MONIQUE L. GREGORY

Valley Cottage, New York *****

Home 845-***-****

Mobile 914-***-****

linkedin.com/in/monique-brothers-gregory Email: acw3ra@r.postjobfree.com

QA MANAGER

Test Strategies & Plans Task Plan Management Traceability Matrixes Team Management Project Leadership Training Audits Health Claims

SUMMARY Highly accomplished QA expert who is proficient in developing Test Plans and Strategies. Talented in interpreting technical designs and translating the material into a digestible format for Test Analyst/Business Community. Motivational leader who coaches, develops and mentors staff to embrace and achieve management objectives under critical deadlines. Disciplined and goal-oriented with strong analytical, communication and organizational skills.

EXPERIENCE

Managing QA Lead QA Manager, Emblem Health Plans, New York, NY 4/2011 – 7/2016

Planned and coordinated functional and regression testing of moderate to difficult complexity to ensure business acceptance, user acceptance and system integration of new releases of enterprise projects.

Developed appropriate test strategies to efficiently and successfully validate business objectives.

Organized resource teams and conducted internal QA Kick-Off meetings to ensure the Test Plans are followed.

Oversaw multiple projects with a limited staff. Organized and assigned appropriate task to staff based on individual talents and skill-sets in order to meet strict deadlines.

Chaired QA Turnover Meetings with development staff, software vendors, consultants, user community, support staff and system managers.

Chaired QA Test Case Overview Meetings with Program Managers, Project Managers, Business Partners and Development Teams.

Analyzed Business and Technical Requirements and translated them into supportive Test Plans and Traceability Matrixes to ensure all aspects of the project have been tested.

Utilized knowledge of EmblemHealth’s business model and operating environments to identify trends and potential issues in quality control processes which impact claim processing.

Evaluated the effectiveness and efficiency of the testing process to be used across the project.

Audited test results from on-shore and off-shore teams to confirm test case objectives were met.

On-boarded and off-boarded consultants as necessary to reach business objectives.

Conducted one-on-one and off-shore training for new hires.

Created QA Forecasts and ensured the budget was adhered to.

Provided general managerial responsibilities of conducting Semi-Annual and Annual Employee Performance Evaluations and approved staff timesheets via the PPM System which reflected staff project allocation to stay within budget.

Sr. QA Test Analyst, Emblem Health Plans, New York, NY 12/2004 – 4/2011

Executed the Test Plan from the Test Lead. Performed functional and regression testing of moderate to difficult complexity to ensure business acceptance, user acceptance and system integration of new releases of enterprise projects using HP ALM.

Developed detail test cases from Test Strategy, BRD and TRD for UB04 and HCFA1500 claim processing systems which included AP-DRG, DRG, APG, ASC, APC, HIAA, and Medicare Contract pricing. Validated claim pricing via Provider Contracts and Product Lines of Business. Determined expected results.

Understood the life cycle of a claim whether it was submitted electronically or via the mail to the generation of a check, Explanation of Benefit and Remittance Advice.

Developed and executed appropriate test strategies to efficiently and successfully validate business objectives.

Developed, debugged, executed and maintained test automation scripts.

Interacted with development staff, software vendors, consultants, user community, support staff and system managers in BRD Gathering Sessions and Triage Calls.

Recorded results and compared actual results to expected results. Utilized production data as verification when applicable or available.

Analyzed Business and Technical Requirements and created Test Cases and Traceability Matrixes to ensure all aspects of the project have been tested.

Utilized knowledge of the HealthCare’s business model and operating environments to identify trends and potential issues in quality control processes which impact claim processing.

Ensured tests are repeatable, verifiable and understandable for technical and business functions.

Reported testing status to the Team Lead and the QA Manager. Created and published a Project Notebook which documented the QA effort performed for each project.

Environment: AIX, OS/390, TSO/ISPF, COBOL II, VSAM, File Aid, CICS and JCL

UniVerse/PICK Basic Developer, Emblem Health Plans, New York, NY 12/1998 – 12/2004

Responsible for the life cycle development and execution of projects originating from Small Business, Marketing, and Government departmental request.

Developed and modified new and existing programs requested by internal customers (EPMO).

Designed, coded, tested, debugged, and documented those programs. Provided on-going support for the new and modified programs.

Wrote Business Requirements, Technical Requirements, Test Plans, and Implementation Plans to support program creation or modification.

Worked with the Data Warehouse group to gather, organize and create a flat file holding provider demographic and specialty data for the quarterly Provider Submission to the DOH (Department of Health).

Amended and tested programs on the Viaduct system for Y2K compatibility.

Mapped Vytra’s Provider Contracts to HIP’s during the Vytra/HIP Integration

Environment: HP Universe, Pick BASIC, TCL, FTP Server, Access Database

Analyst/Medical Claim Examiner, Emblem Health Plans, New York, NY 8/1996 – 12/1998

Responsibilities included processing and approving of high dollar hospital, anesthesia, and surgery claims utilizing hospital contracts, single case agreements, DRG (Diagnosis Related Grouper), APG (Ambulatory Payment Grouper), ASC (Ambulatory Surgery Classification), APC (Ambulatory Payment Classification) and HPR (Health Procedure Recommendations) guidelines.

Reviewed claims on appeal and sent correspondence informing the subscriber of the decision.

Handled all laboratory complaints for company.

Collected and organized data for monthly report card for directors.

Provided support for customer services representatives.

EDUCATION Bachelor of Science, Computer Information Systems

Dowling College, Oakdale, NY

TECHNICAL MS-Word, MS- Excel, MS-Projects, Pick Basic, Compuware QA Director, Test-Partner, ALM,

EXPERTISE Knowledge of SharePoint, Knowledge of FileAid and JCL

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