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, SeleniumVisual 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

• 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/ benefit configuration

• 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

• 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 (contract)

• 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 (contract)

• 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.