MADHU VANGAVETI

Phone: 347-***-****

E-mail: abgf36@r.postjobfree.com

SUMMARY

o Over 8 years of professional experience in Information Technology with

extensive experience in performing Manual/Automation Testing.

o Strong experience in developing Test Plans and Test cases using

requirements and design documents while specifying Testing Overview,

Approach, Strategy, Scope, Roles and Responsibilities.

o Well versed in GUI standards for both Web and Windows applications

o Worked on Various Healthcare areas like Enrollment, Benefits,

Authorizations, Claims and EDI X12 etc. Experience in Healthcare

concepts such as HIPAA, SOX etc.

o Experience in reviewing requirements, Business requirements Gathering,

Data warehousing, and Evaluating Data Sources.

o Proficiency in Defect management, including Defect creation,

modification, tracking, reporting using Industry standard Tools like

Quality Center and Rational Clear Quest.

o Hands on experience in Health Care, Banking and Insurance Industry.

o Experience in Claims Adjudication systems like Diamond, Xcelys, NASCO

and Trizetto Facets.

o Expertise in Testing, Creating, Analyzing, HIPPA Data for EDI Health

Systems and HL7 messages validation.

o Worked on pre authorization of claims in Xcelys and knowledge of CPT,

REV codes.

o Experience in Installing, Configuring and Administering Rational

tools, Mercury Automated Testing Tools

o Expertise in performing different types of Testing: Black box,

Integration, Stress, Volume, System, UAT, Regression.

o Strong knowledge of Software Development Life Cycle (SDLC), Testing

Methodologies and Techniques

o Possess specific experience performing testing including Backend,

Frontend, Regression, Functional, Interface, Usability, Verification

and validation, End-to-end testing.

o Strong communication and interpersonal skills to maintain effective

work relationships with all levels of personnel and ability to work as

a part of team.

o Proficient in writing SQL queries to perform data driven tests and

involved in front-end and back-end testing.

TECHNICAL SKILLS:

|Testing and Defect |QuickTestPro, WinRunner, Test Director, Quality |

|Tracking Tools |Center, Load Runner, Rational Clear Quest, |

| |Rational Test Manager, Requisite Pro. |

|Operating Systems |Windows-98, 2000/NT, ME, XP, UNIX and MS-DOS |

|Languages |Java, Perl, HTML, JavaScript, CSS, VBScript, |

| |ColdFusion, PHP, TSL, .NET, SQL, PL/SQL |

|RDBMS |Oracle 10g, SQL Server, DB2. Teradata |

|Tools |TOAD, SQUIRREL, Dreamweaver, Flash, FrontPage, |

| |MSVISIO, Para soft SOA tool, CVS, PVCS, VSS, |

| |VISIO, VSAM, ISAM, SPUFI, AbInitio, Informatica,|

| |Data Stage. |

|GUI Tools |Oracle Developer 2000 and Visual Basic |

| |6.0,Crystal Reports, BO. |

|Application and web |Web logic 6.0, IIS, Apache Server, Web Sphere |

|Servers | |

|Version Controls |PVCS, Microsoft Visual Source Safe, Clear Case |

PROFESSIONAL EXPERIENCE

Kaiser Permanente, Rancho Cucamonga, CA QA Analyst

Aug 2010 - To Present

For more than 50 years, Kaiser Permanente (KP) has provided

comprehensive coverage, the largest provider

Network and extraordinary customer service to people across

the state and around the country.

KP Insurance Company serves millions of customers through a

full range of health plans, life and disability insurance,

Annuities, retirement savings products and services. Kaiser

Permanente is currently implementing Claims

Encounter and Strategy (CCES) for California. This is

considered to be the world's largest claims implementation

Project (250 million Members). As part of this project i was

responsible for the following tasks -

Tested the configuration for the Model Office

Implementation. Good knowledge on Provider module - Provider

master,

Vendor Master, Provider Contract Pricing and Price

schedule. Tested various modules of Xcelys

(Claims processing applications) which include but not

limited to Membership, Providers, Authorizations,

Benefits, Finance and Claims Modules. Tested Various Lines

of Business - (Commercial, Medi-care, Medi-cal)

Responsibilities:

. Manually Created and executed various Test Procedures and Test Cases

(Manual Testing)

. Analyzed system specifications, requirements and developed detailed QA

documentation that included test plan, test cases, test procedures, test

reports and QA good practices.

