Business Analyst, Quality Assurance Manager
Resume:
Beverly Jane Adams
Decatur, GA 30030
****.*******@*****.***
QUALIFICATIONS
20+ years in healthcare insurance with CIGNA, UnitedHealth and Yale New Haven Health
Project management, client implementation, and Quality Assurance management
Eight (8) years managing onshore and offshore resources
Nine (9) years dental reviewer experience with CIGNA
Two+ (2) years Dental Assisting Instructor
Two (2) years experience as an IT business analyst; Java,web-based, Underwriting, Sales and Broker software system
WORK EXPERIENCE
Connecture, Inc. Atlanta, GA April 2008 – May 2010
Business Analyst
• Serviced client, Blue Cross Blue Shield, MI, during their SIT, QA and UAT development.
• Supervised offshore and on-site QA staff during test case development and execution.
• Performed Quality Assurance smoke testing during code deployment.
• Experienced in SDLC throughout the project life cycle (requirements, code development, unit testing, QA testing, smoke testing, UAT and implementation).
• Directed, created and executed test cases/scripts in QA environment.
UnitedHealth Group, Hartford, CT June 2006- April 2008
IT Quality Assurance Consultant
• Developed and executed test scripts for Automated Underwriting Program (AUP); proprietary claims processing system.
• Developed and executed test scripts for Producer Data Base using Mercury Test Director and QTP.
• Facilitated daily triage/defect meetings during QA and UAT test phases
• Managed the Java/Livelink based Automated Underwriting Program, Financial Underwriting Phase 2 projects for Small Business (2-50 employees) and Key Accounts (51-99 employees).
• Assisted in budget and resource planning.
• Liaison to the offshore vendor, India, and onshore business partner.
CIGNA Corporation, Bloomfield, CT January 2000 – May 2006
Quality Assurance Test Manager
• Developed and executed test scripts on Mercury Test Director dental offshore project; liaison with offshore companies, AMR and First Image.
• Full claims processing knowledge from Eligibility through adjudication
• Planned, executed and monitored script execution and monitored release defects using DB2 Mercury Test Director.
• Accountable for following standard test process and procedures including risk based planning.
• Project lead that successfully implemented Billing application, DB2 mainframe outsource to India.
• Analyzed defects until 100% defects were resolved.
Prior 2000 Healthcare Experience
Yale New Haven Health, Managed Care Division, New Haven, CT 1996-1999
Client Manager for: Oxford Health Plan, Norwalk Hospital and CIGNA Health Care.
• Managed implementation of Third Party Administrative services for Connecticare, Oxford Health Plan, Norwalk Hospital and CIGNA Health Care.
• Validated TXEN Claims, AS400 system and data mapping validation via EDI transaction ‘834.’
• Exhibited knowledge from Eligibility through adjudication
• Headed million dollar Java based imaging project: customer service call-tracking, mailroom and claim-routing.
• Developed, tested and managed support staff and claims personnel using imaging system.
• Client Manager for the Pharmacy Benefits Management (PBM) division.
• Achieved 100% milestone deliverables.
CIGNA Corporation, Bloomfield, CT and Atlanta, GA 1981-1996
Quality Analyst/Lead Dental Analyst, Dental Auditor, Dental Reviewer
Dental Claims Processing
• Developed dental business requirements, QA test cases and data requirements on DB2 mainframe platform for CIGNA initiative, “Transformation” project.
• Executed dental claims and reviewed complex dental claims with x-rays for nine (9) years.
• Assisted Dental Consultant in claims/benefits determination.
• Dental claims auditor on DB2 mainframe, one (1) year experience.
• Responsible for conducting monthly claim audits on all dental personnel.
• Trained personnel in Puerto Rico office on proprietary dental claims system, DentaCom. Trained onshore dental personnel on PPO product.
• Liaison, SME to Puerto Rico office.
• Liaison on outsourcing mail room project responsible for developing and implementing strategy to offshore vendor, AMR, Santo Domingo.
• Provided on-site support during transition to Santo Domingo and provided ongoing on-site support to personnel.
• Responsible for developing and implementing dental data entry outsourcing project to First Image Corporation, Kentucky.
• Provided on-site support during transition of data entry to First Image and provided ongoing on-site support.
Skills -Tools:
DB2 mainframe, Java, Livelink, SQL, QTP and Mercury Test Director
Microsoft Office suite: Word 2003, Project, Excel, Access
EDUCATION
North Georgia State University Dahlonega, GA
Atlanta College of Medical and Dental Assistants Atlanta, GA
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