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&#Street Address ; Louisville, KY
Work Status: Permanent Resident
ROLE CONFIDENT
IT BUSINESS ANALYST
Claims Domain
AGILE
SCRUM
CLAIMS
EDUCATION
Masters in Business Administration (MBA)
Jawaharlal Nehru Technological University, India
SKILLS
TECHNICAL SKILLS
MS WORD
MS EXCEL
MS PPT
SQL
PERSONAL SKILLS
COMMUNICATION
CONTINUE LEARNER
ORGANISOR
TEAM LEADER
SOCIAL
INNOVATIVE
PROBLEM SOLVING
COOKING
SPORTS
COMMUNITY SERVICES
HELP HOMELESS
FOOD DRIVE
SCHOOL SUPPLIES
PARKS CLEANING
Candidate's Name
Business Analyst | Claims Executive
5 Years of IT experience in Business Analyst and Requirements Gathering
7 Years of Domain experience in Healthcare Claims
Experience in Software Development Life Cycle (SDLC), Waterfall Model, Agile methodologies
Committed to professionalism and highly engaged with the customer to deliver data-driven business insights
EXPERIENCE
Business Analyst (May 2022 - Present)
Client: Humana Inc., Tampa, Florida
Employer: NTT Data
Humana Inc. is a fortune 100 company that market and administers health insurance in the United States. Humana market its health benefit consumer services in all 50 states and D.C., Puerto Rico by offering various health and supplemental benefit plans. Its government segment comprises of beneficiaries of government benefit programs and operates in 3 lines of businesses: Medicare, Military and Medicaid. The commercial segments consist of members enrolled in its medical and specialty products marketed to employer groups and individuals.
Responsibilities:
Worked with Product Owner and Development teams to participate in Business Requirements gathering.
Documented the Business Requirements and clarified to IT Dev teams for their design.
Participated in Joint Application Design sessions.
Worked with QA team and guided them to create functional test cases and scenarios.
Responsible for submitting Status Reports to management summarizing completed Milestones and Tasks.
Conducted Show and Tell sessions.
Validation of results in lower environments (Test) and reported defects along with the QA team and followed up with the development lead to resolving any outstanding defects.
Business Analyst (Nov 2019 May 2022)
Client: RxCrossroads - McKesson, Louisville, KY
Employer: NTT Data
RxCrossroads - McKesson Provides Commercial solutions for brand and specialty pharmaceuticals, including third-party logistics, custom pharmacy programs, and patient access and data and analytics solutions.
Responsibilities:
Analyzed the Contracts for different biopharmaceutical companies, Created and updated Functional Required Documents by gathering functional and non-functional specifications contributed to the continuous improvement process for requirements analysis.
Evaluated information gathered from multiple sources, reconcile conflicts, decomposed high-level requirements. I communicated with different Stakeholders, Business Groups, and User groups to elicit and to analyze Business Requirements. Assisted the Project Manager and QA Team, coordinating between team members according to the business requirements.
Created test cases and scenarios and met all project data deliverables and deadlines. Performed unit testing to confirm accuracy, quality, and completion as determined by the established requirements.
Create new Cases in iCMS to validate data and reconcile it with portal data
Responsible for submitting Status Reports to management summarizing completed Milestones and Tasks. Conducted user walkthroughs, documented customer concerns, and communicated to project management teams.
Reported defects along with the QA team and followed up with the development lead to resolving any outstanding defects.
Involved in Okta Implementation and security remediation by testing the Manufacturer and Physicians portals.
Business Analyst (Nov 2018 Oct 2019)
Employer: MoonIT Solutions, Frisco, Tx
MoonIT Solutions is provider of digital transformation services. Their customer-first approach enables to create innovative digital solutions with focus on providing connected and customized business solutions helping organizations to improve their digital footprint. They work at the intersection of strategy, design and innovation to catalyze change and deliver results. Proven successful delivery of software development solutions for more than 10 years.
Responsibilities:
Understand the User requirements and help preparing user stories
Clearly document Business Requirements Specification for IT
Clarify IT Stakeholders with Business Requirements
Prepare User Acceptance testing strategy and Test cases
Perform User Acceptance testing and approve product
Perform Production Validation after Prod Release
Claims Executive (Oct 2015 - Oct 2018)
Employer: Firstsource Inc, Louisville, Ky
Firstsource is a leading provider of customized Business Process Management (BPM) services. They are specialized in helping clients stay ahead of the curve through transformational solutions in order to reimagine business processes and deliver increased efficiency, deeper insights and superior outcomes. They are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines and India. Their rightshore delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals.
Responsibilities:
Investigate, analyze, and determine the extent of insurance company's liability concerning personal, casualty, or damages, and attempt to effect settlement with claimants.
Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information.
Calculate benefit payments and approve payment of claims within a certain monetary limit.
Analyze information gathered by investigation and report findings and recommendations.
Examine claims form and other records to determine insurance coverage.
Interview or correspond with respective units and to correct errors or omissions and to investigate questionable claims.
Prepare report of findings of investigation.
Refer questionable claims to investigator or claims adjuster for investigation or settlement |
