PROFESSIONAL SUMMARY:

• Fast paced and work - oriented Data Analyst with over 9+ years of experience in the IT industry, with exhaustive knowledge in the Healthcare, Insurance domain. Specific experience and knowledge in Claims processing system and Hospital Reimbursement methods like DRG, Capitation.
• Strong understanding in various stages of SDLC using various methodologies such as RUP, WATERFALL, AGILE, SCRUM.
• Experienced with data movement/ Data mining/Data warehousing projects using various ETL process/ data mining tools.
• Conscientiously followed agile methodology and conducted scrum/sprint meetings with the team members.
• Worked with heterogeneous relational databases such as Teradata Oracle, MS Access and SQL Server.
• Developed Implementation, Testing and Support of Data Warehousing and Data Integration Solutions using Informatica Power center and IDQ.
• Experience in designing and developing Data Warehouse applications using ETL and Business Intelligence tools like Informatica Power Center, Datastage, Mainframes SAS, SSAS, SSIS, SSRS, OLTP,OLAP, Business Objects.
• Extensive experience organizing Joint Application Development (JAD) and Joint Requirement Planning (JRP) sessions, Interviews, workshops, Requirement Elicitation sessions and Rapid Application Development (RAD) sessions with end-users/clients/stakeholders and the development group.
• Good knowledge in interacting with Informatica Data Explorer (IDE), and Informatica Data Quality (IDQ).
• Experienced in Facets implementation, involved in end to end testing of Facets billing, claim processing and subscriber/member module.
• Experience with RDBMS using SQL, SQL queries in writing SQL scripts for backend testing and generating reports.
• Conducted business validations, covered the following deliverables: Facets providers, Facets claims and Facets membership and operational reports.
• Experienced in FACETS Implementation, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module
• Used Trizetto Network Pricer to manage the transition to pricing claims with ICD-10 code sets, and Trizetto Facet for medical claim processing.
• Good understanding of various software testing life cycle STLC levels.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Knowledge of claims Guidewire systems and policy administration system.
• Worked on Insurance tools like Guidewire 7.0 (Policy center, Claim center and Billing center) and Duck creek.
• Experience in Personal Property Casualty, Commercial Automobile, Reinsurance, Group and Life Insurance Systems, Home Owner Insurance.
• Experience working on Guidewire Claimcenter.
• Good knowledge in Property & Causality, Fixed Income, Foreign Exchange Options Market Concepts (Swap, Hedge, derivatives, options, and exchange rates), Equities, Derivatives (Options and Futures), Stocks Trading Process, Portfolio Analysis, Asset management and Cash management.
• Strong experience in healthcare areas such as Medicaid and Medicare programs, Claim processing, provider eligibility.
• Excellent knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Medicaid and Medicare regulations, Health Care Reform (HCR), Electronic Medical Record (EMR) and Electronic Health Record (EHR) and Medicaid Management Information Systems (MMIS).
• Experience in performing data validation and data integrity using SQL Queries
• Expertise in writing, maintaining and executing Test plans, Test strategy, Test cases and Test scripts.
• Good programming skills in Java,VB, Oracle, SQL, PL/SQL and experience in SQL Server, Access and Oracle Databases.
• Proficient in Java, JDBC, Java Script, Ruby, C, C++, Oracle, SQL Server, SQL, PL/SQL and in web Technologies like HTML, XML and CSS.
• Experience with Relational Databases like Oracle 10g/9i/8i, DB2 ESE, MS SQL Server 2005/2010, DTS, Sybase, Teradata V2R5, MS Access and formats like flat-files, CSV files

TECHNICAL SKILLS:

Testing Tools: HP ALM, Quality Center, Soap UI, Selenium

Operating Systems: UNIX/LINUX, Mac iOS, Windows

VBScript, Java, XML, SQL, T: SQL, PL/SQL

Oracle, MS: Access, MS SQL, MY SQL

MS: Office, TOAD, SSMS, Eclipse

Methodologies: Waterfall, Agile Scrum, RUP

Business Intelligence: SQL Server Reporting Service, SQL Server Report Builder

ETL: SQL Server Integration Service, Informatica Power Center

PROFESSIONAL EXPERIENCE:

Confidential, Madison, WI

Sr. Data Analyst

Responsibilities:

• Performed extensive Gap Analysis between the Company's Legacy System and Guidewire Billing System.
• Involved in the implementation of Guidewire Policy Center integrated with the billing process and working with policy transactions for making the invoices for account.
• Defined Product Model Requirements for Private Passenger Auto, Homeowners, and Commercial Auto.
• Efficiently worked in the working Prototyping as well as in the Iterative phases.
• Ensured successful implementation by monitoring progress through each SDLC phase.
• Worked on Policy Center configuration User Stories including Renewal, Policy Change & Reinstatements for commercial lines of business.
• Performed Integration testing, System testing, Regression testing and Performance testing of Billing Center, Policy center and Payment manager in Guidewire application based on the business requirements
• Creation and execution of test cases. Involved in User Acceptance Testing (UAT) & in defects lifecycle.
• Actively worked with the Business Users in the UAT phase by helping them build test scenarios and resolving any anomalies in the results of the reporting elements.
• Recommended a reporting solution in the Oracle Data Warehouse that would minimize the impact on the system from evolving business needs.
• Modified User Stories in Guidewire Policycenter, Claim Center and Billing Center upgrade.
• Facilitated Guidewire workshop for Guidewire suite display-PolicyCenter, ClaimCenter and BillingCenter, Product Model.
• Identified high level requirements in Inception for Guidewire PolicyCenter, ClaimCenter and BillingCenter.
• Worked on the commercial property and casualty domain and made specific changes to the same for the smooth flow of the process.
• Managed General Liability, Commercial Property, Commercial Package, Commercial Auto and Workers Compensation policy lines
• Worked on Property and Casualty insurance company as an Underwriter. Strong understanding of rating in Property and Causality.
• Involved in generating Test cases for property and casualty Insurances for Different Levels of Business.
• Department to perform analysis, review, and estimation of client requests, prepared and reviewed requirements and client documentation for Personal Lines Property and Casualty business.
• Interacted closely with End users from Underwriting & Claims teams and SMEs to understand and gather the business needs and requirements.
• Work closely with production underwriters to review commercial property insurance renewal and new business opportunities to ensure proper risk identification, analysis and assessment and the development and growth of a profitable portfolio of business.
• Identified high Gaps between functionalities of current system and Guidewire.
• Identified system requirement for it’s integration with Guidewire System.
• Arbitrated conflicts within and across the teams as they arise.
• Coordinated and Conducted Joint Application Development (JAD) Sessions for the business users.
• Facilitated Brain-storming sessions.
• Analyzed the as is and to be state of the project and performed Gap Analysis, Impact Analysis and SWOT Analysis for the Claim Center and Policy Center implementation.
• Developed the activity diagrams, data flow diagrams to show the system flow for the application.
• Used Data Flow approach, User-Interface approach and UML approach Provided Project update & feedback.
• Conducted structural walk-through Developed and Analysis Use case diagrams, Activity Diagrams & Sequence diagrams.
• Used Object Oriented Analysis & Development (OOAD) modeling to provide development team a view of the requirements for Construction phase activity.
• Engaged with stakeholders to capture business and systems requirements using different elicitation techniques for the proposed Guidewire application.
• Concentrated on implementing Guidewire batch integration in replacing the existing NW legacy Batch applications like PRI and billing.
• Extracted data from IBM, Oracle, Excel, and Flat File and inserted into a centralized warehouse using SSIS.
• Used several Data flow transformations like cache to improve performance.
• Deployed packages using the Project Deployment Model
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Involved in requirement gathering and database design and implementation of star-schema, dimensional data warehouse using Erwin.
• Used Universal Data Modeling Techniques to assist Confidential in designing their Data Warehouse/Data Marts and Metadata Management Solution that will integrate Oracle Financials.
• Used package logging for tracking operations and collecting debug information.
• Authored SSRS 2008 reports to meet advance presentation layout requirements such as tablix, matrix, charts, and sub reports.
• Completed Data Mapping for Group and detail Product analysis and report writing.
• Developed Data Mapping and Crosswalk documents.
• Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Created parameterized reports in SSRS 2008 and wrote expressions to execute complex reporting requirements
• Provided Efforts Estimate and coordinated the test schedule using Agile testing methodology in UAT phase.
• Reviewed business requirements, functional specifications to ensure quality of SDLC deliverables. Analyzed requirements using Rational Rose Requisite Pro - RUP.
• Designed projects using Agile methodology as Scrum.
• Embedded various images within complex tabular reports based on conditions written in expressions
• Deployed reports using Report manager, SSDT, and inside SharePoint 2007
• Allowed managers to receive reports via subscriptions in Reports Manager
• Created parameterized reports in SSRS 2008 and wrote expressions to execute complex reporting requirements.
• Embedded various images within complex tabular reports based on conditions written in expressions.
• Created perspectives/views, for other SQL developers, using SSAS
• Processed cubes using SSAS adhering to Microsoft Best Practices
• Used the Scrum model in handling business requirements.

