Summary:

• Over 7 years of professional work experience with an earned reputation for meeting demanding deadlines and delivering critical solutions on various levels of Quality Assurance in IT, Insurance and Healthcare Industries.
• Involved in thorough study of Business Requirement documents and functional requirement specifications.
• Participated in weekly meetings with Business Analysts, Development and QA team to discuss the milestones, progress and the issues.
• Analyzed testing results and generated QA daily status Reports and communicate with team for future priorities.
• Exceptional problem solving, decision-making, strong interpersonal and communication skills.
• Excellent understanding of the Software Development Life Cycle (SDLC) with emphasis on Black Box testing, functional testing, GUI testing, system testing, regression testing, security testing. Skilled at building a strong team environment, and have ability to acclimatize to new technologies and situations with ease.
• Was involved in writing the test plans, test cases, executing the test cases, linking the test cases with the requirements, logging the defects and tracking the defects.
• Involved in writing complex SQL Queries for verifying the data in database and reports.
• Performed the back-end testing to ensure data consistency on front-end by writing and executing SQL queries.
• Experience testing migration of 4010 to 5010 EDI transactions and data mapping
• Extensive experience in Healthcare/Claims adjudication with knowledge of ICD-9 & ICD-10
• Used Quality Center as repository for requirement analysis, design test cases, Execute test cases, Bug tracking and reporting.
• Performed End-to-End Testing Manually before Automated Testing.
• Experience on testing windows and Web based applications.
• Identified the positive and negative test cases for functionality, integration and system testing of the application.
• Defined and performed the Test strategies and associated scripts for the verification and validation of the application and ensuring that it meets all defined business requirements and associated functionality.

Skills:

Methodologies

SDLC, Waterfall, Agile, Scrum

Operating Systems

Win NT/2000/XP, VISTA, LINUX, UNIX.

Testing Tools

Quality Center, QTP

Programming Language

HTML, SQL, ORACLE, C, C++,UNIX, VBScript

Business Modeling Tools

UML

Database

MS Access, Oracle, MS SQL Server, MySQL

Confidential, FL May'12- Present
Sr.QA Analyst
Florida Health care Plans systems are one of the largest consumer health organizations, takes pride in offering affordable Individual Health Insurance Plans for residents of Volusia and Flagler Counties. Specialty operations include Group health care plans, Part C and Part D Medicare Advantages plans, Florida Healthy kids program, Individual health care plans for employees and residents, behavioral health, dental and vision, life insurance, and complete pharmacy and medical management.
Florida Health care plans obtainable introduced Qiclink to provide quality health care products and services designed specifically to meet the changing health care needs of customers. As a part of the claim adjudication the whole idea is to migrate data from MC400 legacy to the Host web application system Qiclink in order to meet the standards of Trizetto Qiclink to perform claim processing and adjudication with final payment for TPA Third party Administration business by customizing updating Qiclink system.

820 FHC Florida Health choices:
The current medical insurance billing system which is MC400 iSeries legacy was equipped with submitting claims to insurance companies and patients, and following each claim in order to collect payment for the services delivered by a healthcare provider. 820 Automation of premium cash posting ( AR cash entry) using the received Florida Health Choices 820 payment data with automated creation. Further enhancements modification in EDI manager with Legacy system has been made which also ensures that payments are wired directly to the designated bank account providing the correct end details of whole transaction.

BER Batch Engine Refactoring Process:
FHCP already equipped with legacy system called MC400 for our current members. MC400 will work together with EDI manager to validate match and do cross walk for all Members, Providers, Diagnostic codes and Procedure codes Tables in order to process claims successfully within EDI manager application and MC400 iSeries Legacy system to meet against the standard Business rules criteria with Business object validation.

Responsibilities:

