Project Health Insurance

ac2dhs@r.postjobfree.com Rubin Kaur

860-***-**** Business/ System Analyst

AVAILABILITY:

ASAP

Open to relocate

TOOLS/METHODS:

Agile, Waterfall

SQL

JavaScript

XML

EDI

HP Quality Center

MS Visio

MS Office (Word, Excel, PowerPoint, Project, Outlook, Access)

SharePoint Server

Rational TestManager

Rational Requisite Pro

TOAD

Oracle Financials

JIRA

HP ALM

Rally

RESTful webservices

API

UNIX

Terra Term

RELEVANT CLIENTS:

UnitedHealth Group (Optum)

Humana

EDUCATION:

Bachelors of Science, University of Florida

RELEVANT EXPERIENCE

Business Analyst professional with 2 years of expertise in Health Insurance domain. Within the past roles was responsible for enhancements to various systems and web portal upgrades to increase efficiency. Highly experienced in working with the development as well as the business side to create complete technical and functional specifications.

SKILLS INVENTORY

Analysis/Design:

Experienced in different Business Analysis Methodologies: Iterative Software Development Life Cycle, Waterfall and Agile.

Highly skilled in conducting analysis like GAP Analysis, SWOT Analysis, Feasibility Analysis, Cost Benefit Analysis, Risk Analysis and Impact Analysis.

Proficiency in designing, developing and facilitating UAT testing, Regression testing, Smoke testing, System Integration Testing including defect logs.

2 years experience supporting web applications and software development application groups.

Organized Brainstorming Sessions, Joint Application Development (JAD), Interview Sessions, Workshops, Focus Group, Surveys, Questionnaires, Document Analysis, and Observations with Subject Matter Experts (SMEs), end clients and Business Owners.

In-depth knowledge of Health Insurance Portability and Accountability Act (HIPAA), ICD Codes, Healthcare Claim Processing and HIPAA Standard Transactions X12-837 for Equivalent Encounter Information, X12-835 Claims Payment and Remittance Advice, X12-276/277 Health Care Claim status request and response, X12-270/271 Eligibility inquiry.

Expertise in analyzing the Business Requirements and documenting them into artifacts like Business Requirement Document (BRD), Functional Specification Document (FSD), Functional Requirement Document (FRD) and System Requirement specification (SRS) and Requirements Traceability Matrix.

Excellence in creating UML Diagrams (Use Cases, Sequence Diagrams, and Activity Diagrams) Workflow diagrams employing MS Visio.

Exhaustive knowledge in designing Prototypes, Mock-up screens, and Wireframes using MS Visio during developing Graphical User Interface based application.

Experienced in working as a Scrum Master in an agile environment and facilitated scrum ceremonies, resolved impediments faced by the team and assisted the Product Owner with activities related to the Sprints.

Worked in recording and maintaining the artifacts like Sprint Burn down charts, Product Burn down charts, product backlog and impediments list.

Demonstrated competency in leading and mentoring individuals to maximize levels of productivity.

SUMMARY OF EXPERIENCE

Systems Analyst

UnitedHealth Group, Optum Technology, CT July 2016 – Present

Optum is a health services business dedicated to making the health system work better for everyone. As a company, we fundamentally believe that the health system can work better for everyone. And together with our clients, we deliver integrated, intelligent solutions designed to modernize the health system and improve the health of individuals and populations. The project focused on the implementation and cross-application integration of a new claims processing system. As a Health Care Business Analyst on a integration project my specific assessment area was the modification and upgrade of the Oracle Financial System to incorporate claims coming from the new processing system in order to make payments/reimbursements to providers, members, etc.

Reviewed, analyzed, and evaluated business systems for end user needs, including documenting requirements and creating process workflows.

Analyzed functional requirements segregated them into use case specifications and created use case diagrams using MS Visio.

Facilitated JAD sessions with management, development team, users and other stakeholders to refine functional requirements.

Coordinated with business owners to determine project requirements.

Created FRS (Functional requirement specifications) and system requirement documents, along with process flows.

Identified gaps between features when data was being mapped from old system to new system, analyzed issues and provided solutions.

Worked on HIPAA EDI transactions such as 835 and 837.

Participated in the analysis of the existing processing, worked with fellow business analysts in methodology for defining 835 and 837 mapping processes to prepare for new system integration.

Extensive experience in configuring data mapping document.

Configured HIE API to allow user applications to communicate with the modules of the system.

Wrote SQL queries to pull data from the database in Unit and Test stage, and also for UAT.

Tracked defects using Rally and assisted QA teams to resolve defects.

Assisted Scrum Master in project planning and execution, resource planning and QA status report meetings.

Performed duties of Scrum Master and led the team to produce quality software on a predictable schedule using agile principles and practices.

Managed Product Backlog with the help of Product owner and Scrum development team by using Rally. Also generated reports to analyze the performance of the project.

Wrote and managed all of the business and functional requirements of the new screens, forms, and reports, as well as the added and enhanced features for Oracle Financials in Rally.

Environments: Agile-Scrum, MS Visio, MS Office, SharePoint Server, SQL, HTML, TOAD, SQL Developer, UNIX, Terra Term, Rally, Oracle Financials, RESTful webservices, API, JavaScript, XML, EDI

Business Analyst

Humana, FL June 2015 – May 2016

Humana Inc.is an American managed healthcare company that markets and administers health insurance, the second-biggest provider of Medicare benefits. Humana markets its health insurance services in all 50 U.S. states, D.C., and Puerto Rico, and has international business interests in Western Europe and Asia. My Project was to incorporate a wide range of features for policyholders and new customers in Humana’s Web Portal. I worked with an application that was taking care of Online Account Services that included Billing Application, Checking the bill history, changing customer profile, ordering insurance ID cards.

Involved in documenting Business Requirements Document (BRD) by conducting interviews with the project stakeholders, SME’s and Business users.

Documented Traceability Matrix (RTM) to ensure all the features for the project has been captured and mapped back to the requirements in the BRD.

Performed GAP analysis and documented business and system level use cases to derive the requirements illustrating the functional behavior.

Collaboration and reviews with different application owners and SME’s to ensure the GAP Analysis was performed accurately.

Documented and reviewed the post implementation summary with the senior management regarding the gaps identified during the project.

Implemented an integrated solution with complete line of traceability for all the artifacts of web development projects.

Business Process Modeling (BPM): Business process improvement and optimization, Document and model business processes, automated workflows and Manage business rules.

Thorough understanding of business process to help determine the user needs.

Developed design for the application for management to analyze the market trends, behavior, habits etc. by collecting relevant data at various points and organizing the data into appropriate data warehouses and data marts.

Developed Data Flow, Work Flow, Process Flow, and Entity Relationship Diagrams in MS Visio.

Performed application functionality user acceptance testing experience (UAT) (i.e. front-end application testing) in a controlled testing environment that replicates the end user usability of the application.

Used HP quality center to log defects and assign to the right team to ensure the defects are addressed on a timely manner.

Responsible for creating UML modeling plans, use cases, process flows, wireframes and business requirements documentation using Visio.

Ensured the UAT test scripts review sessions with business owners to test the application functionality and provided necessary training material.

Environments: Waterfall-Agile, HP Quality Center, JIRA, SharePoint, TOAD, Requisite Pro, Rational TestManager, UML, SQL, MS-Office, MS Visio, HTML

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