Name: Vamshi

Phone No: ad2ohe@r.postjobfree.com

Email: +1-289-***-****

Professional Summary:

Dedicated Business Systems Analyst with over all 6 years of with proficiency in Health care, Banking and Retail domains, utilizing analytical thinking and relevant expertise to help the organization comprehend its long-term goals. Delivered Customer Onboarding, Data Migration, Feeds Processing, Web Applications, Electronic Data Exchange via API’s Projects with a strong technical acumen and the ability to bridge the gap between business needs and technological solutions. Exceptional communication & problem-solving skills. Adept at fostering collaboration and consensus among stakeholders to drive business success.

Experience and strong understanding of Business Requirements Gathering, Business intelligence, Internal Audit, Project Planning, Data management, Business Process Flow, API Flows & Business Analysis.

Worked in industry standard Software Development Life Cycle (SDLC) methodologies like Waterfall and Agile. Adept in all ceremonies in Agile and Drafted user Stories and Maintained the Product Backlog.

Reported Project Progress in Governance Calls and reported on KPI’s and RAID Log & Identified solutions / Contingency Plans to mitigate the risks with Senior Stakeholders.

Experienced in business process flows, business process modeling, case tools, business analysis, gap analysis and organizational change management.

Solid understanding of Membership, Claims Processing, Billing, Benefit/ Eligibility, Authorization/ Referrals, COB, and have experience in HIPAA standards and corresponding EDI transactions (837, 834 and 820).

Knowledge of health care services regulatory environment in compliance with HIPAA, ICD, MITA, MMIS.

Knowledge on Medicaid, MMIS, HIPAA EDI transactions 278, 820, 834, 835, 837, ICD-9, ICD-10, HL7, HMO, PPO, ANSI X12 Procedural and Diagnosis codes.

Used Microsoft SharePoint as a Web-based Content Management System as well as a Document/ Project Management tool. Good understanding of the AS-IS and TO-BE business processes and experience in converting these requirements into technical specifications.

Experience in defining BPM process, creating Process Flows, Workflow Analysis and UML Diagrams like Class, Activity/ State, Sequence, ER diagrams using MS Visio, Enterprise Architect and Pencil etc.

Expert in creation of various documents including the BRD, Use Case Specifications, FRD.

Adequate knowledge in - Claims processing (auto adjudication), COB, EOB/ Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, HER, HIX, Confidential, Medicaid, CDHP (consumer driven health plans).

Extensively worked on architecting APIs using RAML & deployment to iPaaS API Runtime.

Extensive Data Analysis, GAP Analysis and Querying with Database Applications with Oracle, MS Access and Used queries like Joins, NVL statements, Union, Ranking functions, and procedures to extract information and use it for Analysis, reporting and testing. Designing the process to identify the suspicious information about the lenders and brokers.

Defining the Alerts and notifications on any suspicious activity with borrower’s information and validation through the watch list to prevent AML activities.

Worked with business teams to gather the requirements for the process of integration and automation of reports from various data sources.

Worked with compliance team to ensure all regulations (TRID, UDAAP, FCRA, FAC etc.) are followed.

Assisted DBA with Database team, performing data mapping from source system to target system.

Participated in several testing phases including the creation of Test Case (TC) documents, Acceptance, Functional, Regression Testing, and Integration Testing, etc.

Facilitate daily UAT Testing call for all UAT testers using the Post Closing Platform.

Coordinated defects with developers and tracked them until resolution in defect tracking system (DTS)

Maintained a structured approach in organizing requirements to ensure that critical business rules and requirements are met with the help of Requirement Traceability Matrix (RTM). Developed Test plans, Test case and Test procedures in manual and automated test environments for different testing procedures like System Integration Testing, regression testing, User acceptance testing and Performance testing.

Experienced in conducting Developing Dashboards in Tableau & present findings to Senior Management

Professional Experience:

Company Name: AbbVie, Toronto, Ontario March 2023 to Till Date

Role: Senior Business Systems Analyst

Description: This project is mainly for management system to manage end-2-end support for their customers with private, state, and federal medical insurance like Medicare and Medicaid. This includes various modules like health portal, Practice Management, MMIS, Claims, RCM, and Billing modules etc. It also provides support features to Providers, Employers to manage their contracts, benefit/claims configuration payments methodologies of facets in the system. The system handles appropriate decisions relating to fee schedule and payment calculations by applying Medicare Advantage and CMS Regulations. Also provides benefits & assistance programs for their own employees too. Also, it is tightly integrated with leading healthcare insurance industries for easy claim adjudication/processing.