. Created test cases in Mercury Quality Center.

. Involved in creating and Executing Test Scenarios based on functional

requirements.

. Worked closely with the Architects, Business Analysts, Developers and DBA

team for knowledge sharing and to resolve issues.

. Coordinated with the QA Team for testing activities across multiple

systems and managed Conversion test execution.

. Tested various modules of Xcelys (Claims Processing apps) which include

but not limited to Membership, Providers, Authorizations, Benefits,

Finance and Claims Modules.

. Tested various Lines of Business (Commercial, Medi-Care, Medi-Cal).

. Good knowledge on provider module - Provider Master, Vendor Master,

Provider Contract pricing and price Schedule.

. EDI Claims Processing - documented enhancements to the EDI Claims

Processes to ensure accurate processing of claims of various

member/provider scenarios.

. Validated mapping of ICD 9 codes with corresponding ICD 10

Diagnosis/Procedure Codes.

. Used MS Visio for flow-charting, process model and architectural design

of the application.

. Involved in regression testing for overall business process and executing

them in QA Environment.

. Defects were tracked, prioritized, fixed, reported and analyzed variation

between Expected and Actual results

. Worked with developers and business users to ensure defects are resolved.

. Processed claims and enrolled members from different input ways and

verified the members and claims loaded to Xcelys.

. Created test data and performed testing on various modules like Members,

Authorizations and Benefits etc.

. Mapped claims, payments, and status to back-office database.

. Logged the defects in Quality Center and maintained track of the defects

throughout the life cycle.

. Participated in QA Team meetings and bug tracking meetings.

Environment: Xcelys, Diamond-950, Quality Center10.0, QTP 10.0, HIPAA/ EDI

X12, Manual Testing, SQL Developer, Oracle 10g, Claim Picker, SharePoint,

Informatica 8.6, ASP.NET, Web Services, SOA, Mainframes,

Blue Cross Blue Shield, Jacksonville, FL(BCBS,FL) Sr QA

Analyst Jan 2007 to July 2010

For more than 60 years, Blue cross & Blue shield of Florida (BCBSFL) has

provided comprehensive coverage, the largest provider network, and

extraordinary customer service to people across the state and around the

country. BCBS of Florida is committed to advancing the health and well

being of all Floridians. We envision a health care system that is

effective and efficient delivering value to our customers through an array

of meaningful choices.

DIAMOND 950 is a healthcare customer relationship management product for

Blue Cross Blue Shield. The product is used to maintain provider,

subscriber and physician information like claims processing, Benefits,

pricing and adjudication etc.

BCBS claims processing systems allows for rapid integration with legacy

applications. Share IT application re-writes in a thin client framework,

for Health and Prescription drugs Insurance coverage for Medicaid and

Medicare Claims Processing. This application involves Enrolling members

electronically and manually and servicing their Medicare and Medicaid

insurance needs through various business partners such as CMS, PDM, and

PRIME etc,

PBM (Pharmacy Benefits Manager): Modify DIAMOND to provide the ability to

accept and store real-time prescription drug Claim accumulators from a new

pharmacy benefit management system know as PRIME for the purpose of

integrating these values with BCBSF health accumulators. PRIME will be the

responsible for facilitating all pharmacy programs within the Diamond

System. Diamond will be responsible for accepting the new pharmacy program

Med script.

Responsibilities:

. Involved in writing Test Cases and Static reports for Integration testing

(IT), and System Testing (ST), in accordance to the Use Case and Technical

Design Specifications.

. Manually Created and executed various Test Procedures and Test Cases

(Manual Testing)

. Performed Functional, GUI, Regression, System Integration, User

Acceptance, Configuration and content testing. Performed claims

processing and Billing is done through PBM (Health Trans) and Claims

Accumulation and Adjudication is done through Diamond.

. Involved in creating and testing Professional, Institutional and

Pharmacy claims through API to Diamond.

. Conducted Regression Testing manually on various builds of the

application and reported the defects to the developers using a Customized

EXCEL Spreadsheet utility for the bug reporting and tracking with Mercury

Quality Centre.