• Reviewed the Business Requirement Documents (BRD) and the Functional Specifications.
• Created Test Plans by going through the design and functional specifications.
• Involved in developing Test Scripts as per the business requirements in Quality center.
• Followed Agile - Scrum testing methodology.
• Performed data-driven testing to read test input data from an Excel File so as to test the application with different positive and negative data.
• Analyzed the system requirement specifications and developed appropriate test plans, test cases test scripts and executed testing.
• Designed and documented test plan, test strategies, test cases in EDI Test Manager by evaluating the requirement document in Requisite Pro and performed hands-on testing for complex test conditions, scenarios and scripts so HIPPA transactions in EDI formats are verified.
• Validated and analyzed EDI outbound and inbound Transactions.
• Performed Positive and Negative testing, Black Box testing, and End User testing.
• Validated EDI transactions like EDI 834 (Benefit Enrollment and Maintenance), 277/275(Health Care Claim Request for Additional Information and Response), 276/277(Health Care Claim Status Request and Response), 835(Health Care Claim Payment/Advice), 837 and (Health Care Claim: Professional, Institutional and Dental) as per HIPAA 5010
• Reviewed the Business Requirement Documents (BRD) and the Functional Specifications.
• Created Test Plans by going through the design and functional specifications.
• Validated all the information from HIPAA to QICLINK .
• Migrated and validated all information from MC400 iseries legacy system to QICLINK in DEV environment.
• Resolved any problems found within QICLINK and when testing the SQL data database while validating against the business rules.
• Worked with other teams to review and modify process flows to increase productivity and effectively utilize QICLINK features not provided by the MC400 iSeries legacy systems
• Worked with Qiclink System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 834,820 and proprietary format files and Reports development.
• Worked on the EDI claims including both the batch processing BER (Batch Engine Refactoring) and direct data entry.
• Assisted informational needs in mapping of Test Cases.
• Development team to fix the issues raised during the conversion period
• Validated the application against the expected results by inserting Database and GUI checkpoints.
• Extensively used of JIRA tool for defect reporting and tracking and prioritizing defects
• Performed QA Acceptance testing for test workflows with business users and performed data encryption testing as per HIPPA guidelines to ensure the privacy, security and confidentiality.

Environment: Qiclink, SoapUI, Web Services, JIRA , Oracle, MC 400, EDI Manager DB2, MS Office 2007, Windows XP, XML, XML Generator

Confidential, MD Dec\'10 - MAR'12
Sr. QA Analyst
CAREFIRST MODEL OFFICE
The Model Office Project intends to address the implementation of Facets as a solution for the mid and small size segment of the market. It will require of various external web service applications to reference the new Facets , so that information can be exposed to members and providers via appropriate channels. The testing effort includes web services that process requests for information that is housed within FACETS components.
Responsibilities:

• Involved in Test Plans and wrote Test Scripts for Manual Testing.
• Performed Positive and Negative testing, Black Box testing, and End User testing.
• Validated EDI transactions like EDI 834 (Benefit Enrollment and Maintenance), 277/275(Health Care Claim Request for Additional Information and Response), 276/277(Health Care Claim Status Request and Response), 835(Health Care Claim Payment/Advice), 837 and (Health Care Claim: Professional, Institutional and Dental) as per HIPAA 5010
• Multiple 837map set developed for each client (clearinghouse, internal, and external trading partners), as well unique mappings were needed in each map to accommodate various conditions dealing with Provider, Subscriber, PAY-TO and BILL-TO Provider information needed to identify multiple conditions dealing with batch processing of claims.
• Involved system testing on EDI transaction 270/271 for both inbound and out bound.
• Verified and validated HIPAA compliant X12N format for both inbound and outbound healthcare EDI transactions as per ICD 10
• Troubleshoot any problems found within FACETS and when testing the SQL data database while validating against the business rules.
• Responsible for working with the team to review and modify process flows to increase productivity and effectively utilize FACETS features not provided by the legacy systems
• Worked with Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 834 and proprietary format files and Reports development.
• Validating all the information from HIPAA to FACETS.
• Used SOAP UI for testing Web Services, inspecting WSDL files, generating SOA envelopes, and accelerating many other common XML tasks encountered when developing Web-Service enabled applications.
• Involved in creating projects, test suites and done parameterization in SOAP
• Validated XML, XSD, XPath Syntax, Web Services
• Worked with the client and stakeholders to design and configure all the required claims processing rules.
• Created Claim Test Data and tested various scenarios.
• Assisted informational needs in mapping of Test Cases.
• Worked on the EDI claims including both the batch processing and direct data entry.
• Performed GUI testing, Integration testing, Regression testing, Ad -hoc testing, Negative testing, End to End testing, Load testing, User Acceptance testing on multiple projects.
• development team to fix the issues raised during the conversion period

Environment:Rational Rose, MS Office Tools, Ms Visio, .Net, C#, BizTalk, Windows XP, AS 400, Oracle, SQL, Quality Center, QTP, Crystal Reports, Facets, soapUI

