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Medicare Specialist Resume

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CO

SUMMARY

  • 11+ years of experience with managing and performing all different types of testing web - base FACETS application, HealthCare, midrange and IBM mainframe, Enterprise Resource Planning (ERP) Suite applications, Mobile Applications, including Oracle Financials and Supply Chain Management (SCM) Suite, Transportation Management, Telecommunication, utilizing enterprise-level, SOA (Service-Oriented-Architecture) in areas such as subscriber and member eligibility/enrollment, provider management, claims processing and Healthcare management. Recent experience in teh following.
  • Manage several projects as Sr. QA, involved in test planning, coordinating other testers, working with business analysts, and reporting test case outcomes and defect status to project managers and development teams.
  • Serve as a SME (subject matter expert) on testing Facets provider/group/member/claims extracts and reports that get migrated to various in-house groups, and third-party vendors. Similarly experienced in ETL (extract, transform, load) testing for mainframe to database migration projects.
  • Produce test documentation (me.e. Test strategy, Test plan, and Summary) for sign-off and create executable test scripts in HP Quality Center.
  • Strong SQL skills for Data management using Toad in an Oracle database to verify teh back-end while testing.
  • Advanced noledge of choosing teh appropriate lifecycle and teh planning, monitoring and control of teh systems engineering process, Experience in Agile process & Scrum methodology.
  • Testing for teh Provider conversion from mainframe programs to web based program using Online FACETS applications and validation of data by using Oracle DB2 at Cigna Health Care System testing for EDI, Enrollment & Eligibility, Claims (EOB/EOP) process.
  • Experience with bug/issue identification, bug reporting, and bug tracking.
  • Extensive experience in MS Project, Microsoft Test Manager (MTM) and MS Office tools like Word, Power point, Visio, Excel, Access & Beyond compare, Clear Quest.
  • Expert skills managing and performing all aspects of manual and automation testing activities for web based applications using C#, Java, SQL Server, ASP .NET, UNIX, SQL, Data mining, Querying and analyzing large datasets, QTP, Selenium, Toad (SQL Server), and Mainframe (COBOL) using DB2 and CICS. Experience in ETL testing and validation.
  • Experience with good organizational skills, conflict management and time management.
  • Work closely in an Agile Scrum based team environment.
  • Advance noledge of Medicaid and Medicare.

PROFESSIONAL EXPERIENCE:

Confidential, CO

Medicare specialist

Responsibilities:

  • Provide consultancy and support to Medicare customers for Enrolment & Eligibility.
  • Experienced in EFT process & set up.
  • Setting up Seminars and personal appointments, covering teh following states.
  • Maintaining all teh records for enrollment in Data base.
  • Develop and maintain documentation for policies and procedures
  • Mentoring junior consultants for Health insurance applications.
  • Billing & Payment application expert for UHG.
  • Excellent customer Service experience dealing with clients and prospects.

Confidential, Denver, CO

Sr. QA System Analysis

Responsibilities:

  • Write Test strategy, Test plan, Test cases, and obtain their approval.
  • Business requirements reviewing, validating & verifying
  • Worked on JD Edwards Enterprise Resource Planning (ERP) Suite applications.
  • Developed test cases from teh requirement documents and created test data for teh execution of test cases.
  • Attended all teh reviews from business requirement, technical design, and developing test cases iteratively.
  • Created test lab for execution.
  • Used HP Quality Center to write test cases and log teh test result after executing them.
  • Used QTP for running automation test.
  • Involved in Defect tracking management after teh test cases are executed.
  • Prepare and publish test reports.
  • Generate report from HP Quality center & provide status and progress reports to Management team.
  • Maintain approved project documentation library.
  • Ensure client satisfaction by engaging with client in every phase of project implementations.

Confidential, Greenwood Village, CO

Project Management specialist /Sr. QA Test specialist

Responsibilities:

  • Manage and coordinate all project team members' activities and tasks through completion of implementation.
  • Requirements reviewing, validating & verifying.
  • Develop detailed implementation project plans and project documents inconjunction with company, and client project managers..
  • Complete MS Project plan maintenance. Update % completed.
  • Monitor project resource Allocations vs. Actual.
  • Provided estimate during Sprint planning.
  • Monitor Run rate vs. Budget variances
  • Project Reporting: Complete Clarity Weekly status reporting.
  • Manage testing for Provider conversion from mainframe programs to web based program using Online FACETS applications and validation of data by using Oracle DB2.
  • Tested Facets Letters that were generated as a result of routine nightly batch processes that identified prospective members and a letter server that produced teh pdf file output. Similarly, tested teh output of EOB/EOPs as related to teh dropping of medical insurance claims.
  • Create Test Lab in HP Quality Center.
  • Create Test data in order to execute test cases.
  • Generate report from HP Quality center & provide status and progress reports to Management team.
  • Ensure client satisfaction by engaging with client in every phase of project implementations and providing

Confidential

Software Quality Assurance

Responsibilities:

  • Write/Execute test plans and manage testing activities for all software delivery projects (e.g. Web-based programs, online and batch programs).
  • Attended all teh reviews from business requirement, conceptual and technical design, and developing test cases iteratively and reviewing with QE's team and project management for approval of those test cases.
  • Used Mercury Quality Center extensively to write test cases and log teh test result after executing them.
  • Involved in Defect tracking management after teh test cases are executed.
  • Followed Agile process.
  • Ensure client satisfaction by engaging with client in every phase of project implementations.
  • Attended meeting for new design/existing process to document testing.
  • Conducted regression testing on web, prior to release of teh One World software.
  • Responsible for creating Test Lab and score card in HP Quality Center.
  • Tested enhancement to teh Transportation Application.
  • Developed test cases from teh requirement documents.
  • Created data according to teh test cases, using TOAD.
  • Activating transportation management, transportation constants.
  • Item Setup, Carrier setup, rates and routes setup.
  • Setting up routing restrictions.
  • Entered any defects found in Test director and follow up for teh bug fixes by teh developer.
  • Tested enhancement to teh Transportation application.
  • Developed test cases from teh requirement documents and completed peer review.
  • Teh following applications were tested for enhancement project in Manufacturing APS-SCBM: Base, Customer, Distribution, Sales Order, Purchase Order, Transfer order and Work order.

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