. Involved in validation of Members and Span files to PDM, Provider files,

Pharmacy files, Prof and Inst claims.

. Involved in Enrollment and Claims Processing in Facets, Diamond and

validation of Siebel exceptions for RME [Reconcile Medicare Enrollment].

. Manually tested the java application and generated scripts using QTP for

further automation of the application

. Involved in validation of exceptional errors and Provider correctable

errors.

. Coordinate and performed integration testing for RPE and PBM. Involved in

Data validations, Content Validations, File Lay out Validations and

Uploading the Files into Target Systems.

. Resolved software defects by interacting with developers and Reviewed to

Code to ensure quality software.

. Work closely with Business analysts in understanding the business

requirements.

. Track transaction logs using EAS Viewer.

. Involved in testing the HIPPA/EDI transactions (820, 834, 837, 270, 271)

. Involved in validation of Members and Span files to PDM, Provider files,

Pharmacy files, Prof and Inst claims.

. Involved in Enrollment and Claims Processing in Diamond and validation of

Siebel exceptions for RME [Reconcile Medicare Enrollment].

. Involved in testing the Web services security and Net work security of

the applications and verified the broken links.

. Involved in Requirements gathering using Rational Requisite Pro.

. Performed the Single sign -on and Security and network testing, of the

application for various roles, restricted access over cross browsers for

compatibility and correctness and browser compatibility test.

. Verified ETL mappings, DW Reports are done correctly or not using SQL

Statements In a Data Warehouse Environment

. Business Intelligence reporting development to design, develop and

implement operational reporting and OLAP analysis

. Analyzed the user/business requirements, functional specifications and

created the Test Plan in Quality Center

Environment: Diamond 950, Quality Center 9.2, QTP 9.2, .Net, File-Aid/CS,

web sphere, DB2, Oracle 10g, Quality Center 9.2, Lotus Notes, SQL

Developer, MS-Office, SharePoint, Unix, Rational Req Pro, RUP, Ab Initio,

Java, XML.

Kaiser Permanente, Pasadena, CA Sr QA Specialist

Sept 2005 to Dec 2006

For more than 50 years, Kaiser Permanente (KP) has provided

comprehensive coverage, the largest provider

Network and extraordinary customer service to people across

the state and around the country.

HDHP SCAL- PIMS (Pharmacy Informatics Mgmt System): High

Deductible Health Plan (HDHP) is a PIMS Project, which is a

Kaiser Permanente's New Health Plan, This project involves The

following HDHP modifications will be tested for the various PIMS

modules - Pharmacy Member Identification and Verification, Pharmacy

Adjudication and Verification, Accumulation, Pharmacy Pricing, Manual

Adjustments, POS Collection, Reporting etc.,

NMF-AccuTraq/DTraq: Worked as a Sr. Functional Tester for Data

Migration project. Data Migration involves extracting data from

various Kaiser Data sources to satisfy the data request for various

applications like AccuTraq, DTraq and RDS and forward to the

application suite for load and processing. Data is provided in a text

file, which is then validated at layout and content level to make sure

that the correct data is populated in the data file.

Responsibilities:

. Involved in writing Test Cases, and Static reports for Integration

testing (IT), User Acceptance Testing (UAT) and System Testing (ST), in

accordance to the Use Case and Technical Design Specifications.

. Involved in testing the Pharmacy Claims adjudication and Billing

processing is done through PBM (Health Trans) and Claims Accumulation and

Adjudication is done through Diamond.

. Building and Maintaining the General Tables and Bridges Translation

mapping tables with variety of types including Translation, Category and

String types.

. Participated in the connectivity testing, IET, with the legacy systems

and with the middleware called IB (Integration Broker).

. Involved in testing the various transitioned members like Part D to HDHP,

HDHP to Non HDHP, Hospice, SNF etc.,

. Involved in Data validations, Content Validations, File Lay out

Validations and Uploading the Files into AccuTraq and DTraq.

. Involved in testing the identification of Membership and benefits data

for California which come from Foundation systems SCAL to PIMS using ADOBE

interface.

. Involved in security testing (Cookies, token authentication, Refer Auth,

XSS)

. Involved in testing Pricing calculations for Branded and Generic drugs.

