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Test Cases Life Insurance

Location:
Johnston, RI, 02919
Salary:
98,0000
Posted:
January 07, 2020

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Resume:

Kiran Jettigundla

212-***-****

ada8hc@r.postjobfree.com

PROFESSIONAL SUMMARY

A result oriented IT professional having over 10 years of total corporate experience in Software Quality Assurance, QA Lead, QA/Testing, Programing, System analysis, design offering full life-cycle experience Software quality assurance with a wide variety of projects and environments on Client-Server and Internet/Intranet environments in Windows platform.

Good understanding and implementation of Software Testing Life Cycle (STLC).

Testing experience in Web, Client/ Server & Mainframe applications developed under UNIX, Windows operating systems.

Expertise in testing FACETS implementation, Integration Testing of Facets with custom interfaces and in-depth knowledge in healthcare

Experience in Analyzing user needs and software requirements to determine feasibility of design within time and cost constraints.

Extensive experience in testing FACETS applications mainly in Claims processing, Medical Agreement configurator, Provider, Group, Subscriber/Family, membership and NetworX.

Extensive experience in Enrolling subscribers manually in FACETS and Verifying the Class plans and rate information for groups in FACETS.

Experience on Enrollment, Claims Processing, ITS Claims, and Customer Service Applications which are supported by FACETS

Extensive experience in Creating and testing Referrals and Preauthorization’s in Facets UM Application.

Extensive experience in Creating and testing Referrals and Preauthorization’s in Care Radius Application

Excellent Black Box testing and White Box experience in Manual test methodology and test tools like Quality center, Test Director, Clear Quest, Clear Case and RQM.

Expertise in developing testing documents - Test strategies, test plans, test design specifications, test case specifications and test procedures.

Experience with Data Analysis based on Requirement Gathering, Gap Analysis, Business Process Modeling, Data Quality Analysis, Data Conversions, Source Systems Analysis and Reporting Analysis

Strong technical skills along with understanding of Software Verification, Validation and QA processes

Performed Integration, System, Regression, User Interface, Back-End and UAT testing using manual test methodology.

Extensive experience in UAT testing and coordination of business users.

Experience in Automating Web Application Testing using Selenium WebDriver with TestNG framework.

Experience on validating Deductible and OOP accumulation for Member and Family accumulation based on Benefit matrix.

Experience in Executing Selenium Test Cases and Reporting defects.

Proficient in overall Defect Management/Problem solving including tracking bugs and reporting using HP Quality center, HP ALM, Clear Quest and Test director.

Worked extensively with EDI-HIPAA standards.

Worked on Web services testing using SOAPUI.

Worked on Automation tool Selenium to execute automation test cases.

Experience in leading automation team and experience in building automation scripts.

Knowledge in testing EDI 835,837 files.

Knowledge on Parameterized Queries for generating Tabular reports, Formatting report layout, Sub reports using Global Variables, Expressions, Functions, Sorting the data, Defining Data Source and subtotals for the reports using SSRS 2008/2005

Knowledge in developing Drill through and Drill down reports using Crystal Reports and MS SQL Server Reporting Services (SSRS)

Good experience in Pega rules process commander (PRPC).

Possesses working knowledge of RDBMS, in Oracle, SQL Server, Sybase and DB2.

Good knowledge of Data Warehousing methodologies and concepts, including star schemas, snowflakes, ETL processes, dimensional modeling and reporting tools.

Experience in writing SQL, PL/SQL, and T-SQL Statements.

Good knowledge of ETL tool Microsoft SQL server integration services.

Quick learner and good performer both in team and independent job environments.

