Renu Sanjiva Rai

Princeton, NJ - *****.

Mobile - 516- 417-1113

acef0a@r.postjobfree.com

SUMMARY

Result oriented professional with 7+ years of professional IT experience with strong focus

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on Business Analysis and SQL background in various domains like Healthcare and

Finance. Maintained positive communications and working relationship at all levels

Extensive experience in Software Development Lifecycle Process (SDLC), Iterative,

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Waterfall and Agile methodologies.

Expert knowledge of all phases of Software Development Life Cycle (SDLC) involving

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Business Process Analysis, Systems Analysis, Design, Development and Implementation .

Good knowledge of the Rational Unified Process (RUP) and experience with Rational Tools

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like RequisitePro, Clearcase, ClearQuest, Rational Quality Manager, RSM.

Prepared business requirements documents, system requirements specifications, scope,

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business processes, business rules and functional specifications.

Experienced in designing and executing various types of test plans and test cases.

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Experienced in translating user requirements into functional specifications, Use Cases and

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UML diagrams such as Sequence diagram, ER diagrams and Data Flow diagram.

Proficient in conducting JAD sessions, User Interviews and Presentations.

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Ability to resolve business as well as technical issues and served as a liaison between

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business groups and technical developers.

Experienced in reporting tools such as Crystal Reports 11.0, SQL Server 2008 R2, SSIS,

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SSRS. Strong experience in MS Excel for reporting using macros, functions and pivot tables

Good SME on ACA implementation of Qualified Health Plans ( QHP), Essential Health

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Benefits (EHB), Cost Share Reduction (CSR), Subsidies, SERFF templates, Exchanges

and Direct Enrollment flow

Good knowledge of Care Management operations like Utilization Management, Disease

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Management, Case Management, Precertification?s, ICD9, ICD10 & CPT codes

SME on Senior Market segment product offerings of Medicare, Prescription Drug Plan

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(Part D) and MediGap/Medicare Supplemental plans

Proficient in the use of T-SQL for developing stored procedures, triggers, tables, user

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functions, relational database models and data integrity, SQL joins and query writing.

Quick learner, excellent communication skills and good performer both in team and

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independent job environments.

SKILL SET:

Rational Tools: Requisite Pro, Clear case, Clear Quest, RQM, RSM.

Microsoft Tools : MS Visio 2010, MS Excel, MS Word, MS PowerPoint, MS Access,

SharePoint.

Reporting Tools: Crystal reports, Business objects (BO)

Database: MS SQL Server 2008 R2/2008/2005/2000,

Database Tools/IDE: T-SQL, DTS, SSIS, BIDS, MS Visual Studio 2010, SQL Server

Management Studio.

Other: UML Modeling, Business Process Analysis, Systems Analysis

EXPERIENCE:

I KON Software Services ( http://www.ikonss.com/) Jan 2008 ? Present

Some of the key projects listed below

WELLPOINT Health Exchange Product / Quoting System Nov 2012 ?

Present

Business Systems Analyst

Description: This project was to build a web based quoting system as part of the Health Care

Reform (ACA) mandate which offered the Health exchange based plans to the subscribers. The

modules for the integration of the product and rating system was the key to this web based

system and I worked as the business systems analyst supporting this integration.

Responsibilities:

Involved in the project lifecycle from inception to implementation

Meeting with stakeholders for requirements gathering and analysis Collaborating with the

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Sales and Retention business units to understand strategic goals

Use case modeling and documentation for system interaction and business rules.

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Create the product benefit mapping grid to extract the required benefits that have to be

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displayed on the web interface.

Work with Actuarial team to understand the rating area and service areas where products are

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to be offered and documenting the business rules around service and rating areas

Provide project and informational updates to management as available and/or assigned.

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Working with the architecture/development team for design and analysis of the system

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Assisting the QA team to come up with the Test plan. Creating requirement traceability

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matrix

Triaging Testing defects with Business, Development and QA team.

