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Claims Quality/audit Rep /business Analyst Resume

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CA

SUMMARY

  • Detailed oriented Business Analyst with over 6 years of experience working in various implementation across domains like Finance, Banking, Healthcare, Insurance.
  • In depth knowledge of phases such as Planning, Requirement, Design, and Development for the software/system development process.
  • Well versed in working with (SDLC) methodologies including Waterfall, Agile (Scrum), and RUP (Rational Unified Process).
  • Experience in facilitating JAD/JAR sessions (Joints application development), Elicit business requirements using client interviews, document analysis, requirements workshops, surveys, etc.
  • Experience in performing business analysis which include GAP Analysis of AS - IS AND TO-BE, RISK, IMPACT, and Feasibility Analysis of the project.
  • Pro experience in creating UML Use Case diagrams, class diagrams, Activity diagrams, Sequence Diagram, Swimlane Diagrams, and ER diagrams etc.,
  • Experience in creating wireframes and prototypes across the project using tools like Justin Mind.
  • Experience in conducting demos, walkthroughs
  • Well versed in creating BRD’S AND FRD’S, Use Cases, Product Backlog, User Stories according to methodology and using Excel and MS Project.
  • Experience creating user interface prototypes and UX mockups, as well as documenting UI screen behavior.
  • Good understanding of RDBMS concepts and procedures for data migration across application and modules.
  • Knowledge of data modeling, Data integration, Data mapping, Data validation, and verification with tools like Transoft and Oracle.
  • Ability to define and map data conversion tables as part of Data Integration Strategies.
  • Experience in coordinating with SQA (Software Quality Assurance) teams, understanding of Test Planning, Strategy, and Test Executions.
  • Experienced in managing and coordination of UAT across the project, Preparing UAT Plans, Test Cases, UAT Training.
  • Experience in creating User Documentation, User Training and Planning for Deployment, Process, Post Production Support, and generated reports using MS VBA etc.
  • Experience in coordination with project manager for project planning based on Web/mobile Based Systems, Resources and Budget Planning.
  • Ability to understand, model and document business processes using techniques including process flows, activity diagrams.
  • Coordinated with SQA (Software Quality Assurance) teams, understanding of Test Planning, Strategy, and Test Execution used SharePoint.
  • Experience documenting the functional aspects of web/mobile services including: inputs, outputs, logic, and validation logic QA and UAT, defect and change management process, user training and user documentation and production support.
  • Technical Knowledge of SQL, DDL, DML and XML, Teradata (for mobile/web based, where functions are predefined) Knowledge of Data Warehousing concepts and Extract, Transform and Load (ETL) process
  • Understanding of Financial market regulatory policy compliance and process
  • Experience in Loan Origination System (LOS) Money Markets, loan origination, and mortgage
  • Knowledge of Asset Management, Financial Management, project management lifecycle understanding.
  • Ability to work independently or in a team setting
  • Ability to organize, prioritize, and complete multiple tasks in a high production environment
  • Excellent Problem Solving skills and an Entrepreneurial Attitude
  • Proactive in identifying, escalating, and addressing project issues and risks
  • Worked with Vendors and Clients and other offshore team members outside business hours
  • Excellent verbal and written communication skills

TECHNICAL SKILLS

Operating Systems: MS Windows XP/Vista/7/8/10, Linux, Unix, iOS, Android

Browsers: Fire Fox, Chrome, Mozilla, Safari

Databases: My SQL, MS Access, Oracle, SQL Server, Teradata

Testing tools: HP QTP, Load Runner, Selenium, ALM, ARC (Advanced REST Client), SFDC, JIRA, Appium

Business Tools: OBI EE Plus (Oracle Business Intelligence) SQL Developer, MS Visio, MS Project, MS Office Suite, MS SharePoint, Crystal reports, MS Access, OBIEE

Languages: SQL (DDL, DML), C, C++, HTML, Java, MS EXCEL VBA

Defect Management Tools: JIRA, Bugzilla, Quality Centre/ ALM, Rational Clear Case

Modeling Tools: Just in Mind, SharePoint, Work brain, Kronos

Other Tools/ Applications: Oracle Financial Services Software (OFSS), Tableau, Eclipse, Oracle, Kronos, SimpleKPI, Tomcat, Empower, WFM, WBS

PROFESSIONAL EXPERIENCE

Confidential, Edison, NJ

Sr. Business Analyst

Responsibilities:

