SUMMARY:

• Over 8 years of extensive experience as Tester, Sr Test Lead, Business System Analyst & Development in Health Insurance and Financial Domains
• Experience as Tester and Sr Test lead in the Healthcare and Financial domains on various areas like Claim Processing, Front End Claim keying, Provider contracts, Claim formats, EOBs (Explanation of benefits), Checks generation, Medicare(Senior business) enrollments and member and provider grievances &appeals, VOIP apps and Call centre apps
• Experience working on HIPAA 5010 version of EDI transactions 837I & 837P claim formats
• Experience working on NSF, HCFA and UB 92 claim formats
• Experience working on HIPAA transactions ASC X12 835, 275, 276 and 277
• Extensively worked on ICD 9 and ICD 10 codes
• Strong Interpersonal Skills in interacting with SME’s, Project Stakeholders and Senior Management.
• Extensive hands on experience on Manual testing and team leading experience on automation testing
• Expert on Manual testing. Worked on Mainframe testing, VOIP testing, Siebel testing, Silverlight testing & Web Services testing
• ISEB-ISTQB certified professional
• High degree of exposure to Test director, Quality centre, SOAP UI tool, Hiper Station(mainframe automation tool), Rational Clear Quest(RCQ), Requisite pro(ReqPro), Ration Quality Manager(RQM)
• Lead automation teams where Rational Functional Tester(RFT) and Quick Test Professional(QTP) used
• Worked on different testing levels such as System testing, User acceptance testing, End to End testing, System Integration testing and Regression testing
• Extensive experience in preparation of test estimates, Test strategy, Test plans, Test approach, Test scenarios design, Test scripts execution & Defect management for both SIT and UAT
• Lead a team of 12 members. Extensive experience in task allocation, monitoring, tracking & reporting
• Hands on experience on COBOL, JCL, VSAM, DB2 and CICS coding
• Excellent Communication and Presentation Skills both oral and written. Proven ability to convey Business requirements and Technical needs in clear, concise, and effective manner.
• Have strong knowledge of Rational Unified Process (RUP), Waterfall and LeanIT methods of SDLC.
• Prepared Business Requirement Documents (BRD) and Functional Requirement Documents (FRD) for multiple Healthcare projects
• On time escalations, raise issues and concerns at right time
• Have a good experience in Preparation of RTM(Requirement Traceability Matrix), Test Evaluation Summary doc(TESD) and Test Closure Docs
• Extensively worked on SQL server 2005, 2008 and DB2 databases

TECHNICAL SKILLS:

Methodologies:

Waterfall, LEANIT and SDLC.

Business Processing Tools:

MS Visio, Rational Requisite Pro, Clear Case

QA Tools:

Test Director, Quality Center, SOAP UI Tool, Rational Clear Quest, Rational Quality Manager & RFT

Languages:

COBOL, JCL, CICS, DB2 & VSAM

Databases:

Oracle, SQL Server , DB2 & MS-Access

Workflow Tools:

MS Visio, MS Word 97/2000, MS Excel 97/2000, MS Access 97/2000, MS Project

Platforms :

Windows (2000, NT, XP & 2008)

• Master of Computer Applications(MCA)
• Bachelor of Science in Computers

PROFESSIONAL EXPERIENCE:

Project Description: It is a new enterprisewide system designed specifically for Commercial, State Sponsored and Senior Business Grievances and Appeals. Currently, there are multiple Grievances and Appeals tracking systems across the enterprise. Multiple systems make it difficult to report, track and trend grievance and appeal issues from an enterprise perspective. So this particular system will unify these systems for enterprise tracking and Reporting applestoapples.

Responsibilities:

• Developed Test ideas/Scenarios for Member and Provider grievances, appeals and inquiries and administrative and clinical appeals
• Lead a team of 12 members. Assign, monitor, track and report tasks/activities
• Developed Test ideas/Scenarios for integrated requirements that interact with Member enrollment systems, Provider application, claim processing applications and Utilization Management applications.
• Extensively interacted with business partners, doctors, registered nurses and other review agencies during project design phase
• Prepared MOU on Member, provider and inquiry workflows for all kind of grievances and appeals.
• Provided 50% and 90% Level of estimate for testing work to get hours allocated for the project execution
• Prepared Requirements Traceability Matrixes (RTM) that contains mapping between requirements, BSA deliverables, DEV deliverables and test deliverables
• Prepared Test strategy, Detailed Test plan, Test Evaluation summary for the project
• Participate in Daily status report and weekly status meetings
• Conduct defect management process
• Support UAT testing
• Participate in deployment activities and conduct IT checkout

Environment: MS Visio, SOAP UI Tool, MS Excel, Rational Requisite Pro, Rational Clear Quest & SQL.

