplicate work effort and real requirements.

Environment: Windows 2000 platforms, Microsoft Office, Sybase, SQL Navigator, Business Object, MS Visio, MS Project.