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Generate benefit comparison reports for benefit data on the web system to the source system

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(product filing data) to validate the accuracy of the benefits.

Triaged all product benefit related issues between Product business, Enterprise Benefit

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administrators (EBA) and IT to resolve discrepancies found during benefit validation

process.

Document scope for the User Acceptance Testing and triage UAT defects.

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Generate Post production reporting on product benefits compliancy.

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Creating reports for analytical data required by the business to understand the system metrics.

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Project SME was around the healthcare products offered for the individual market segment

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as part of ACA implementation of Qualified Health Plans (QHP), Essential Health Benefits

(EHB), Cost Share Reduction ( CSR), Subsidies, SERFF templates, Exchanges and Direct

Enrollment flow

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Environment: Rational Tools, MS SQL Server 2008, Management Studio, SSIS, Web

sphere Application Server, Windows 7

Enterprise Product System Mar 2011 ? Nov 2012

Business Systems Analyst

Description: This project was to setup an enterprise repository for the healthcare plans /

products for all market segments within the enterprise. This was a product configurator which

comprised all the attributes for sales, utilization management and claims adjudication. The

system also has an administrative web UI for benefit administrators to configure product benefits

Responsibilities:

? Involved in the project lifecycle from inception to implementation

Meeting with stakeholders for requirements gathering and analysis

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Work with the Product business and Enterprise Benefit administrator to evaluate the

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benefit hierarchies and come up with optimal solution for representing the benefits on the

product configurator.

? Evaluate the impact of date segments when existing benefits have to be updated due to

mandates and provide impact analysis.

? Analyze product benefits consuming systems like SBC / Evidence of Coverage (EOC)

generator, Web portals, Claims systems, Care management systems and aid them in

documenting the benefit mapping documents for the required benefits for the respective

systems.

Assisted in mapping the product contracts to the provider network system.

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Documented the steps and pre-requisites required for setting up benefit configurations on the

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product configurator tool.

Use case modeling and documentation for system interaction and business rules

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Documented the pre-existing Business process from product filing to product

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configuration and the re-engineered process of product filing and configuration.

Creating requirement traceability matrix. Assisting the QA team to come up with the Test

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plan.

Mapping benefit attributes from UI to System

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Creating reports for analytical data required by the business to understand the system

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metrics.

Triage QA defects with the development team

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Impact analysis of ICD9 ? ICD 10 migration on product system.

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Environment: Rational Tools, MS SQL Server 2008, Management Studio, SSIS, Web

sphere Application Server, Windows 7

Senior Online System Feb 2010 ? Feb 2011

Business Systems Analyst

Description: The project was to build an online insurance quoting application that would help

the users to find the right insurance for Senior Medicare, Part-D and Medicare Supplement plans.

The user can learn about insurance, get a quote, retrieve a quote or buy an online insurance

policy. For the first time applicant, the user creates a login profile with a valid user id and

password. After authentication of this information, they can submit their enrollment and pay their

payments online. Also they could contact the representative in case of any online collaborative

assistance.

Responsibilities:

Collaboration with the business teams / users in understanding the requirements, while

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providing the required system information to them.

Assess the impact of proposed changes with the development team and interfacing teams.

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Update the use case document as needed to incorporate approved changed request once the

affected requirement documents get update.

Interact with external teams. Analyze the interfacing system?s impact on our application.

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Performed requirement walkthroughs with the Development and QA teams with the aim to

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develop testing strategies and test plans such that test cases reflect user needs.

Developed and maintained all work plans, acted as a key client contact, handled all kinds of

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scheduling and facilitated all status meetings.

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

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Carried out mapping analysis, test case preparation, test execution, defect reporting,

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regression testing and final documentation.

Communicated with the QA team about the impacted functionality that needed to be included

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in their test planning.

Prepared deliverables like Use-Case diagram, Data flow diagram and Entity relationship

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diagrams using MS Visio.