Confidential,Cincinnati Oct 2009 – Feb 2012

Project Title: Senior Enrollment Platform (SEP)

Project Description: Senior Enrollment Platform is the enrollment and maintenance application for WellPoint’s Senior Business designed for Medicare Advantage (MA Only), Medicare Advantage with Part D (MAPD) and Part D (PDP) plans. Members are entered into application by Paper or Electronic process. Inbound and outbound interfaces are used to feed data into and out of system from source.

Responsibilities:

• Extensively worked on Medicare Advantage(MA), Medicare Advantage & Prescription Drug(MAPD) and Prescription drug plan(PDP) businesses for different plan years such as 2010, 2011 and 2012
• Extensively worked on Paper enrollments, Electronic enrollments, OLS(online store) applications for Senior business
• Reviewed business requirements for Central, North East and West regions on Agent Commission process
• Extensively worked on integration with enrollments, billing, claim processing applications
• Extensively worked on test scenarios creation for CMS mandated requirements that deal with plan changes, coordination of benefits and accurate agent commission calculations

Automation Test Lead: Responsibilities

• Coordinate automation of proper manual regression test scripts
• Propose enhancements to automation enterprise framework
• Propose the best practices for increased automation execution throughput
• Coordinate custom functions and macros development required for automation work
• Prioritization and execution of regression scripts based on impact to the functional modules in a particular release
• Plan different phases for automation scripts preparation
• Make sure scripts maintenance happens periodically
• Suggest improvements to the framework code
• Assigning, tracking, monitoring and reporting tasks/activities on test script preparation and test script execution
• Defect management
• Coordinate with framework development and IBM teams for RFT(Rational Functional Tester) and framework related issues

Role: Manual Test lead: Responsibilities

• Participate in design walkthroughs and understand the functional changes/enhancements
• Prepare Test estimation
• Identify appropriate resources for the testing
• Prepare Master Test plan in RQM(Rational Quality Manager) and Test strategy document in word format
• Coordinate test scripts preparation once design docs are finalized
• Coordinate Peer Reviews and business reviews for test scripts
• Highlight issues/risks in advance
• Involve in test environment and code drop planning sessions
• Involve in Test Data preparation and support activities
• Coordinate Test execution
• Coordinate proper defect management process thru RCQ(Rational Clear Quest)
• Run and participate in defect triage calls
• Make sure the requirements are loaded to ReqPro(Requisite Pro)
• Coordinate different change requests for a project as appropriate
• Daily status reporting to clients and management
• Onshore/Offshore coordination
• Coordinate integration test activities
• Make sure the right regression scripts are added to regression suite
• Prepare test evaluation summary

Environment: MS Visio, MS Excel, Rational Requisite Pro, Rational Clear Quest, & SQL.

Confidential,Basking Ridge, NJ Sep 2006 – Sep 2009
Module Test Lead
Project Title: TOPS (The Online Processing System)

Project Description: TOPS is a mainframe-based claims processing system that allows the client to process claims throughout the United States of America wherever client has the business. This particular system processes HCFA, NSF, 837I, 837P and RX claims. It also interacts with front end keying systems, summary check system and consolidated eligibility systems and network provider systems. This particular system also has the capability to generate 835s for eligible providers.