Environment: Windows, Microsoft Office (Word, Excel, PowerPoint, JIRA, Confluence, Visio, SharePoint), Oracle, RUP, UML, SQL, Quality Center, Guidewire Insurance Suite (Claim Center 7.0).

Confidential, Buffalo, NY

Data Analyst

Responsibilities:

• Worked with diverse team of Business users, internal and external stakeholders by conducting meetings, interviews and focus group sessions to Elicit and understand ACA and HIX, FFM and SBM policies, requirements and prepared and document BRD and FRD.
• Conducted numerous JAD sessions with Business users, developer and SMEs to gather requirements for information (data sets) for Federal data exchange. Understood and gained knowledge about 1095-A correspondence.
• Prepared several use cases and designed use case diagram, activity diagram and sequence diagram.
• Worked on requirements of the 820, 835, 837, and HIPAA transaction across the enterprise.
• Gathering sessions for the EDI Transactions between providers, payers and employer groups.
• Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Worked on developing the business requirements and use cases for Facets batch processes.
• Extensively worked with HIPAA Privacy Facets application groups.
• Responsible for configuration development and solution within the Facets system.
• Experience working on integration, Data Mapping, XML Facet, And Gap analysis.
• Tested and delivered Inbound/Outbound Facets interfaces.
• Developed a detail project plan and helped manage the data conversion migration from the legacy mainframe system to the target SQL Server database.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets
• Tested and delivered Inbound/Outbound Facets interfaces.
• Helped streamline the 276/277 transaction in order to enable easier and faster exchange of information between the payer and the provider.
• Reviewed all payer contracts resulting in appropriate reimbursement and data integrity.
• Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
• Troubleshoot any problems found within FACETS and when testing the SQL data database while validating the business rule.
• Involved in configuration of Member and Provider Module in FACETS.
• Participated in 1CD 9 to ICD 10 codes conversion requirement gathering sessions and created high level business requirement document.
• Defined ICD-9 to ICD 10 mapping process using GEMs (General Equivalency Mapping) crosswalk file.
• Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System-Related to the HIPAA.
• Implemented HIPAA standards, EDI (Electronic data interchange) 837,835 and 834, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding.
• Overseeing and maintaining the EDI Inquiry Problem database including the evaluation of problems or issues through to resolution.
• Managed the Scrum daily standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
• Interacted with stakeholders and gathered requirements as per the business needs using Waterfall-Scrum environment.
• Interfaced with The Centers for Medicare and Medicaid Services (CMS) to assemble business requirements for FFM and documented them in Business Requirement document and summary reports.
• Maintaining knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets and evaluating the impact of proposed changes in rules and regulations.
• Interacting with the stakeholders to get a better understanding of client business processes and gathered documented the business requirements.
• Identified SMEs (Subject Matter Expert) and drove the requirements gathering Worked on High Level Requirements with SME’s, Developers and Stakeholders for different applications.
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases (RDBMS), application systems, temp tables, flat files etc.
• Created and maintained the Requirement Traceability Matrix between the requirements and other products such as design documents and test plans.
• Conducted User acceptance testing (UAT), System testing, Integration testing. Validated and helped verify defects to weed out cosmetic problems and keep the project on schedule.