  • Project activities were Agile - Scrum methodology
  • Actively participated in sprint planning and scrum meetings
  • Created User stories and incorporated into the product back log.
  • Worked actively with Project Team for project planning in resource and budget planning
  • Worked with Stakeholders and management team to develop business objectives and project scope
  • Gathered Requirements by conducted JAD sessions with various groups, Product owners, SMEs and customers and translated them into business requirements and functional requirements
  • Used my experience applying analytical skills to diagnose needs, drive solutions, 1:1 user profile review, and set Priorities.
  • Carefully reviewed and assessed gathered information, defined key facts and identified potential problems and suggested feasible solutions
  • Worked closely with portfolio managers, the loan origination support team, Underwriter, and project managers to understand the Mortgage industry and learned about Loan Process Services (LPS)
  • Worked with offshore team members outside business hours
  • Performed GAP analysis (AS-IS and TO-BE) of Custom screens of the web site and data it will capture
  • Created Data Mapping and document transformation rules for my project
  • Ensured that System Requirements Specification (SRS) and Systems Design Specification (SDS) documents were agreed to and Approved
  • Mapped current business processes to new system and participate in the transition to the new solution, verifying that the data was properly transferred in the ETL process
  • Develop detailed specification documents that include features and functions of the new system
  • Created Use Case diagrams, activity and Swim Lane diagrams using MS Vision.
  • Supported the design process by conveying special interface requirements through prototypes/mockups for UX/UI interfaces.
  • Prepared trial runs of programs and software applications to be sure they will produce the desired information and that the instructions are correct
  • Performed logical data modeling, Data Vetting and accuracy, data integration created class diagrams and ER diagrams and used SQL queries to filter data and perform validation.
  • Interacted with QA to develop and define smoke/sanity and regression testing, then developed functional testing then created Ad-hoc reports using SQL database
  • Created Loan Pipeline Report Template so the user could access directly from loan locator, see deals grouped by deal status, read status comments for a quantitative and qualitative assessment of the pipeline
  • Conducted Customer surveys and prepared reports (through MS VBA) and spreadsheetsfor the team members
  • Develops and analyzes business reports for project owners using Oracle Financial Services Model Risk Management
  • Managed the SRS, SDS, Product back log, and test plans using SharePoint.
  • Developed and documented User Acceptance Test (UAT) and test plans
  • Ensured that the delivered product matched the business and user features and functions

Confidential, Pleasanton, CA

Business Analyst

Responsibilities:

  • Plan, design and recommend business processes to improve and support business activities, followed the Waterfall SDLC methodology.
  • Facilitating meetings with clients, conducted JAD sessions, questionnaires, surveys and interviews with the team to gather and document requirements and explore potential solutions.
  • Gathered and analyzed client's business requirements and processes and communicate these requirements by constructing conceptual data and process models, including data dictionaries and volume estimates from organization.
  • Performed extensive requirements analysis and requirement gathering including data analysis, Risk Analysis and impact analysis for readiness of ICD-10 conversion.
  • Performed GAP analysis of EDI transactions for Claims Management including X12 834, 270,271,837,275,276,277,835.
  • Used UML diagrams like Use Case diagram, Activity and Swimlane diagrams for the business process of the company using MS Visio.
  • Validated the requirements and mock-up screen designs of new GUI for internet based application with the product owner and other stakeholders.
  • Identified various points of integration among the new and existing applications and required integration with other IT components.
  • Maintaining good business knowledge with health care claims adjudication systems, including the end-to-end life cycle of a claim and EDI 837 and 835 transaction and encounter data processing
  • Interface with team to integrate HL7
  • Involved in Data mapping, Data Integration and Data Validation.
  • Analyzed the existing data model and provided suggestions and recommendations
  • Assist in providing time estimates for project related tasks.
  • Assist with developing the methods and procedures required to identify whether current business goals and objectives meet organizational needs.
  • Created test scenarios and UAT test plans to be used in testing the business applications in order to verify that client requirements are incorporated in to the system design using SharePoint.
  • Developed and executed test suites and operation scenarios to detect report and track defects using Quality Center.
  • Performed in analyzing testing results throughout the project

Confidential

Claims Quality/Audit Rep /Business Analyst

Responsibilities:

  • Defined various businesses critical processes for claims like claim validation and pending/denied claims analysis for the Medicaid health programs.
  • Preparing the reports on Audits and Quality scores and sending to the team.
  • Support New batches OJT support On-The Job Training shared the observations with respective Manager. Sharing best practices with the team regarding process.
  • Understanding medical terminology in relation to the diagnosis and procedures.
  • Followed adjudication policies and procedures to make sure proper payment of claims
  • Researches claim overpayments and requests funds
  • Analysis of reports, Assigned for Quality Audits
  • Analyzed the gathered requirement and reviewed Business Requirement Document (BRD)/Functional Specification Document (FSD)
  • Excellent familiarity with all Microsoft Office applications
  • Performed Internal & External audits for associates and Ensuring 100% quality in the team
  • Practiced Change Mgmt. with project manager ensuring thatchangesare thoroughly and smoothly implemented, and that the lasting benefits ofchangeare achieved.
  • Developed test scenarios and implemented test plan, providing key input in working with users in defining project and system requirements.
  • Collected and documented business processes as well as business rules and conducted project related presentations.
  • Used Share point for content management and document management.

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