Responsibilities:

• Facilitated Working sessions, articulated requirements, make recommendations for process andbusinessflows, develop consensus on requirements, performed analysis of requirements, by developing SRS(System Requirement specification), andcollaborating with users to reduce project risk and to increase quality.
• Developed system specification for STBK claims(Smart Total Bill keying) which is front end claim keying system
• Developed design documents for 837P, 837I, NSF and HCFA claim formats
• Extensively worked on Auto adjudication and manual adjudication of claims
• Experience working on HIPAA 5010 version of EDI transactions 837I & 837P claim formats
• Experience working on NSF, HCFA and UB 92 claim formats
• Experience working on HIPAA transactions ASC X12 835, 275, 276 and 277
• Extensively worked on ICD 9 and ICD 10 codes
• Good understanding of 835 provider formats/sections
• Extensively worked on EOBs(Explanation of benefits) and check generation for providers and members
• Good understanding of Copays, Coinsurance, Deductibles, provider contracts, member eligibilities, Diagnosis codes & procedure codes
• Extensively worked on both professional and institutional claims for real time examples
• Maintained SA action_log, clarification_Log, Risk/issues log and discussed them with business regularly during analysis and design phases
• Understand BRD, DSS and involve in walk-through.
• Involve in Test plan, Test design and Test execution
• Peer review of test scripts
• Cross training the team members and help in knowledge sharing
• Impart health care domain knowledge to the new joiners in the team
• Clarify all the questions of the testers encountered during execution phase
• Keeping track of defects till the closure and contact business team if needed for defect resolution. QC(Quality centre) was used for defect management
• Provide Sign-off for the project artifacts
• Prepare project closure document
• Review high level test outline and detailed test outline prepared by QCA in team
• Assist peers during test data preparation phase
• Groom and mentor resources in the team.

Environment: Test Director, Quality Center, MS Office, MS Excel, MS Visio, MS Project

Confidential,Basking Ridge, NJ Sep 2005 – Aug 2006
Business System Analyst
Project Title: TOPS(The Online Processing System)

Project Description: TOPS is a mainframe-based claims processing system that allows the client to process claims throughout the United States of America wherever client has the business. This particular system processes HCFA, NSF, 837I, 837P and RX claims. It also interacts with front end keying systems, summary check system and consolidated eligibility systems and network provider systems. This particular system also has the capability to generate 835s for eligible providers.

Responsibilities:

• Designed system specifications for Coordination of benefits(COBs) and Claim adjustments such as over paid & under paid
• Developed design docs for different enhancements on plan benefits and claim processing
• Extensively worked on both professional and institutional claims for real time examples
• Produced functional specifications and lead weekly meetings with SMES, business owners, developers and testers to discuss outstanding technical issues and deadlines that need to be met
• Conducted Joint Application Development (JAD) process with Stakeholders to analyze deliverables and system constraints.
• Maintained SA action_log, clarification_Log, Risk/issues log and discussed them with business regularly during analysis and design phases
• Conducted walkthrough sessions with all stakeholders to walk through the design docs to go for sign off on different docs
• Provided supported for DEVELOPMENT, SIT and UAT teams from SA perspective
• Facilitated defect triage calls and helped prioritize the outstanding defects
• Consistently maintained lessons learnt logs and made sure appropriate teams follow them for better quality improvements
• Helped DEVELOPMENT during impact analysis of the claim processing knowledge
• Established self as SME on modules such as claim processing, claim key in & summary check
• Always mentored junior resources in the team

Environment: Test Director, Quality Center, MS Office, MS Excel

Confidential,Basking Ridge, NJ Sep 2004 – Aug 2005
DEVELOPER
Project Title: TOPS (The Online Processing System)

Project Description: TOPS is a mainframe-based claims processing system that allows the client to process claims throughout the United States of America wherever client has the business. This particular system processes HCFA, NSF, 837I, 837P and RX claims. It also interacts with front end keying systems, summary check system and consolidated eligibility systems and network provider systems. This particular system also has the capability to generate 835s for eligible providers.

Responsibilities:

• Understand the Business requirement and Detailed System specification documents
• Prepare Development estimates
• Perform impact analysis for the enhancements and prepare TDDs(Technical Design documents)
• Develop code using COBOL, JCL,VSAM,CICS and DB2
• Facilitate code review meeting with SMEs
• Prepare unit testing scripts, perform unit testing in DEV environment and document unit testing results in share point
• Support defect fixes for SIT and UAT
• Participate in release activities and facilitate IT checkout
• Support Warranty bug fixes

Environment: COBOL, JCL, CICS, DB2, VSAM & Test Director