Environment: Edifecs Spec Builder, Rational Requisite Pro, ClearQuest, UML, RUP, MS-Project, MS-Visio, MS-Office,

Confidential, Tampa, FL

Data Analyst

Responsibilities:

• Deduce & formalize Functional Requirements from business and design specifications.
• Analyzed payer/submitter specific 4010 claim editing to migrate it to 5010 claim editing system Identify and document transition issues from format.
• Using Agile methodology supported the Compass system that manages budgets during the bidding and contract management project for Clinical Research studies.
• Worked on HL7 including complete lifecycle of interoperability specification (Deployment, Adoption, utilization, Adherence etc.), clinical decision support, exchange of clinical documents.
• Involved in discussions with Project manager, SME and Developers to understand the Requirements specifications in order to prepare the appropriate use cases and test cases.
• Involved in preparing Test Plans based on User Requirements Document (URD) and prepared the Test Functional/System/ Integration Test Cases and Test Procedures.
• Followed a structured approach to organize requirements into logical groupings of essential Business processes, Business Rules, and Information Needs, thus ensuring that Critical Requirements are not missed.
• Followed AGILE methodology and created User Stories, assisted the business analyst in creating Product backlog, sprints and sprint backlog.
• Document and track inherent issues and correct errors to maintain system after implementation.
• Ensured Compliance of EDI transactions of 835 - Healthcare Claim Payment/Remittance and 837 Health Care Claim
• Implemented specifications of testing EDI transaction code sets based on HL7.
• Assisted the data warehousing team to build data marts. Also performed ETL activities to design the data warehouse.
• Removed Duplicate records, rejected invalid Data using Informatica Data Quality(IDQ)
• Use of data transformation tools such as DTS, SSIS, Informatica or DataStage.
• Tested jobs and used Informatica as an ETL tool to load the final loads. Created ETL test data for all ETL mapping rules to test the functionality of the Informatica graphs
• Created data driven test to handle the input Test Data and customized checkpoints with parameters.
• Did profiling and Data Quality Analysis of the data to find out anomalies in the data and highlighting the effectiveness of the tool (IDQ) to do that.
• Worked closely with Testing team and helped in testing the Informatica mappings, workflows, Abinitio Graphs and Teradata scripts
• Proficient in writing SQL queries for data analyzing
• Developed Complex database objects like Stored Procedures, Functions and Triggers using SQL
• Involved in analyzing data, reviewing entity relationship diagrams, and designing Data Dictionaries.
• Involved in Functional Testing, Integration Testing, End-End Testing, Front End Testing, Acceptance Testing.
• Develop and maintain sales reporting using in MS Excel queries, Visual Basic 6.0, SQL in Teradata, and MS Access. Produce performance reports and implement changes for improved reporting.
• Created Informatica mappings with PL-SQL procedures to build business rules to load data.
• Active involvement in the planning and implementation of the validated testing endeavors.
• Maintaining quality levels with the use of agile development practices such as automated testing, continuous integration, and refactoring, in addition to regression testing
• Managed user stories and conducted Scrum Ceremonies throughout the product development life cycle.
• Captured all the issues received from the stakeholders in an issues list and addressed the same in the respective meetings.
• Facilitated and participated in the meeting sessions with the Business Users and Stakeholders to define the project scope and boundaries using the RequisitePro.
• Conducting JAD sessions with business stakeholders to reach a decision on changing strategies regarding the way business will be conducted on the new platform
• Involved in GAP Analysis and Technical Feasibility study with the technical leads and other SMEs (Subject Matter Expert).
• Outline and document UAT (User Acceptance Testing) Test Plan & Test scripts.
• Create and maintain the RTM and the Execution log for all phases of testing.
• Performed trouble shooting problems and finding solutions
• Reported and tracked defects/bugs to the development team using HP ALM.

Environment: EDI, ICD-9, ICD-10, Facets, IDQ, Informatica, Oracle, ETL, Teradata, DB2 UDB SQL Server 2008, SSIS, SSRS, PL/SQL, TOAD, MS Excel, XML, MS Access.

