RIDHIMA

Sr. QA Analyst

Objective: Obtain a challenging career as a QA/Software Tester/Business Analysts with a progressive

organization that utilizes my skills, abilities and knowledge and provide opportunities for career growth

that will add value to the organization.

Summary

● 8 plus years of extensive experience in Quality Assurance of Software Development Life Cycle

(SDLC) specializing in Quality Assurance Process and Methodologies.

Experience in different methodologies like Waterfall, Agile/SCRUM and Rational Unified Process.

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Solid expertise in testing software applications using Manual Tools ( Quality Center/Test Director,

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Mantis) and Automated Testing of web services, web applications on Windows and UNIX operating

systems.

Extensively performed manual testing primarily Smoke, Integration, Functional, Regression, UAT,

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Black Box, Backend Testing, GUI and Browser Compatibility testing.

Proficient in Test Plan formulation, Test Case design, Test Scenarios and Test Reports.

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Extensively worked on HP Quality Center to Write Test Cases, Execute Test Cases, Log Defects,

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Track Defects and Prioritize Defects.

Developed database queries to assist in testing effort. Extensively used SQL to create, maintain and

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verify sets of test data.

Proficient in writing detailed and well-organized Requirements & Test Cases using HP Quality Center

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(QC), reporting Defects and raising any issues to the Team Lead, BA, QA Manager.

Excellent exposure on Defect Life Cycle and Release Management.

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Efficient and proven track record with handling Change Requests by the Clients.

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In House experience with HIPAA/EDI (835, 837) /CMS Standards, requirement analysis, design,

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implementation, and documentation.

Excellent knowledge of Health Insurance Plans ( Medicare Part A, B, C and D), managed care

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concepts (Medicaid and Medicare), implementation and knowledge of code sets, ICD-9, ICD-10.

Extensive knowledge of IBM lotus notes and Microsoft Outlook 2003.

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Working knowledge of Notepad++ and Member DTRR, BEQ Files.

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Ability to understand and analyze business process and workflows with the objective of providing

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recommendations for the best of technology with Business Users, Management unit, developers –

onshore/ offshore teams.

A motivated, self-starter/team player with strong communication and leadership qualities.

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A knack to learn new tools and technologies with strong analytical skills.

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TECHINICAL SKILLS

Databases Oracle 8i,9i,10g, MS SQL server, MS Access, IBM DB2

Languages C, C++, Java, SQL, XML, C#, VB, ASP, Assembly, VHDL

Testing/Defect Tracking Tools MS Office: Word, Excel, Access, Power point, Project, Visio, Front

Office, Rational Rose, Team Test, Doors, Clearcase, Clear Quest,

LoadRunner, WebSphere, HP Quality Centre, QTP, Bugzilla, Mantis,

Test Director, JIRA, SharePoint

Operating Systems Windows 98/XP/2008 SERVER/WINDOWS7, UNIX, RHEL4.0,5.0

Industry Standards HIPAA, CMS, SOX, ISO, Six Sigma, CMM

PROFESSIONAL PROFILE

Client: Health Plan Services, Tampa FL Aug’ 13 –

Present

Role: Quality Assurance Analyst

Project: G2E (Go-to-Exchange); BSC (Blue Shields of California)

Responsibilities:

• Involve in development and execution of Test Cases, test plans to validate files and workflows for

Quality Assurance.

• Create/load/process EDI transactions- IB 834 files, member return and effectuation files.

• Perform GUI Testing, Negative and Positive Testing, Data Validation, Regression testing etc.

• Participate in daily scrum meetings and sprint reviews and implement Agile QA

processes/practices for efficient tests.

• Provide QA Sign off after completion of testing and publishing results.

• Defect Management- report, analyze, test defects using Quality Center.

• Provide test team status reports on weekly/daily basis to the leads and the project manager.

• Attend Internal/External team meetings for status updates and defect reviews.

• Validate and send MBP/MRP Reports to the carrier.

• Process Maintenance/ change records coming from Exchange.

• Make HOP binder payments after case issuance/enrollment and request OSR.

• Train new associates on various tools and in house softwares.

