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EMAIL AVAILABLE / PHONE NUMBER AVAILABLEPROFESSIONAL SUMMARY:Business Analyst with over 9 years of experience in providing IT business analysis and consulting services to the domains such as Property and Casualty Insurance and Guidewire Applications.Proficient in Business Writing, Business Process Flow, Business Process Modeling, Business Analysis.Expert in Commercial Property and Casualty, General Liability, Commercial Lines and Personal Lines Insurance, Workers CompensationWorked extensively on Guidewire Policy Center and Guidewire Claim Center.Vast Insurance business knowledge with project experience in various LOBs such as Personal (Auto, Dwelling, Homeowner) and Commercial (Commercial Auto, Workers Compensation, Commercial Property, General Liability, Business Owners Policy (BOP), Commercial Package Policy (CPP).Experience with P&C Insurance domain along with Policy Administration System and Write business policies and procedures.Experience in facilitating Joint Requirement Planning (JRP) sessions with Business User Groups, conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.Good knowledge in the Property, Casualty, Annuities, Disability, and Supplemental Insurance policies include administration, sales, customization, claims.Experience in Guidewire suite (Policy Center and Claim Center) implementation and integrations.Hands on experience in using the Smart Comm Tool to do pdf overlays for personal lines documents provided by Business SMEs.Experience working on Receipt of ACORD Tech Account (TA), Claim Movement (CM) and settlement messages via file service, web servicing the middleware components.Experience in testing applications for Commercial Lines Insurance such as Ocean Marine, Other Liability, Commercial Automobile, General liability, and Commercial Property.Expertise in Thunderhead Product Suite, including - installation/upgrade, administration, data modeling, document design, document delivery and integration with external systems - using Web services.Experience working with Guidewire for Claims, Billing and Policy management core systems.Extensively experience in interacting with the designers, developers to ensure functional implementation of business requirements and QA Team in executing Test Plans, Test Scenarios and Test Cases for Claim Center Module using Guidewire.Experience in conducting Joint Application Development (JAD) sessions with the stakeholders and the project managers by conducting personal interviews, Questionnaire, Brainstorming, and Rapid Application Development (RAD) methodology to get a better understanding of client business processes.Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.Insurance experience includes Personal Property Casualty and Commercial Automobile Product knowledge, Reinsurance for Commercial Property Casualty, Group and Life Insurance Systems, Health Insurance, Auto Insurance and Homeowner Insurance.Strong understanding of project life cycle and SDLC methodologies including Waterfall and Agile.Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.Proficient experience in working on FACETS environment and possess an extensive knowledge about various modules of FACETS system such as Claims and membership.Knowledge and Experience on Membership Enrollment, Billing, Claims Payment Processing in relation to HIPAA, EDI, 5010 X12, ICD-10 codes 834, 837,835, and 270, 271 transactions.Groups and network, payer administration system, billing, capitation, member enrollment, benefit plans and groups.Expertise in Claim Processing which includes Health Insurance Portability and Accountability Act (HIPAA) Gateway and Claim Adjudication System.Strong experience and understanding of health care industry, claims management process, Knowledge of Medicaid, and Medicare Services.Good understanding of health care plans, Claims Management process, Medicaid and Medicare Services.Proficient experience in working on FACETS environment and possess an extensive knowledge about various modules of FACETS system such as Claims and membershipServed as a liaison between the internal and external business community (Claims, Billing, Membership, Customer service, membership management, and Provider management).Extensive experience in Unified Modelling Language diagrams (like Use Case, Activity, Sequence, data flow) and charts respectively using TFS, JIRA and MS Visio.PROFESSIONAL EXPERIENCE:Erie Insurance, Erie, PA November 2021 PresentBusiness Analyst/Data AnalystResponsibilities:Elicit Automation requirements from the Business and document in the form of Features and User stories.Design Solution for the requirements to resolve Business problems and achieve the desired value.Present the proposed solution to the Business with the Effort estimation.Analyze the need for Integration systems and the data to be sent to the target Integration system for communication.Draft sample SMS and Email contents, review with the business and obtain signoff from Clients Legal and Compliance teams.Obtain signoff from the Business to implement the proposed solution and obtain Cost code.Provide walkthrough to the Development and testing team for detailed understanding on the requirements and solution to beimplemented.Review the Test Scenarios and Test results and ensure no defect leakage to production.Ensure UAT environment availability and test data required to complete UAT testing.Co-ordinate with the Users and assist with Test steps to complete UAT testing.Investigate on the root cause and fix in case of any production defects during the project warranty period.Achievements:Implementation of Automated customer communication resulted in reducing the number of calls by 60% thereby reducing theservice cost by US $ 650K every quarter.This led us to another proposal from the Property LOB to implement a similar solution to reduce the Customer service calls.Philip Healthcare, Atlanta, GA July 2020 November 2021Business AnalystResponsibilities:Worked in the agile environment and performed gap analysis, created, and executed test plans, business requirements, and project plan for business initiatives.Wrote SQL Queries to create tables, stored procedures and performed data analysis, data mapping.Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues.Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.Documented various key elements of HIPAA compliance and made sure that they are understood by the development teams. Test cases written for the project were HIPAA complaint.Involved in analysis of HIPAA compliance and EDI Transactions sets and took part in discussions for designing the EDI transactionsConducted Claims and HIPAA Compliance Training to run the test cases. Also worked with NPIDesigned and developed Use Cases, Activity Diagrams, and Sequence Diagrams using Ms.Visio.Managed RTM (Requirement Traceability Matrix) to track the project flow.Integrate Health IT project with Health IT Interoperability Networks and utilize FHIR.Analyze healthcare workflows, interpret data models, perform gap analysis, traceability matrix and translate/integrate them into UML models and technical/functional design documents.Capture, analyze and validate complex Business Process Models (BPM) for current state (As-Is), Interim and future state (To-Be) models by applying BPMN Process.Duties include working with business stakeholders and the project teams to elicit business requirements, conduct JAD sessions, and develop functional use cases.Work in health plans, Medicare & Medicaid to document encounter reports.Provide technical support by answering user questions, troubleshooting glitches and system issues and documenting and escalating user questions to appropriate personnel.Documented function, non-functional, and system requirements as use cases, and user stories in JIRA.PriceWaterHouse Coopers - Omaha, NE March 2018 June 2020Guidewire Business AnalystResponsibilities:Managed the project related to transition cycle of Insurance application (Property & Casualty) i.e. from APPS to GUIDEWIRE following the Kanban methodology.Gathered requirements for Policy creation, Underwriting process, Product model development and delinquency process.Prioritized and sized business requirements and allocated resources to kick off the project.Proposed and created solutions including new and modified processes and procedures to complex business problems.Identified and documented risks and their impacts and provided recommendations to mitigate the risk.Conducted walkthroughs and defect meetings periodically to assess the status of the testing process and discuss areas of criticality.Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.Documented business requirements and business AS-IS and TO-BE process flows.Experienced in testing Client-Server and Web-Based Applications.Worked on Configuration and Integration/Business process End to End user stories for Policy center (Policy Administration system) and Billing center (Account receivable and commission system).Worked on New Business, Policy change, Reinstatement, PC to CC integration, Policy Documents.Worked closely with Guidewire Policy Center and Payment Manager Teams to co-ordinate the requirements and get strong working knowledge in Guidewire Policy Center product.Updated the existing business process diagrams and created new business process diagram.Coordinated team mailbox to ensure timely completion of business requests and task assignmentEnvironment: Agile, Guidewire Guidewire Policy Center v8, Guidewire BillingCenter v8, SOAP UI, Rally, Jira, MS Office, MS Visio, Oracle, Windows 10.Health Spring, Nashville, TN September 2016 Feb 2018Business AnalystResponsibilities:Based in Nashville, TN, Health Spring (est. 2010) is one of the countrys largest and fastest growing coordinated care plans, whose primary focus is Medicare Advantage plans. Health Spring currently owns and operates Medicare Advantage plans in various states. Health Spring also provides a national stand-alone prescription drug plan. Involved in the COMPASS project including the migration of data from existing legacy system to FACETS.Worked on Member Management, Eligibility, Claims, and Provider modules within FACETS.Conducted extensive analysis on migration and conversion of Provider and Member data.Clarified QA team issues and reviewed Test Plans and Test Scripts developed by DEV and QA teams to ensure all requirements have been covered in scripts and testedInvolved in documenting business processes by identifying the requirements including system requirements.Was involved in process flow analysis for content management system.Involved in the complete SDLC as well as testing life cycle.Worked in creating interfaces for various external vendors.Created Technical Specifications for the 835 and 837 files with their changed and new contents to create 5010 complaint files.Wrote multiple Test Cases for multiple transactions include 837, 835, 276, 277, 270 271 transactions.Reviewed administrative and Clinical practices and procedures: point of care, scheduling, registration, Clinical documentation, Patient care, and charge entry, medical coding, and diagnostic testing procedures associated with multiple business units.Worked on Healthcare system implementation including