SUMMARY

• Above 11 years of extensive experience in the US Healthcare industry demonstrating strong Business Analysis skills, having blended experience in various business areas of Health Plans. Viz, Claims, Eligibility, Enrollment, Products & Benefits, Contracts, Billing, Customer Service, Business Intelligence etc.
• Above 9 years of experience in Requirements Elicitation in different applications including Facets, QNXT & MetaVance.
• Good knowledge on SDLC, RUP Workflow, Unified Modeling Language, Data Modelling techniques.
• Proficient in training and mentoring resources in US healthcare practices.
• Well versed in Collecting, interpreting, and distilling customers’ business requirements into clear specifications and other product/application development artifacts.
• Proficient in Translating textual concepts and complex relationships between entities into visual displays.
• Expertise in Facilitating meetings/Capture meeting notes, and creates project artifacts like: BRD, Use Case Documents, Wire Frames, Functional Specifications, UAT Plans/Cases, and Functional Test Plans/Cases etc.

TECHNICAL SKILLS

Languages: PL/SQL (Basics), ORACLE

Operating systems: Windows

Version Tools: SharePoint

Tools: MS VISIO, Informatica

Methodologies: SDLC, RUP, UML, AGILE

Applications: Facets, QNXT, MetaVance.

Work flow tools: Macess

PROFESSIONAL EXPERIENCE

Business System Analyst

Confidential

Responsibilities:

• Conduct requirements sessions with business users to understand the need for data.
• Document the requirements and identify the preferred destination on data marts for the new business attributes.
• Assist during the data modelling sessions to update the business attributes on the preferred destination.
• Create a high level design document and conduct walk - through sessions with client to convey the system changes at a high level.
• Conduct data profiling activities and create source to target mappings.
• Co-ordinate with development teams and assist them during the development phase.
• Perform impact analysis due to change in Facets application/interface functionality and asses the impacts on RDI system.
• Prepare and maintain estimates, project plans, and traceability matrixes of the projects.
• Manage incidents and work with technical team to perform the root cause analysis.
• Participate in solution assessment meetings and provide consent on proposed solutions.

Confidential

Business System Analyst

Responsibilities:

• Understand the existing systems/applications used by HP team members for supporting BSC’s business operations for Membership segment.
• Prepare process documentation for the existing systems and business processes.
• Prepare training materials for the offshore team to support the customer (BSC) with minimum dependency from onsite team.
• Train offshore resources on the business systems and business processes of the customer for providing support from offshore.
• Train and mentor resources for Business Analysis activities.
• Prepare business requirements documents for enhancements, service requests, business needs.
• Conduct stakeholders sessions for requirement elicitation.
• Provide suggestions on Technical design for the technical team, for customer’s requirements.
• Prepare test cases and test reports for the business requirements.
• Perform Functional testing and provide assistance during User Acceptance testing.

Confidential

Business Analyst

Responsibilities:

• Conduct stakeholders sessions for requirement elicitation.
• Designing the prototypes of application as per the specifications received from the client.
• Provide suggestions on Technical design for the technical team, for customer’s requirements.
• Prepare test cases for the business requirements.
• Perform Functional testing and User Acceptance testing.
• Prepare User Documentation
• Conduct Application training for end users

Confidential

Configuration Specialist

Responsibilities:

• Educating the development team on QNXT Application, Configuration and the technical specification prepared as per client request.
• Configuring the various modules in QNXT Application which helps in Implementation and Conversion.
• Discussing with the onshore team in configuring the contracts for different groups and hospitals.
• Prepared FTC for the Tools that are developed by developers.
• Assisted Developers in generating the reports which in turn generates letters for Claims, Customer Service, Enrollment & Recovery.
• Build test data for the testing team for instances such as policies, premium rate tables and Administration Fees for Group Customers.
• Performing Quality Audit for the deliverables of configuration team.
• Analyzing the SQL queries and helping the configuration executives to configure the data as per the requirement.
• Running Payment process which includes generating checks and requesting for the refunds
• Building the Benefit Plans.

Confidential

Business Analyst

Responsibilities:

• Prepared documents for the current state application.
• Prepared documentation for the future state.
• Artifacts prepared for this projects are, high level and low level Use cases, Functional Specifications, Functional Test Cases.
• Coordinate with the Onsite Team and work closely with the development team in developing the new application on a different technology.
• Explain the specifications to the technical developers and verified their questions on all the requirements that were captured.

Confidential

Subject Matter Expert

Responsibilities:

• Adjudicate Medical & Hospital Claims
• Was part of the training team who was responsible for conducting the initial training for new joiners on the US Healthcare and the application usage
• Was also involved in a SME focus Group known as Knowledge Management Team where in my role was to identify the most recent happenings in the US Healthcare Industry and prepare a report/presentation and present/circulate the same within the company
• Performing root cause analysis for high dollar claim errors