• Create dummy /base IB 834 files for preliminary/sanity/end-to-end testing.

• Prepare Batch data for various scenarios that can be utilized for testing enotes, bills, welcome

letters etc.

• Involved in development and execution of Test Cases, test plans to validate files and workflows

for Quality Assurance.

• Create/load/process EDI transactions- IB 834 files, member return and effectuation files.

• Performed GUI Testing, Negative and Positive Testing, Data Validation, Regression testing etc.

• Participated in daily scrum meetings and sprint reviews and implement Agile QA

processes/practices for efficient tests.

• Provided QA Sign off after completion of testing and publishing results.

• Supported and participated in Exchanges including CA and MD.

• Defect Management- report, analyze, test defects using Quality Center.

• Provide test team status reports on weekly/daily basis to the leads and the project manager.

• Attend Internal/External team meetings for status updates and defect reviews.

• Validated and sent MBP/MRP Reports via FTP to the carrier using Mainframe.

• Validated OB 834s and Effectuation files to be sent to Exchange and carrier partners.

• Process Maintenance/ change records coming from Exchange.

• Made HOP binder payments after case issuance/enrollment and request OSR.

• Train new associates on various tools and in house softwares.

• Created dummy /base IB 834 files for preliminary/sanity/end-to-end testing.

• Prepared Batch data for various scenarios that can be utilized for testing e-notes, bills, welcome

letters etc.

• Involved in XML validation for off Exchanges.

• Responsible for review of requirements from Business Functional Specifications and conducted

code as well as application design walkthroughs with Business, dev. team and test team members

respectively to create Application Design Document.

• Followed Agile Methodology to emphasize on real time communication over written

documentation.

• Participated in building automation test scripts based on BPT module of Quality Center.

• Involved in developing detailed test plan, test cases and test scripts using Quality Center for

Functional and Regression Testing.

• Extensively worked in preparing the EDI transmission files, dropping them in Inbound, Outbound

Interfaces and validate the data according to our test scenarios.

• Validate the date from EDI transaction with Facets.

• Performed backend testing

• Performed negative and positive testing using SQL Queries

• Performed Manual Testing to check the usability of the application.

• Maintained Test Metrics; actively participating in daily scrum and project planning meetings &

provide weekly status updates showing the progress of the testing effort.

• Involved in end to end testing of FACETS Billing, Claim Processing and Subscriber/Member

module.

• Conducted Back-End Testing using SQL Queries for the purpose of Database Integrity/ data

validation.

Client: BeneCard PBF, Orlando FL Aug’ 12

– Aug’13

Role: Senior QA Tester

Project 1: MTM (Medication Therapy Management Program)

Benecard PBF Medication Therapy Management (MTM) Program was developed and managed by

licensed practicing pharmacists and physicians intended to provide relevant health information and

support to beneficiaries and optimize therapeutic outcomes through improved medication use for targeted

individuals. This program is required by Medicare to be provided to all beneficiaries with an opt-out

method of enrolment and is designed to reduce undesirable events such as drug interactions and adverse

drug events as well as improve medication use to promote the health and well-being of the enrollees in

accordance to HIPAA.

Responsibilities:

● Designed and Developed Test Cases and Test Scripts from BRDs, FRDs for testing functionality of

web based application maintaining HIPAA 5010 standards.

Performed Functional, Unit, Integration, Regression, End to End testing and Cross Browser

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Testing.

Analyzed criteria for the testing and worked on fast paced Agile Environment for changes and

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updates to the sites and its functionalities.

Actively attended Project Stand-up meetings and interacted with the team including BAs, System

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Analysts, developers and upper management.

Reviewed Requirements with the business and lead developer at every phase of the project.

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Helped in solving/testing the cases/tickets of the project.

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Supported QA builds/deployments.

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Responsible for designing Test Steps, Requirement Mapping to Tests, Executing Tests manually,

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Defect Logging and Defect Reporting.

Tracked and reported test execution status and further escalated risks and issues to the management.

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Successfully designed, developed and implemented a complete regression test strategy for the

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application.

Proficient knowledge of HIPAA 4010, 5010 and ICD-10 codes complying with CMS standards for

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generating patient documentations.