SME on this project was around the Senior Market segment products and rate including

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Medicare, Prescription Drug Plan (Part D) and MediGap/Medicare Supplemental plans

Environment: MS Excel, Teradata, Mainframes, Oracle 11g, MS PowerPoint, MS Word,

MS Visio, MS Share Point, MS Outlook, UML, JCL.

Active Health Management, Broadway, NY Jan 2008 ? Dec 2009

SQL Server Developer

Description: Active Health Management is an experienced leader in providing population health

management solutions that are designed to help our customer?s nationwide support health

outcomes and manage health care costs. We utilize leading-edge analytics and evidence-based

clinical standards to offer integrated population health programs and services to support

strategies for a variety of organizations including health plans, providers, employers and

state/local governments. Active Health Management supports customer strategies to achieve

their health and cost goals through a patient-centered, holistic approach to engage individual

engagement and proactive prevention of illnesses, promote healthier lifestyles and promote

quality care.

Responsibilities:

Provided optimized solutions, error free data migration and suggest re-usable

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code/components to implement enhancements in a more efficient manner in the new system

without affecting the existing functionality.

Worked with the DBA to propose robust database architecture.

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Created Stored Procedures and functions to support efficient data storage and manipulation.

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Created and managed tables, functions indexes, using TSQL in development environment.

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Extensively used TSQL to manipulate and architect to produce results for users. Wrote

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Queries such as sub queries and nested queries in T-SQL, Stored Procedures, and Views to

store the data of clients, advisors.

Extracted data using SSIS packages (ETL) from different server locations and data sources.

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Developed a number of packages for the ETL processes to load the Claims, Members and

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Providers data into production database.

Active role in the post-production analysis, support and documentation for the application.

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Created Deployment Plan for phased deployment of multiple units within the existing data

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model to migrate to an updated data model.

Good hands on knowledge of reporting tools such as Crystal Reports 11.0, SQL Server 2008

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R2, SSIS

Environment: SQL server 2008, Microsoft Visio, DTS, Query Analyzer, Erwin, crystals

Reports, Visual studio, Service now.

Dithya Pvt. Ltd, Bangalore, India Jan 2005 ? Dec 2006

SQL Server Developer

Responsibilities:

Involved in designing Flow charts, Data flow Diagrams etc. for the business documents and

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categories using Microsoft VISIO

Developed SQL Queries to fetch complex data from multiple tables in remote databases

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using multiple join statements such inner join, left join and right join to retrieve data

Performed Index analysis on tables and developed more efficient solutions using Clustered,

Non-Clustered and online Indexes for performance boost

Worked on Import & Export of data from one server to other servers using tools like Data

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Transformation Services (DTS)

Created Views to facilitate easy user interface implementation, and Triggers on them to

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facilitate consistent data entry into the database

Used SQL profiler to view indexes performance to mostly eliminate table scan.

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Used TSQL Queries and SQL Scripts to perform efficient data load based on complex

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Business rules.

Involved in analyzing and designing disaster recovery / replication strategies with business

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managers to meet the business requirements.

Involved in project planning also schedule for database module with project managers.

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Responsible for generating annual reports based on the growth of company with respect to

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customers.

Scheduled report and exported in PDF format.

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Used Export / Import utility to load/write database table data from heterogeneous tables and

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view.

Deployed SSIS packages using File System and MSDB deployment model to automate the

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data loading process after setting up proper proxies account at SQL server instances.

Worked on optimizing existing SSIS packages to reduce the data loading time drastically.

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Used Explain plan and ETL best practices as bench mark for optimization process.

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Environment: MS SQL Server 2008, MS Excel, Windows 97/2000/XP, Microsoft Performance

Point, Microsoft Share Point Server, T-SQL, MS Access and SSIS

EDUCATION:

M aster of Science in Accountancy, University of Phoenix 2013

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D iploma in Computer Science, Pune University, India 2004

Bachelor?s in Commerce, Pune University, India 2003

WORK PERMIT: PERMANENT RESIDENT

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