Confidential, Grand Junction, CO

Data Analyst/ETL Tester

Responsibilities:

• Analyzed & obtained a thorough grasp of the business process and documented the System specifications, Business requirements and the Testing process.
• Conducted Business meetings for the claims adjudication process and its work flow.
• Managed Test Plans, Test Strategies and Test Procedures
• Validated the updating of fact table records with in a database transaction
• Validated under varying loads of records under one transaction with rollback recovery
• Reviewed Use Case diagrams for creating the different test cases
• Wrote SQL statements and SQL queries to check the contents of the Sybase tables of the application.
• Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access.
• Extensively Performed the data validations and profiling using IDQ
• Loading staging tables on Teradata and further loading target tables on SQL server via DTS transformation Package.
• Worked on automation of ETL processes with scheduling tools and exception-handling procedures
• Involved in Data Integration using Informatica tool
• Responsible for selecting Test cases for Functional and Regression test sets
• Involved in design and development complex ETL mappings and stored procedures in an optimized manner
• Involved in Informatica Data Feed Testing using Informatica Repository Manager and Workflow manager
• Replicated operational tables into staging tables, Transform and load data into enterprise data warehouse tables using Informatica from their legacy systems and load the data into targets by ETL process through scheduling the workflows.
• Prepared Business Intelligence reports development efforts by working closely with business Object, Teradata, and ETL teams.
• Fine-tuned existing Informatica maps for performance optimization
• Responsible for creating Test Data sets for Functional and Regression testing
• Wrote test cases for positive and negative scenarios for functional, GUI and security testing.
• Performed back-end testing on Oracle and SQL Server databases by writing SQL queries
• Executed test cases using Rational Test Manager for Data Conversion, which required setting up data on SQL Server database
• Used various DML and DDL commands like Select, Insert, Update, Sub Queries, Inner Joins, Outer Joins, Union, Advanced SQL etc. for the data retrieval and manipulation
• Verified the data on the destination database after conversion using SQL Queries
• Designed complex queries using Sub query and joints and embedded them in VBScript functions for obtaining data from data base
• Created test scripts to meet the performance test requirements
• Maintained database objects such as tables, indexes, views, triggers and stored procedures for testing purposes
• Performed testing on various browsers like IE6, IE7 and Mozilla Firefox
• Used UNIX Shell Scripting and executed SQL Queries on Oracle in back end testing
• Responsible for generating Test status Report for which SQL Queries constructed to Query the Oracle Database used by Test Director and Quality Center.

Environment: EDI, ICD-9, ICD-10, Facets, IDQ, Informatica, Oracle, ETL, Teradata, DB2 UDB SQL Server 2008, SSIS, SSRS, PL/SQL, TOAD, MS Excel, XML, MS Access.

Confidential, Charlotte, NC

Jr. Data Analyst

Responsibilities:

• Participated in JAD sessions to understand the scope and the requirements of the project.
• Developed and reviewed test plan, test scenarios, test cases using BRD and use cases.
• Scheduled and executed test cases, logged defects using Quality Center testing tool.
• Performed testing for both positive and negative test scenarios and test cases
• Followed the HIPAA implementation guides for preparing the EDI files.
• Tested EDI transaction sets - EDI 837- Healthcare claim, EDI 835- Healthcare claim payment/remittance advice, EDI 278 - Healthcare service review for pre-authorization and referrals for HIPAA compliance.
• Verified HIPAA ASC X12 5010 compliance for both inbound and outbound healthcare EDI transactions.
• Tested processing of claims for members on individual, group, employer based and Medicare Advantage health plans using various test scenarios and test cases.
• Co-ordinated and performed System Testing, GUI Testing, Functional Testing, Integration Testing, End to End testing, Regression Testing and Performance testing.
• Performed load testing and stress testing of Web Services and XML using SOAP UI
• Used Soap UI for testing of the Front end Web Services.
• Verified data integrity and data mapping by performing Back-end testing using SQL queries.
• Defined terms, conducted stakeholder analysis, elicited business needs, conducted business process modeling, and facilitated JAD sessions for various applications Identified the key Stakeholders and the Business Users of the application.
• Created a product roadmap for the various stages and releases throughout the project lifecycle.
• Conducted JAD sessions with the stakeholders, end users and SMEs (Subject Matter Created process flow diagrams in MS Visio.
• Conducted timely requirement review sessions with the Stakeholders and end users to ensure the product verification.
• Wrote SQL join queries to extract data from various databases for testing purposes
• Performed manual testing to run all the test cases.
• Communicated testing efforts and results to QA lead and business users.

Environment: Informatica, Oracle, ETL, Teradata, DB2 UDB SQL Server 2008, SSIS, SSRS, PL/SQL, TOAD, MS Excel, XML, MS Access.