Reviewed test plans and assisted team members with successful execution.

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Performed Database testing to verify if correct data is being retrieved; worked extensively with IBM

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DB2.

Built Test Scenarios by referring to the Change Requests, UX (mock-ups), Business/Functional

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Requirements and actual developed screens to ensure that the business requirements have been met.

Updated the existing test plans by adding some columns to the test plan and inserting new test cases

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in between the existing ones to complete the functionality of the application for Traceability Matrix.

Used Mantis to track the status of the bugs/tickets logged by the user.

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Sent UAT notification emails to the business for Release tracking- Roadmap, after successful

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execution of the test plans.

Tested the tickets logged in the Mantis by testing the functionality of the application as explained in

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the description of the Mantis.

Resolved issues pertaining to tickets in various modules of the application.

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Created tickets for defects, enhancements with Target Version per Business request.

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Maintained the status of the Mantis tickets to Ready for UAT/ PROD/ Assigned/ QA Failed etc.

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accordingly to the required action.

Reviewed FRs and updated FRDs, BRDs with columns such as Test Case Identification ID ( TCID),

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for RTM purpose.

Reported issues in the Issues spread sheet with defects/enhancements layout on SharePoint.

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Maintained folders and uploaded test plans, test scripts, test plan templates and various test

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documentation on SharePoint.

Used SharePoint to access all the Technical documents, Use cases etc. needed for the project

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lifecycle.

Performed cross platform and cross browser testing with data integration maintaining HIPAA

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Standards.

Worked closely with developers to resolve the technical issues to meet the dead lines.

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Documented Test Cases with expected and actual Test Results, Test Procedure and reported to

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QA/Release Management Lead.

Strong knowledge of Conducting CMR members/patients, Pre-Work, Rx, OTC medications for

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functional, regression testing.

Executed test cases manually; compared and analyzed actual with expected results referring to UX,

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FRDs and reported all deviations to the appropriate individual(s).

Reported the execution status per release cycle to QA Manager.

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Attended Testing Update Meetings with the manager, team leads and other testers discussing testing

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strategies/methodologies for upcoming releases.

Attended development status meeting with the Development managers and development leads.

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Project 2: PDP-EGWP (CMS+ Commercial)

BeneCard PBF provides self-funded prescription benefit program administration with a personalized

approach through focused, clinical expertise. Our transparent business model operates on a customized

claim processing system offering unlimited capability and flexibility to respond to client needs in an

evolving marketplace.

Advanced clinical programs and advanced technologyprovide the framework to maximize the use of all

data elements available. This allows BeneCard PBF to filter the information, focus on clinical

opportunities and facilitate interaction between the physician, the pharmacist and the patient to effectively

promote complete health care. The Centers for Medicare & Medicaid Services (CMS), previously known

as the Health Care Financing Administration (HCFA), is a federal agency that administers

the Medicare program and works in partnership with state governments to administer Medicaid and health

insurance portability standards.

Responsibilities:

Developed Enrollment and Eligibility, COB, EOB etc. Master Test Plans,Test Strategy report and Bug

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Summary report.

Prepared and executed Manual test scripts

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Raised and tested issues in issue tracking software Mantis, and ensured they had relevant details for

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successful defect analysis.

Tracking test execution status, reporting status and escalating risks and issues.

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Coordinated with Developers to ensure timely and accurate fixes using Mantis.

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Documented testing processes and writing test plan to ensure business requirements are completed and

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delivered as planned.

Converted high-level test requirements into reliable, repeatable, and maintainable test cases

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Performed Database testing to verify if correct data is being retrieved.

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Analyzed system requirements and developed detailed Test plan, Test scenario, Test cases and Test scripts

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for testing the Application under Test (AUT).

Successfully designed, developed and implemented a complete regression testing for the entire system

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Testing and Quality Assurance experiencein different PBM (Pharmacy Benefit Management)

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functional areas ( Eligibility, Benefits, Clinical Programs, Specialty Rx, Medicare Part-D)

Performed Functional and Regression Testing on SmartD Rx web application

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Testedvarious modules/sections of the PBM application including Billing & Payment, CMS, Benefits,

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Eligibility, Commercial Members, Drugs, Prescriber and Pharmacy .