Responsibilities:

Lead Multiple ETE Strategic Initiatives / BOW Projects for AFC Compliance and Streamlined Operations for Business Users / Case Investigators in AFC Tool Nice Actimize.

Implemented Product Enhancement Via Web Application to Create Webform Cases in Risk Case Management (RCM) platform for Different BUs in adherence to current Investigation model.

Workflow permission model, eSAR, Case edits, RFI, Case Details, Case Views, DART reports, Email notification model, QA Sampling process, EAP big data feeds and Aging/SLA's which replaced Manual Case Creation by Case Investigators / Supervisors.

Involved in gathering high-level business requirements to automate claims and developing detailed user stories and process flows.

Participated in Sprint Planning, Daily Scrum Stand Up, and Sprint Retrospective meetings.

Participated in the development and grooming of Project Backlog Stories (Requirements) with business and technology partners. Involved in design sessions in prototyping new systems to enhance the business processes, operations, specifications, diagrams, scenarios, mockups, and/or data models.

Created & delivered various requirement documents like BRD, Use Case, UML Diagrams, FRD, RTM etc.

Resolves requirement conflicts and barriers as they arise.

Adhere to all personal confidentiality and HIPAA requirements as outlined by Operating Policies and Procedures.

Worked as part of Master Data Management (MDM) team and worked with the business and data governance groups to help the client develop their MDM program.

Worked on data profiling of source systems as needed to support design work.

Led the effort to strategize the MDM initiative gather the Business Rules, matching strategy, survivorship rules from the Business. Worked with Health and life insurance teams in a project called Enterprise data management.

Participated in identifying opportunities dat impact business strategy and system performance, JAD sessions with Stakeholders to enable technical solutions for process improvements.

Performed business/system analysis, detailed program design, coding, testing, deployment, technical documentation, and maintenance support. Additionally, conducted analysis necessary for state government reporting.

Modifying existing reports using Crystal Reports versions 5 through 9 and including XML to match the criteria established by the users. Creating sub reports, using XML as a data source, setting new data sources, verifying database structures, and functions and formulas with string manipulation. Identifying the key users and SME’s And Gathered Business Requirements using appropriate elicitation technique, did various analysis, Identifying the gaps and opportunity for product grooming and quality aspect of the product feature.

Co-ordinating with onsite and offshore teams for project updates and other project related tasks to do using MS SharePoint and involved in conducting various meetings related to project completion.

Created Requirement Gathering Document, Business Requirement Document, Use Cases and Use Case Scenarios using MS word, MS Excel, visualized those using UML diagrams in MS Visio.

Worked on Trade related Data Families and SMEs from Portfolio Management system and SPARTA etc. order processing systems to gather the Feeds processing requirement for the Data Warehouse.

Conducted detailed interviews, workshops, and analyzed existing system documentation of AFC Systems, Core Banking.

Investment Banking Applications to solicit client and system requirements, ensuring a thorough understanding of business needs for Deposit and Investment Account onboarding.

Functional experienced in Claim Life Cycle and Health Care Payer domain process along with various line of health insurance system like PPO, HMO, POS.

Experience in Service Now on implementing end - to-end Service Catalog.

Drafted complex SQL queries for data extraction, manipulation, and analysis using SQL functions, joins, and subqueries to retrieve and analyze data efficiently.

Validated the accuracy and integrity of data processed by the system during UAT, ensuring alignment with predefined criteria and compliance standards.

Reported Progress in Governance calls to senior Stakeholders and reported on the KPI’s / RAID log with Governance Presentation Decks.

Facilitated SIT, UAT, Performance testing phases and resolved defects and worked closely with Business and Release Management for Go Live.

Environment: Software Testing, Reconciliation and Remediation, Hardware Management, Technical Support, Programming, Java, Oracle 9i, Peregrine Service Center, Win XP, UNIX, PeopleSoft

Company name: Citi Bank, Toronto, Ontario Feb 2022 to Feb 2023

Role: Sr. Business Analyst

Banking domain

Description: Implementation of nCino Bank Operating System end-to-end solution that has automated streamlined its lending practices to increase the loan value, cost reduction, eliminate duplicative data entry, increase workflow efficiency easier regulatory review digital loan files and documents easily and remotely with increased transparency and flexibility. Provide customers with a way to interact digitally through an online portal.

Responsibilities:-

Worked on deciding report format best suited to organize data in a meaningful way to produce desired results.

Worked on running basic queries using SQL and creating reports.

Responsible for data analysis and modeling, report design and building using various data tools.

Administered all aspects of Agile with Scrum processes.