. Involved in testing the adjudication and accumulation for dispense

covered drugs and non-covered drugs for different benefits and different

plans for a member individual and family with below, crossing and met

annual deductible and OOP Max.

. Verified claims response messages, accumulator values and % of member

liability billing sent from PBM to PIMS. PIMS has a real-time bi-

directional interface to an external vendor - Health Trans (PBM). SCAL

PIMS communicates with Health Trans using industry standard NCPDP 5.1

format. This project involves end-to-end system testing of various

interfaces - PIMS & Health Trans.

. Resolved software defects by interacting with developers and Reviewed to

Code to ensure quality software.

. Manually Created and executed various Test Procedures and Test Cases

(Manual Testing)

. Tested data migration and data validation to ensure that integrity of

data was not compromised.

. Resolved software defects by interacting with developers and Reviewed to

Code to ensure quality software.

. Involved in validation of the HL7 messages between Epic and Ancillaries.

. Involved in System testing for verifying Pulling Records into PIMS, View

Summary Record, View Detail Record, Demographics, Add/Edit Patient

details, Patient Lookup Lines, Inquiry screen, Benefit Summary, Rx

Dispensing & Claim Submission, Refills, Trial Claim, Claim status, Claim

Submission/Refunds, Mail Order Rx Dispensing, Claim status, Claim

Submission/Refunds, Review, View the order, Print Label and Reversals.

. Involved in validating the Critical field reports and running the Java

Scripts for the Critical Fields Reports on Historical Extracts and

Content Validations.

. Validated Extracts and its transformation rules and logged all the issues

and defects in Quality Center. Provided Screenshots to identify &

reproduce the bugs.

. Resolved software defects by interacting with developers and Reviewed to

Code to ensure quality software

Environment: Diamond 950, PIMS, Health Trans, Epic Hyperspace, HL-7,

Quality Center 8.2, Q.T.P 8.2, DB2, Mainframes, Java, XML, J2EE, Ab Initio,

TOAD, Oracle 9i. Linux, FS, DTraq, Accutraq, MQ Series.

Blue Cross Blue Shield, RI Sr QA Tester

Jan 2005 to Aug 2005

For more than 60 years, Blue cross & Blue shield of Rhode Island (BCBSRI)

has provided comprehensive coverage, the largest provider network, and

extraordinary customer service to people across the state and around the

country.

DIAMOND 950 is a healthcare customer relationship management product for

Blue Cross Blue Shield. The product is used to maintain provider,

subscriber and physician information like claims

processing, Benefits, pricing and adjudication etc., DIAMOND 950 will

replace BCBS's Long Range Systems Plan (LRSP) mainframe with a system which

provides user-friendlier capabilities and a more intuitive design as well

as adding functionality to groups and member administration, provider

contracting, benefit plan management, utilization management, capitation,

customer service and premium billing.

Responsibilities:

. Analyzed the user/business requirements, functional specifications and

created the Test Plan in Rational Test Manager

. Extensively involved in Database testing by writing SQL queries for

various LOB's for Institutional and Prof Claims.

. Resolved software defects by interacting with developers and Reviewed to

Code to ensure quality software.

. Conducted Regression Testing on various builds of the application and

reported the defects to the developers using a Customized EXCEL

Spreadsheet utility for the bug reporting and tracking with Rational Clear

Quest.

. Interact with business users to create business requirements for Medical

Management.

. Performed the Diamond application test manually to verify that the

expected results were matched with Actual results.

. Involved in Validate Claims, Reverse and Rekey claims, Potential

Duplicate claims, Quick entry claims, internal entry claims, EDI Claims,

Availity Claims, Batch Claims and Exact duplicate claims.

. Verified BMA for Prof Claims and Institutional claims.

. After Payment cycle, Involved in Verifying the EOB's and RA's.

. Claims processing and Billing is done through Diamond, and verified ERN

flat file Records positions.

. Involved in verifying the 835 files. As per X-Walks verified Segments,

Service line balancing, Claim balancing and Transaction balancing.

. Experienced in EDIFEC's Tool to validate 835 AND 837 files.