Registered CMS as well as Commercial members on the BenecardLCRx site i.e. PBF which is the

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external site being used by the users.

Enrolled the members into the PDP/EGWP plans of CMS by running the DTRR files for Claims

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processing.

Referred to the Business/Functional Requirements to test the actual developed screens

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Created test plans by referring to the Business/Functional Requirements and actual developed screens

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to ensure that the business requirements have been met.

Updated the existing test plans for Claims, COB, EOB etc. by adding some columns to the test plan and

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inserting new test cases in between the existing ones to complete the functionality of the application

Used Mantis to track the status of the bugs/tickets logged by the user/business.

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Experienced in determining the membership eligibility, billing experience within life and disability in

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health plans.

Involved in various walkthroughs, meetings with the Business Analysts, Technical unit.

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Developed Test Cases based on Requirement Specifications and Design Documents.

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Involved in Testing Enrollment and Eligibility, Prior Authorization and CMS Subsystem.

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Used SharePoint to access all the Technical Documents and Use Cases and uploaded Test Plans.

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Interacted with developers regarding priority of bugs and update the status of bugs once they are fixed

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and conducted Functional (Positive and Negative), and Integration Testing.

Prepared Traceability Matrix to review the requirements and Test Case coverage.

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Investigated software bugs and interacted with developers to resolve technical issues using.

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Participated in team meetings and conference calls to discuss issues and their solutions.

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Document the Test Cases, Test Results, Test Procedure and Report to team leader.

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Participated in Weekly Testing Status update Meetings.

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Performed GUI, Regression, System and Backend testing.

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Compared and analyzed actual with expected results and reported all deviations to the appropriate

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individual(s) for resolution

Successfully designed, developed and implemented a complete regression test strategy for the application

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dealing with Member Eligibility followed by Claims Processing.

Performed Functional, Unit, Integration, Regression and End to End testing.

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Worked on DTRR and BEQ files. Wrote SQL queries in DTRR and BEQ files to insert data in the

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corresponding columns of the required tables.

Verified and validated the Application’s overall functionality using SQL queries.

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Performed Functional and Regression Testing on SmartDRx and entire PBM application ensuring

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HIPAA Compliance with each module.

Used the Mantis (Bug tracking tool) to track the status of the bugs/tickets logged by the user.

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Changed the status of the ticket to “Ready for UAT” after successfully testing the ticket in QA

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Environment, uploaded the test plan in the Mantis to support the testing done and added a note in the

mantis stating completion of ticket.

Changed the status of the ticket to “Ready for Prod” after successful UAT testing by the Business

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Owners.

Involved in discussions with the developers and with the Business Analysts to cross confirm the

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functionality of the application.

Explained the functionality of the application to some of the new associates.

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Environment: Agile, Windows XP/2000, Java/J2EE. MS Excel, MS Word, Notepad++, Mantis, SQL,

SharePoint.

Client: Coventry Health Care, Minneapolis, MN Feb’

11 - July’ 12

Role: QA Tester

Project: Upgradation from ICD-9 to ICD-10.

The project aimed at ICD-10 Care Management Impact Analysis where Care Management utilizes

multiple software systems to support the intake and processing of authorization requests, the exchange of

data between the payer and vendors contracted to perform services on our behalf, manage Case and

Disease programs, provide robust reporting and decision support, and generally automate and facilitate

their business processes. The authorization requests consumed ICD-9 codes that need to be replaced by

ICD-10 codes to meet the mandate date.

Responsibilities:

Participated in JAD sessions for capturing business requirements and encapsulating in test plans.

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Played one of the primary roles in collecting and analyzing requirements by interacting with client and

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business analysts.

Created Test Scenarios based on approved/in process BRDs.

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Designed and Developed Test Cases and Test Scripts from SRDs, BRDs and documented them in

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Quality Center.

Analyzed business requirement- Use Cases and activity diagrams.

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Involved in Regression testing using Quality Center.

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Conducted SQL queries in database for backend testing.

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Interacted with the developers on resolving the reported bugs and various technical issues.