Organized and facilitated project planning, daily stand-up meetings, reviews, retrospectives, sprint, release planning, demos, and other Scrum-related meetings.

Provided user training on the various reporting tools.

Provided Master Data Management (MDM) Leadership by working with the business and data governance groups to help the client develop their MDM program.

Guided data stewards and data owners in developing MDM ownership, workflow processes, and seamless user experience. Worked with business teams to gather the requirements for the process of integration and automation of reports from various data sources.

Worked with compliance team to ensure all regulations (TRID, UDAAP, FCRA, FAC etc.) are followed.

Assisted in performing data mining of customer databases to analyze key business issues. Implement new non-traditional products on Vantage-One. Define business requirements based on product specifications. Work with product actuaries for calculation requirements. Identify viable system modifications to support new products.

Strong understanding of Mortgage-Backed Securities, Capital Markets, Retail Banking, including Credit Card, Mortgage, Account Transactions, Wire Transfers, Bill Payment.

Strong knowledge of Finance, Accounting, and Sox Compliance.

Recognized as being dynamic, result-oriented, analytical, and organized in managing multiple priorities.

Worked on Enterprise content management (ECM) used for store valuable content from all over the enterprise to provide ease of use for controlling and organizing files.

Cross functional experience in Financial Services Industry Investment Banking, Retail and Brokerage Services Banking.

Implemented Mantas scenarios specifically tailored for monitoring cross-border payments in correspondent banking, enhancing the detection of illicit financial activities across jurisdictions.

Provided overall design and development guidance to the MDM technical team. Developed Order validation and Order management web services for order entry web tickets.

Drew visual workflow diagrams using formal notation such as the Business Process Modeling Notation (BPMN). Worked on AWS Elastic Beanstalk to deploy, monitor, and scale an application.

Create new EC2 instance in AWS, allocate volumes and giving Provisional using IAM.

Analyzed the Source data and do data Profiling as needed to support design work.

Led the effort to gather the Business Rules, matching strategy, Survivorship rules from the Business.

Facilitated design, analysis, testing, test planning, and test execution for Master Data Management (MDM) project.

Identified and mapped business requirements into system software requirements.

Facilitated with modeling team to design custom surveillance scenarios specific to MX, ACH - NACHA, and Securities messages, tailoring the anti-financial crime system to identify anomalies and patterns unique to each messaging format.

Maintained the Product Backlog closely with the Product Owner in JIRA, worked with offshore team to Monitor, and evaluate project progress consistently to maintain quality and adherence to project scope facilitating early identification and resolution of potential bottlenecks.

Successfully Led end-to-end transition of SWIFT BIC to BIC plus File Consumption, in full compliance with sensitive BIC timelines. Successfully executed the transition, ensuring a seamless shift and minimizing disruptions in alignment with regulatory requirements.

Applied SQL querying techniques to extract, filter, and manipulate large datasets (Customer, Account, Transactions etc.) and utilized various joins, subqueries, and conditional statements for comprehensive data analysis and transformation.

Worked with Vendors to work on AFC Product Upgrade to help address Business requirements and help Business Operationally by moving to latest Version of AML Tool (Mantas).

Environment: Scrum, Oracle, OBIEE, PL SQL, HP ALM/ Quality Center, Rational Requisite Pro, Rational ClearCase, SharePoint, Guidewire, Business Objects, Rational ClearQuest, Mercury WinRunner, Microsoft Visio, ERwin3.5.2, JIRA, Java, VUE Broker Portal, VUE LMS.

Company name: Capco, Hyderabad, India Jan 2020 to Nov 2021

Role: Sr. Business Analyst

Banking domain

Description: The objective of the project was to establish a Common Operating Environment for Traders and Analysts working on the Fixed Income trading desk/Fix Protocol related to Treasury, Liquidity, and worked on the Data Migration process involving from data gathering stage to the Deployment stage. Worked in conjunction with Technology, Wealth Management business to refine policy triggers in reference to the Orchestra E-Communications Surveillance system.

Responsibilities:-

Worked closely with the Business in identifying and documenting requirements.

Authored Agile User Stories and facilitated Grooming Sessions for highest priority User Stories in the Agile Product backlog in collaboration with the Team. Provided MDM usage statistics that show the benefits of various MDM processes.

Worked in development of the Test Plan and Test Cases, conducted UAT (User Acceptance Testing).

Performed Data Analysis and Data Mapping to generate Crystal Reports.

Prepared Project Documentation like Project Charter, Business Systems Design Report, Release Notes, Minutes of Meetings, Action Item Logs, Issue logs, End User Training Materials.