. Involved in Professional and Institutional IP and OP claims to verify the

MER's on member, PEC logic, MEC logic, CC Logic, Member eligibility for

Non ITS Host claims for IBO LOB.

Environment: Rational Suite, DB2, MVS, FACETS 4.5, Mainframes, J2EE, MS SQL

Server, Crystal Reports, Oracle 9i.

Citizens Bank, RI Sr QA Analyst

June 2004 - Dec 2004

Citizens Bank of Rhode Island is a subsidiary of Citizens Financial Group,

Inc., a $78 billion commercial bank holding company in Providence, R.I.

The project implemented for the Citizens Bank Deposit Services, involves

ST/GN upgrade, IMPACS, COB Products, Multi Branding, Brokerage conversion,

Funds Availability and Rewards cards. Act as liaison between Fidelity

Information Services and some of the end user departments within deposit

services like Account Services, Operations Compliance, Operations Services,

Retirement Services, and Statement Rendering. Primary functions include

testing of all deposit requests in the QA region. Validating all deposit

changes that move into production. Ensure compliance of deposit systems to

bank disclosures and fee schedules. Processing changes to the Bank Control

Request.

Responsibilities:

. Involved in writing the test plans, test conditions, test data, test

cases specifications

. Analyzed the user/business requirements, functional specifications and

created the Test Plan in Test Director.

. Manually Created and executed various Test Procedures and Test Cases

(Manual Testing)

. Performed GUI, Functional, Integration and Regression Testing using Win

Runner.

. Created bank setup for the bank account and perform Electronic (ACH),

wire and Check transfers, deposits via

Web app and Back Office system, and verified those transactions in

the downstream systems like BOS, AOM and

In the back-end database.

. Reported bugs to developers using Test Director.

. Performed Database testing (Data Warehouse / ETL) on ETL applications

validating the data in Sources/Targets.

. Detected bugs & classified them based on the severity and Provided

Screenshots to identify & reproduce the bugs. Also prepared Traceability

Matrix, Test Metrics

Environment: Win Runner, Test Director, Load Runner, Informatica 7.1,

Crystal Reports 9.0, DB2, JCL, CICS, MVS, Mainframes, COBOL, Windows NT,

TSO, FileAID, J2EE, J-Unit, Oracle 9i.

Allstate Insurance, IL QA Analyst

Jan 2004 - Jun 2004

Allstate Financial Group is comprised of the nation's largest life

insurance business as well as businesses that market annuities, savings and

financial services products through licensed financial professionals. It

has following products, which customer can open an account online or

through Allstate Agent. The environment that the site runs is a UNIX based

system-running iPlanet as web server and Web logic 6.1 as the app server

supported by an Oracle 8.17 database running a Java code, base featuring

XML for several SSL data exchanges. The system receives and updates

several legacy systems via batch jobs and FTP agents. Savings Products

(Regular Savings, Certificate of Deposits, Insured Money Market)

V Checking Products (Regular Checking, Checking Plus Interest, Senior

Value Checking Account)

V Loan Products (Mortgage Products, Over Draft Line of Credit Account)

Responsibilities:

. Conducted Manual and Automation Testing.

. Data was standardized to store various Business Units in tables.

Summaries for Scripts Status and Daily Transaction were stored in Summary

Tables for Analysis Involved in Setting up Test Environment.

. Interacting with Developers and Business Analyst regarding requirements,

test scenarios and defects.

. Developed test cases for Functional, Integration and System testing.

. Developed scripts for Audit Reports for positive testing of Data

Warehouse Applications.

. Wrote and executed detailed test cases with step by step procedure and

expected result.

. In the execution phase, I executed test plans, run test software,

identify product issues, wrote detailed bug reports and participated in

bug review.

. Defects were tracked, reviewed, analyzed using mercury Test Director

Environment: Win Runner 7.0, Load Runner 7.0, Test Director 7.2, Sun

Solaris 5.8, Oracle 9.2.0.5, ab initio, Crystal Reports 9.0, Visio 2000,

Erwin, Unix, Windows Professional Server, TOAD, SQL* Loader, PL/SQL,.

Educational Qualifications:

. Bachelors in Science(BS)

. P.G Dip in Computer Applications ( PGDCA)

. P. G Dip in Business Management (PGDBM)

Contact this candidate