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Worked on HIPAA EDI 834, 835, 837, 270/271, 278 use cases and collaboration templates depending on

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the business requirements in Claims Process.

Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA

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for 837, 270/271 EDI transactions.

Formulated Test Strategy, Test Plans and Test Cases in Quality Center for the Functional,

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Integration, End-to-End, Usability and Smoke Testing.

Expert understanding of the business process and verified the functional aspect as per the Business

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Process and validated the interfaces with the other systems and data conversion from the legacy system.

Used Quality Center log to view the test results, including verification point failures, procedural failures,

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aborts and also for defect tracking and maintained the trailing history of the defects.

Performed cross platform and cross browser testing.

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Analyzed the testing results to ensure that the results were in accordance with the Gap Analysis expected

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results for 5010 compliance.

Tracked all required resolutions that were identified as needed from Vendors or Payers based on testing

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results.

Environment: Quality Center, MS-Office, Agile methodology,

Client: Magellan Health Services, Inc. Newtown, PA Nov’ 09 – Jan’ 11

Role: QA Analyst

Project: MMIS

Magellan Health Services, Inc. provides managed behavioral healthcare, radiology benefits management,

specialty pharmaceutical management, and Medicaid administration products and services in the United

States. Its Medicaid administration services include pharmacy benefits administration, medical

management information services, fiscal agent services, and healthcare management services.

The project involved performing Gap Analysis and identifying the changes proposed in HIPAA 5010 to

upgrade the Medicaid Management information System (MMIS) to comply with the new standards

mandated by HIPAA. The process involved performing gap analysis, compiling the results, impact

assessment, and designing new screens for system.

Responsibilities:

Involved in Gathering requirements and preparing Business Requirement Documents (BRD),

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System Requirement Specification (SRS) by interviewing Business Users/SME's.

Participated in meetings, Joint Application Development (JAD) sessions and walk in interview with

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the business users to determine new application functionalities.

Coordinate to set up Test Environment, Test Data Source, Test Cycle and Release Cycle.

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Involved in Smoke Testing to validate the test environment.

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Performed functional, Integration, System, UAT and Regression testing and Stress testing of the FNS

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application and prepare test plan, test cases and test procedures in accordance with the Business

Requirements for every cycle.

Used HIPAA 4010 transactions to support the analysis of current business processes and work with

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management to improve and implement enterprise solutions to ensure compliance and got involved in

designing future state processes for HIPAA5010 transaction processing EDI’s 837,835, 270, and

271.

Analyzed HIPAA 5010 related to 837,835, 270, and 271 transactions and assisted BAs performing

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gap analysis between the 4010 and 5010.

Responsible for feasible study for GAP analysis of ICD9-ICD10.

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Involved in the implementation and configuration of Enrollment, Billing, and Claim Payments for Test

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Scenarios.

Identifying Critical test case on each release and updating Regression Suite.

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Generated Test Reports from HP Quality Center (QC) to document all Test Results for management.

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Implemented defect management processes to prevent and track the cause of defects and their

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correction.

Maintained Requirements Traceability Matrix in Rational Requisite Pro and used Clear Quest to

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manage change requests and track defects.

Used Microsoft SharePoint to manage the test documentation and have version control.

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Adhered data transition of the payment and remittance advice as per the EDI standard 835.

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Worked on different EDI scenarios for batch processing.

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Environment: J2EE, UML, RUP, Rational Requisite Pro, Java, Rational Rose, Rational Clear Quest,

Excel, SQL, DB2, Crystal Report, HP Quality Center, SharePoint.

Client: Group Health Incorporated, New York, NY Jan’ 08 – Nov’ 09

Role: QA Tester/Analyst

Project: GHN-COB

Coordination of Benefits (COB) is a federal Health Care Financing Administration (HCFA)

Program. Medicare Coordination of Benefits is the process for ensuring that payment of Medicare

beneficiaries' claims is properly shared among insurers when the beneficiary is covered by private

insurance in addition to Medicare. By coordinating benefits, the COB assists Medicare in paying claims

more accurately the first time, which saves costly follow up and mistaken payments.