enterprise Electronic Medical Records (EMR) and Electronic Health Records (EHR) software.Created data mapping to document migrated data from the existing to new system.Reviewed various Customer transactions using the FACETS application.Gained extensive experience with HL7 for various interfaces.Worked on Adjudication on eligibility-Enrollment, Billing, Group / Member insurances.Coordinated with teams at various geographic locations for releases.Integrate Health IT project with Health IT Interoperability Networks and utilize FHIR.Coordinated with teams for testing functionality for the subgroups module like PBM Pharmacy BenefitData mapping on Enrollment Module (EDI 834) of FACETS and helped with the expansion of Membership and Provider data models.Created workflow diagrams, process flows, and data flow diagrams.Assisted teams with data extracting strategies for data migration.Involved in creating Use Case diagrams for the team to understand the workflow of the systems.Analyzed the business needs for reports and documented the requirements.Analyzed EDI ANSI X12 file mapping and reported in analysis spreadsheet.Effectively communicated UAT results between Users and Development team, and provided recommendations for Change Control Requests (CCR)NJM Insurance New Jersey September 2015 September 2016Guidewire Business AnalystResponsibilities:Work with production underwriters to review commercial property insurance renewal and new business opportunities to ensure proper risk identification, analysis and assessment and the development and growth of a profitable portfolio of business.Worked with Billing center, Customer Portfolio, Forms team to test the integration between these services.Performed Data Cleaning, Data Profiling, and Data Analysis and Data Mapping operations to bring more insights onto the raw finance data.Worked on a project, which dealt with the Production Stabilization and Defect Tracking of the newly migrated Guidewire Billing Center.Responsible for gathering requirements from users in operations group and performing data mapping for the application, confirm and vacillating the requirement at time of BA testingElicited requirements for various Claims Integrations with Policy Center and Billing Center on activities like Policy and Billing Status retrieval, Checks Issued and Void Processes for Claims etc.Involved in testing the Quote & Purchase for both Auto and Home Property Insurance ratings of the customers.Extracted data Analysis from various sources like Oracle and text files using MS Access, SQL procedures Maintained key records for purposes of Compliance review, QA/QC, and/or regulatory inquiry. Performed Data mapping, logical data modeling, involved in creating class diagrams and ER diagrams and used SQL queries to filter dataUsed JIRA for User Story requirements management throughout the Agile Sprints and development life cycle.Involved in creating Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temporary tables, flat files etc.Responsible for writing and modification of PL/SQL stored procedure, functions, packages, and Database triggersIdentify customer-marketing opportunities by applying data mining models and writing advanced T-SQL stored procedures and queries.Environment: Agile/Scrum, Guidewire Billing Center v8, Rally, MS Office, MS Visio, MS SQL Server, Windows 7.Evolent Health Pune, India August 2013 August 2015Business AnalystResponsibilitiesTested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches membership, Billing, ProviderResponsible for maintaining the change notification request document and communicating with the developers in each iteration review meetings.Create and managed requirement types and traceability relationships.Apply knowledge experience of HIPAA Act Rules and Regulations HIPAA transactions.Perform research on Member, Provider, Claims, Authorization, Appeals and Grievances data from FACETS back end and front-end application system for reporting purposes.Extensive involvement in data mapping using FACETS data model.Acquire signoffs at the beginning and end of each process from the project sponsors.Facilitate numerous meetings for the creation of design documents, gathering requirements from the users, Business Owners Project Managers.Conducted Joint Application Development (JAD) sessions with stakeholders to develop the correct specifications.Assisted developers in understanding the business requirements.Monitored the development process to identify whether the requirements are rightly implemented or not.Validated technical designs created by system analysts against functional specifications.Worked with QA team to design test plan and test cases for User Acceptance Testing (UAT)Worked as a liaison among stakeholders both business and IT side in order to elicit, analyze, communicate, and validate requirements for changes to business processes.Create and communicated the prototype requirements to the development team in Excel formats as templates for the reports.Assign tasks to the project development team, monitoring and tracking process of the project.Responsible for configuration / compatibility and BA testing with the help of FACETS, SharePoint, and Tidal scheduler.Accountable for creating Test Plans and conducting the testing and defect analysis.Extensive use of FACETS back-end tables and front-end application system for data validation purposes.Perform UAT with the Business Owners respectively.Education:MBA in Technology and Finance Management from Herzing University, Georgia (September 2015 September 2016)Bachelors in commerce from Siva Sivani Institute of Management, Hyderabad, India (2010 2013) |
