Software Engineer Health Insurance

OBJECTIVE

To take a challenging role on business operations and IT Development as Business Systems Analyst in Facets and give an efficient and effective solution that would help the organization to achieve the best solution in business process which would increase its productivity in market.

SUMMARY

8+ years of experience in Information Technology.

5+ Years of experience as a Business Systems Analyst in Facets Membership/Provider/Accums.

1+ Years’ Experience of Facets Claims Processing Module.

5+ Years’ Experience of Facets Batch Processing & Custom Batch processing.

Excellent communication skills, writing skills as well as presentation skills. Experience working with business users as well as senior management.

Solid understanding of all phases of Software Development Life Cycle (SDLC) methodology (such as requirement, analysis, design, data modeling, business process modeling, implementation and deployment).

Broad knowledge of Test plans, Test cases and test scripts from the Requirements Document.

In-depth knowledge of risk engineering, data modeling and mapping, and design using Visio.

Good knowledge of Sybase and SQL.

Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).

Capable of managing multiple projects simultaneously.

Exceptional problem solving and sound decision making capabilities.

Experience in writing queries/scripts for data analysis for Business need.

Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.

Experience in User Acceptance Testing, Smoke Testing, Regression Testing, Performance Testing and Functional Testing.

Experience working in Medicare and Medicaid projects Mandates.

Created Requirements Traceability Matrix to keep the stakeholders informed of the progress of the project.

Strong expertise in Health Insurance Enrollment, Provider & Network Management, Accumulator Sync up for Comingle Plans.

Belief in team work, dedication, and professional ethics within the working environment.

Extensive experience in conducting Joint Application Development (JAD) sessions for project definition involving analyzing requirements, creating prototypes, user interface, database schema and system design.

Well versed with HIPAA, Facets, Enrollment, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.

Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD).

Organized, goal-oriented, self-starter, and ability to master new technologies, manage multiple tasks while following through from start to completion.

Flexibility in adaption to a wide range of work environments.

Good in requirement gathering including Joint Application Development (JAD) and requirement analysis.

Extensive experience in working in a Customer - oriented environment.

Ability to inculcate new relevant skills with ease in a time sensitive frame.

Analysis done to determine if the system abides by the Federal & State regulations.

Experience in writing Use cases and Functional Requirement Document.

EDUCATION SKILLS

Bachelors in Electronics and Communication Engineering, Anna University, Chennai.

SKILLS

Databases: MS SQL, MS Access, Sybase Languages: SQL, C Sharp, ASP.Net, Unix Shell Script Operating Systems: Windows 98/2000/XP/Vista/NT Project Management: MS Office Suite (Microsoft Word, Microsoft PowerPoint, Microsoft Excel), MS Project Change Management: Rational Clear Quest, RDNG Business Modeling Tools: MS Visio

PROFESSIONAL EXPERINCE

Cognizant Technology Solutions US Corp, Mason, OH Feb 2012 - Till Date.

Business Systems Analyst (Client - Anthem Inc)

Anthem Inc. is an American health insurance company founded in the 1940s, prior to 2014 known as WellPoint, Inc. It is the largest for-profit managed health care company in the Blue Cross and Blue Shield Association. The project is on Central Facets system (States OH, IN, KY, WI, and MO)

Provider and Network Management for new product launch and System Integration

Eligibility/Accumulator Sync up requirement while Renewals of Large Groups for Pharmacy Carve outs.

External Vendor File Feed Requirements for Membership Module.

National Large Group Migrations Requirement for Internal Initiative.

Facets Upgrade (4.71-5.4R2) Impact Analysis.

Responsibilities:

Participating in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Technical Requirements Document (BTRD).

Participating in the planning, development, coordination and presentation of specific testing needs as appropriate to the quality assurance needs of the end user.

Assisting business users in defining UAT test cases and plans; Established and maintained test cases and test data in Quality Center.

Coordinated with the QA Team for testing activities across multiple systems and managed Conversion test execution.

Helps in conducting Gap Analysis (GAP), User Acceptance Testing (UAT), and System Integration testing (SIT).

Involved in understanding the business requirements and use cases and continually participating in discussions with the PDM (Provider Demog Maintenance) Business to determine the Level of changes needed on Provider Area.

Involved in documenting the Business Requirement and review with Project team/SSCR Team.

Involved in providing solution for the Business need on POR/SSCR.

Involved in mapping all the business requirement to Technical response to make sure the coverage of business need has been satisfied.

Involved in brief analysis on the impacts made with the new work flow and thus briefing them before hand to the business.

Involved in updating the Design documents (Use case/Data mapping) for dev team to start with Interface or Extension changes.

Providing the required test data for the developers in order to fix the defects.

Participating in QA team meeting and bug tracking meetings.

Environment: Rational Clear Quest, Rational Clear Case, MS Visio, Sybase, UNIX.

HCL Technologies, Chennai, India Jul 2010-Feb 2012

Software Engineer

HCL Technologies (the abbreviation of Hindustan Computers Limited)[8]offers services including IT consulting, enterprise transformation, remote infrastructure management, engineering and R&D, and business process outsourcing (BPO).

Responsibilities:

Involved in workshop for capturing new requirements for product enhancement.

Involved in developing new screens according to the new requirements.

Involved in loading the business rule for each clients to the product.

Involved in developing new screens using various design Patterns. This application used MS dot net 4.0 Framework, ASP .Net for front end.

Involved in developing Batch jobs to load business rules using SSIS.

Involved in developing Reports for Business user using SSRS.

Environment: MS Dot Net 4.0, ASP.Net, SQL Server 2015 SSIS, SSRS.Requirement Traceability Matrix (RTM).

Profiniti Systems, Chennai, India, June 2009- June 2010

Software Engineer

Healix Infusion Therapy (US Based Client)

Referral Management Systems (RMS) & Nursing Calendar (NC):

RMS is an Integrated Patient Management System, which deals with the end to end tracking of services provided for, customer seeking care from Healix Infusion Therapy. NC is an application used by Nurse Practitioners for tracking the Health Care services provided by Healix Infusion Therapy.

Responsibilities:

Involved in developing the change request that received for RMS & NC.

Involved in creating the installation package for new version of software across application Module.

Involved in creating the reports using SSIS/SSRS.

Responsible for any customer reported issues in the production and solving it in time

Involved in developing 270/271 integration for Eligibility enquiry with external web service.

Frequently communicated with developers to resolve technical issues.

Environment: MS Dot Net 3.0, C Sharp, SQL Server 2015 SSIS, SSRS.

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