Responsibilities:

● Responsible for interacting with clients for requirements gathering, analyzing requirements, creating

detailed specifications, and writing the Software Requirements Specification (SRS) document

● Developed the Test Strategy based on the Business Requirement Document

● Defined Test cases based on functio87nal specifications

● Developed Test Plan and defined Test Subjects in Test Director for performing system testing of the

client application being developed

● Actively participated in all stages of SDLC and STLC

● Involved in Integration testing after integrating the different units

● Executing Test scripts and software Deployment/Release processes

● Tested every new build manually (Sanity Testing) and reported if the most important functionality of the

build failed

● Executed backend tests using SQL queries to extract data from the database.

Wrote SQL queries for checking the Data Transactions and Database Integrity in Oracle.

● Performed end to end manual testing.

● Checked the functionalities of all the modules manually.

● Reported the broken links after manual testing

● Performed regression testing after fixing the bugs manually.

● Involved in User acceptance testing of the application

● Tracked the defects and reported the defects using Test Director

● Actively participated in Defect life cycle

● Performed backend testing to validate data integrity in the database by writing SQL queries.

Environment: Oracle8.0/SQL, Mercury interactive tools (Test Director, Winrunner), MS-office,Win

NT/XP, Unix.

Client: Illinois Dept. of Healthcare & Family Services, Springfield, IL July’06

- Dec’08

Role: Quality/Business Analyst

Project: IEC (Internet Electronics System)

The Illinois department of Healthcare and Family Services (HFS) is responsible for providing healthcare

coverage for adults and children who qualify for Medicaid, and for providing Child Support. I was

involved in the maintenance team for Internet Electronics Claims System (IEC) which needed to assure

compliance with the Security Rule in HIPAA.

Responsibilities:

● Conducted formal interviews and JAD sessions with business users and SMEs to understand and

formulate the artifacts of the security requirements needed to be incorporated in the current running

system.

Using formal questionnaires, documented and prioritized the requirements and changes needed in the

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current IEC system.

Understood the Business Logic, User Requirements& developed Design & User Interface

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Specifications.

Involved in Joint Session meetings with Technical lead to develop a maintenance process plan and

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documented a dynamic Requirements Traceability Matrix.

Validated the compliance of new Requirements with the Security Rule in HIPAA, documented many

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Change Request and Enhancement Request Reports using Clear Case for approval from Project lead.

Performed Manual Testing on different Modules of the Application by executing the Test Cases.

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Create and execute functional test cases, regression test cases, integration test cases based on

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functional and technical requirements.

Prepared the traceability matrices to fill the gap between the requirements and the test cases covered

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while managing defects in Bugzilla.

Executed test cases in QTP, Generated test results using QTP and analyzed Actual Result and

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Expected result.

With consent of business units and technical leads, drafted the new Business Requirement Document

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and System Requirement Specification for the Maintenance process.

Generated simplified Business and System use cases to ensure high degree of compliance with

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Business Requirement Document.

Maintained a continuous follow-up with the technical leads and stakeholder, generating periodic brief

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reports and validating the Requirement Documentation.

Carried out a dynamic Gap analysis to determine the proficiency of the new process plan in

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comparison to the old one, as well as conformance to the requirements.

Implemented an incremental maintenance process plan to enable user acceptance testing on the go.

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Actively involved in generating test cases for each phase deliverable and documented the results in

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Test Reports.

Used these test reports for performing Risk Analysis in case of high priority fault occurrence.

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Reviewed Test Plans developed by the testing team for testing the application.

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Coordinated and prioritized outstanding defects and enhancement/system requests based on business

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requirements, allowing sufficient time frame to ensure accuracy and consider deadlines

Assisted the QA personnel in the creation of Test Cases using Rational Test Manager.

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Involved in performing version control and defect tracking activities using Rational Clear Case

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and Rational Clear Quest.

Used Quality Center to create reports and graphs to help review the progress of planning tests,

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running tests, and tracking defects.

Environment: Windows, SQL Server, Clear Quest, Clear Case, Cognos, Bugzilla, Informatica, MS

Office, MS Visio, MS Project, Requisite Pro, QTP

Contact this candidate