Collaborated with various folks within IT and Business roles including the Product Owners, Developers, Software Quality Analysts, and requestors to better understand and monitor various processes.

Served as Subject Matter Expect (SME) for approving/reviewing Business Requirement Documents (BRD) for the various projects I worked on. Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams, State Diagrams, Activity Diagrams, and business processes and workflows, ensuring that technical requirements were accurately translated into technical specifications. Determined alternative approaches to Basel III regulatory capital calculations allowing significant capital savings.

Strong Analysis knowledge of financial statements, Financing Structures, Cash Flow Forecasting, Capital Budgeting, Asset Allocation, Fixed Income Products, Derivatives, Portfolio Management.

Managing projects for Contact Center Technologies under Technology Infrastructure and Compliance (TIC).

Eagle PACE implementation and redesigning of modules of Web Based Portfolio and asset management system that supports Basel II compliance by Business Process Reengineering.

Worked with the technology team to develop a data model for creating a centralized trade repository and database to hold the data for Volcker.

Set up and facilitated meetings between Electronic Fraud Mitigation department and various business partners, such as Audit, Risk, Corporate Security, and AML, to progress with projects and close Audit findings.

Responsible for reviewing the historical interest rate and FX fixings from Calypso and importing the missing rates into Summit.

Analyzed community bank asset and liability portfolios containing instruments such as CDO, MBS and Treasuries to provide optimization and income enhancement strategies.

In depth knowledge of Total Return Swaps, Portfolio Swaps, Forward Rate Agreements, Securitized Products (CDO), Commodities (Cash Contracts, Futures, Options, and Swaps)

Led the Basel (Market Risk Amendment) standard specific risk calculator implementation effort ensuring compliance with new rule provisions (i.e. covered position definition and market risk).

Conducting audit reviews of new Customer Information File (CIF)/KYC documentation for BSA Risk rating validation at customer onboarding and during periodic due diligence reviews.

Worked with Project Manager and Portfolio Leads to ensure timely delivery of Tasks.

Created and constantly updated the Mapping Documents for various EDI transactions like 837, 834, 835 etc.

Participated and facilitated the Agile ceremonies – Standup, Story Refinement, Planning & Review and Retrospectives.

Worked alongside other teams such as Enrollment, Claims and Encounters to generate the respective EDI files.

Dealt with multiple conflicts and impediments during execution of project work related to stakeholders, timelines, gaps in requirements and worked toward resolution with relevant personnel.

Working knowledge and experience of TIBCO and more recently implemented a project using Edifecs.

Environment: Agile-Scrum Framework, Kanban, Edifecs, MS Azure DevOps, MS Visio, ServiceNow, FACETS, Tidal Automation, Move IT, UltraEdit, NotePad ++, Microsoft SQL, MS Office

Company Name: PrimEra Medical Technologies, Hyderabad May 2018 to Dec 2019

Role: Business Analyst

Responsibilities:

Facilitated and coordinated with decision makers, systems owners, and end users to define business, operations requirements, systems goals and gather functional & non-functional requirements.

Involved in design sessions in prototyping new systems to enhance the business processes, operations, specifications, diagrams, scenarios, mockups, and/or data models.

Created & delivered various requirement documents like BRD, Use Case, UML Diagrams, FRD, RTM etc.

Resolves requirement conflicts and barriers as they arise.

Adhere to all personal confidentiality and HIPAA requirements as outlined by Operating Policies and Procedures.

Performed Analysis on Data mapping between different data models.

Worked on EDI transactions: X12,835, and 837 P.I to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.

Designing the process for Medicare claims creating and billing based on Reference based pricing.

involved in development of claim management data warehouse to assist claim professionals to analyze and administer the claims in an efficient manner for the operational data came from multiple sources and was then loaded into claim management data warehouse.

Developed test cases along with testing team and involved in various phases of application testing; Review and understand the defects and translate those into actionable items.

Performed in-depth tests, including end-user reviews, for modified and new systems, and other post-implementation support.

Captured and managed project risks/issues, execution of risk mitigation/contingency plans and any necessary action items to close that.

Created reports using statistic- based software utilized for data discovery, modeling, and analysis.

Analyzes, develops, prioritizes & coordinates application change requests to fulfill the business needs.

Evaluate, monitor, and ensure system compliance with laws, regulations, policies, standards and procedures.

Provide orientation and training to end users for all modified and new systems.

Environment: Agile-Scrum, SQL Developer, Google Cloud Platform, MS Office, MS Teams, MS Visio, Fiddler, Google Docs.

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