Confidential, OR Jun \'09 - Nov\'10
Sr. Test Analyst
"Premera BCBS" had undertaken a strategic initiative to completely transform the existing tightly coupled, Claims processing and adjudication, legacy system into a loosely coupled SOA based system. Claims to Payment (C2P) is a large business process that involves many applications and components well integrated into the SOA architecture. Getting all the Applications and environment components in a stable state for E2E Testing was a challenging task. I was the Senior Test Analyst in the Testing team. Agile methodology was used for development and testing of the Claim Transactions system and Membership enrollment system
Responsibilities:

• Participated in daily standup meetings to discuss the daily progress and any changes in the requirements
• Interacted with the SME's to discuss the system requirements and uploaded it to Quality Center
• Reviewed, Tested and Verified the Standard Operating Procedures, written for testing the application
• Analyzed system requirements and developed detailed Test plan and Test cases, using Quality Center for testing the functionality, GUI, security, and usability of the system
• Performed manual testing considering the base line of developed test plan and test cases considering both positive and negative scenarios.
• Executed test cases developed by self or peer. Compared and analyzed actual to expected results and reported all deviations for resolution.
• Identified and created test data to support the successful execution of "Claim to Payment" scenarios
• Organized meetings with cross-functional teams to discuss the integration testing approach
• Developed and executed test cases based on the requirements document and the test plan using Quality Center
• Used SOAP UI Web Services tool for testing Web Services, inspecting WSDL files, generating SOAP envelopes, and automating or accelerating many other common XML tasks encountered when testing Web-Service enabled applications.
• Created test data (XML payload) using XML generator and executed test cases to test the Web Services using Soap-UI testing tool
• Created Assertion to Automated the Web services testing
• Created data files for EDI 837/835, 270/271 and 276/277 transactions. Uploaded EDI 837 files for batch processing
• Tested migration of 4010 to 5010 and validated EDI X12 transactions such as 834, 837/835, 270/271 & 276/277
• Performed functional testing, regression testing, integration testing, according to the requirement specification to check if the application is error prone
• Verified that all the features work as described in the Application documentation provided by the Development Team and as defined through study of screens and underlying application code.
• Identified, analyzed and documented all defects that are inconsistent with stated requirements and design specifications by providing meaningful defect reports within the defect tracking system (Quality Center)
• Worked with the application programmers to resolve defects identified during the system test.

Environment: Facets, SoapUI, Web Services, Quality Center, Oracle, AS 400, DB2, MS Office 2007, Windows XP, XML, XML Generator

Confidential, PA Dec\'07 - May\'09
Sr. QA Analyst
Independence Blue Cross (IBC) is a leading health insurer in south eastern Pennsylvania with 2.4 million members in the Pennsylvania State. IBC has offered quality health care products and services designed specifically to meet the changing health care needs of customers. Medicare Advantage Preferred Provider Organization (MAPPO) is a health plan developed for senior citizens (age over 65) in order to provide them the best plan. MAPPO is a PPO which covers Part A, Part B and emergency services. Medicare Advantage Plans are called Part C and are offered by private companies approved by Medicare.
Responsibilities:

• Reviewed the Business Requirement Documents (BRD) and the Functional Specifications.
• Created Test Plans by going through the design and functional specifications.
• Involved in developing Test Scripts as per the business requirements in Quality center
• Followed Agile - Scrum testing methodology
• Developed various test cases for testing HIPAA 834(4010 / ICD 9)
• Developed Test Cases for Database Validity in Open Enrollment of Medicare Part A, Part B and Part C.
• Tested Coverage termination requirements at INS Membership Detail level and HD Health Coverage level.
• Tested Enrollment/Dis-Enrollment and Change in membership status according to the specific DTP segment at INS level.
• Involved in HIPAA/EDI transactions, Analysis, Testing and Defect Evaluation.
• Documented the Daily Defects Status with the help of TestMetrics.
• Performed extensive Back-End testing by writing and executing SQL queries on the database-using SQL*Plus
• Used Quality Center for defect Reporting
• Interacted with Business Analysts for UAT (User Acceptance Testing), and tested the possibilities of system failure with UAT
• Worked on the continuous improvement of QA Process by reviewing and evaluating existing practices with standard testing guidelines

Environment: Quality Center, QuickTest Pro, XML, HIPAA, EDI, HTML, JavaScript, Lotus Notes, Oracle, DB2, SQL, SOAP, IBM Mainframe, UNIX, EDI, Windows XP, Java

Confidential, Starkville, MS Oct\'06 - Nov\'07
Sr. QA Test Analyst
Confidential, is a county owned and operated hospital providing more than emergency care for its patients. OCH invests its resources back into its facilities, its medical technology and equipment, and its communities in order to provide unmatched services for the region\'s residents; an updated billing system was required. This new medical insurance billing system was equipped with submitting claims to insurance companies and patients, and following each claim in order to collect payment for the services delivered by a healthcare provider. It also ensures that payments are wired directly to the designated bank account. Some major tasks involves filling up the claim forms, generating Invoice Number, submitting claims and sending billing statements and all of this is done according to the HIPAA compliance using EDI. This new software delivers 10% more accuracy as compared to old billing software to reduce the rejections, denials and overpayments of invoices due to complexity of claim formats. The company can now focus more intensely on anticipating changing requirements and providing customers with new and value-added services.
Responsibilities:

• Analyzed the system requirement specifications and developed appropriate test plans, test cases test scripts and executed testing.
• Designed and documented test plan, test strategies, test cases in Test Manager by evaluating the requirement document in RequisitePro and performed hands-on testing for complex test conditions, scenarios and scripts so HIPPAtransactions in EDI formats are verified.
• Validated and analyzedEDI outbound and inbound Transactions.
• Created reusable functions in VB scripts using QTP and thru active screens created Shared object repository for the entire test set to test most of the Web modules.
• Validated the application against the expected results by inserting Database, Bitmap and GUI checkpoints.
• Performed data-driven testing to read test input data from an Excel File so as to test the application with different positive and negative data.
• Worked with development engineers in diagnosing and isolating various integration problems and explain defects.
• Analyzed testing environment for both front and backend testing. Developed SQL scripts to test data loading process from and to different data sources.
• Performed QA Acceptance testing for test workflows with business users and performed data encryption testing as per HIPPA guidelines to ensure the privacy, security and confidentiality.
• Helped in integration testing of XML/EDI for data exchange between different business users.
• Extensively used QC for defect reporting and tracking and prioritizing defects and enhancement requests after base lining the requirements.
• Attended change request meetings to document changes and implemented procedures to test changes.
• Involved in continual improvement of automation test scripts to provide improved QA of testing processes and to reduce whole testing cycle time.

Environment:Quality Center, JavaScript, Oracle 8, MS Office, XML, HTML, QTP

Confidential, Cypress, CA May\'05 - Sep\'06

Quality Analyst

Confidential, are one of the nation\'s largest consumer health organizations, offering individuals, employees and Medicare beneficiaries a variety of consumer-driven health care and insurance products. Specialty operations include behavioral health, dental and vision, life insurance, and complete pharmacy and medical management.

The claims transaction project consists of the following modules like Transaction, Claims Processing, and Claims Entry, Employer modules. Transaction module would help speed up the processing time. Claims processing module helps to find the providers in the network; Claims Entry helps to find out about the entry of various groups like employers, plans. Designed and programmed Electronic Claims processing between hospital and insurance companies and Medical Labs, to a variety of platforms.
Responsibilities:

• Developed, implemented and executedtest methodologiesand plans to ensure software product quality.
• Responsibilities included reviewing and analyzing the requirements of the application. Designing the Test plans, creating and running the automated and manual test cases, identifying the defects.
• Created reusable functions in VB scripts using QTP and thru active screens created Shared object repository for the entire test set to test most of the Web modules.
• Conducted review meetings with the development team to set a hard-freeze date and gather input for creating the Test Plans and Test Specifications.
• Involved in Individual tests and workflow tests.
• Creating manual test cases using QC, and executing and analyzing the test results.
• Worked with GUI scripts for the Functional and performance tests.
• Included Standard checkpoints, Table checkpoint, Text checkpoint, Textarea checkpoints, Database checkpoint in the GUI scripts. Created data pools for performing data driven testing for positive and negative test sets.
• Specified Test Cases and Test Scripts for automation using QTP for the testing.
• Attended review meetings, performed Walkthroughs with the developers.
• Involved in writing SQL Queries for different projects for verifying the data in database and for creatingthe different policies used for testing claims project scenarios.

Environment: Windows 2000/XP, HTML, J2EE, Quality Center/TestDirector, HTML, XML, Oracle.

Education: MS in Healthcare Management