TECHNICAL SKILLS

Operating Systems:

MS-DOS, UNIX, Windows 9x/NT/2000/XP/VISTA/2008/2010

Languages:

C, C++, SQL, PL/SQL, VB, UNIX Shell Scripting,

T-SQL

RDBMS

Oracle 9i/10G, MS SQL Server, DB2,Sybase

Applications

FACETS4.41/4.51/4.71/5.10,5.40,PEGA 5.1.SOAPUI,XMLSPY,Streamline,

UCDS,Ondemand,Tiger,CTP,CareRadius,Goodlife,Cafewell,Contentmanager,

Testing Tools:

Mercury Tools ( ALM, Quality Center9.0/10.0, Test Director), Rational Suite,Requisite Pro, Quality Manager, Clear Quest, Clear Case

EDUCATION

Bachelors in Technology

Jawaharlal Nehru Technological University, India

Master of Science

Stratford University, Virginia

PROFESSIONAL EXPERIENCE

Employer: Virtusa Corporation INC, Westborough, MA

Client: Northern Trust, Chicago, IL April-2018-Current

Role: UAT Lead/Coordinator, QA

Projects: Global Fee Billing (GFB)

Northern Trust (NT) is executing a Global Fee Billing (GFB) implementation of Oracle Revenue Management and Billing (ORMB). ORMB will be utilized by the fee team in order to complete fee set up.

Due to unavailability of an upstream contract management system, a custom Fee Setup Portal will need to be created within ORMB to manually input information into the system. Fee Setup Portal will be designed in ORMB to drive towards consistency and standardization in client and fee set up. There will be one fee portal globally, with slight variations to support various regions / business units.

Responsibilities:

Lead team of QA professionals engaged in design or test plans, scenarios, scripts, or procedures for GFB project being performed in a distributed environment

Conducted daily requirement review meetings with the UAT work stream leads and different stakeholders to understand the current state and future state of the GFB system.

Reviewed Functional and technical design documents to understand the future state of the system.

Designed and developed detailed UAT test plan, reviewed with all stakeholders and project team.

Performed Gap analysis on current system and documented recommended approach. Worked as part of a team to analyze validity of process flows for future enhancements and documented test scenarios.

Worked with different source systems to gather the data requirements required for the global fee billing application.

Identified all UAT test scenarios with the help of work stream leads and drafted test cases based on Technical specifications and Functional design docs

Participated in design reviews with UAT team for the feature work.

Worked with configuration and Business users to design matrix for GFB ORMB User and Security Access.

Developed SQL scripts for Oracle databases

Drafted test cases for GFB ORMB User and Security Access testing.

Requested access for the applications to UAT users using IDM request portal.

Conducted training sessions for all the UAT testers on GFB application.

Leading the automation team to develop automation scripts using selenium.

Involved in process of automating regression test suite for GFB project releases.

Trained UAT testers on ALM application for executing test cases and logging defects.

Performed smoke test on the GFB application once the code is deployed to UAT environment to make sure application is working fine.

Scheduled the batch jobs in GFB ORMB application for sourcing the data from upstream systems.

Scheduled batch jobs in GFB ORMB application to generate draft invoice and invoices loading to passport application

Worked on preparing regression test suites for automating test cases for future testing.

Developed SQL queries to pull the test data for UAT users and reviewed test results.

Requested access for all the users that are involved in UAT testing.

Helped UAT testers while performing UAT testing when there is road block in navigating the GFB screens.

Uploaded all the requirements and test cases in HP ALM tool.

Mapped Requirement with Test cases and also linked defects with Test cases.

Logging & re-testing defects and assigning them to the developers/responsible persons and participating in the defects management lifecycle.

Involved in Daily Standup meetings, Defect triage and review meetings.

Environment: ALM, ORMB, Oracle 10g, GFB, MS Office, Microsoft Outlook 2010, Jira, Java,Selenium.

Employer: Virtusa Corporation INC, Westborough,MA

Client: Health Now BCBS, Buffalo, NY OCT 2016-April-2018

Role: Lead Consultant, QA

Projects: Wellness, Care Radius Upgrade, Facets upgrades

HealthNow New York Inc. (BCBSWNY) is a health insurance company operating in Western New York offering in Individual and group medical, dental, vision and life insurance, Medicare and other government programs and pharmacy benefit management. I was involved in Projects: Wellness, Care Radius upgrade, Facets Upgrade, Eye Med Vision Claim and Care Affiliate.

The Wellness Project includes the replacement of the Preventure Wellness capabilities and replaces with a new vendor (Welltok). It is currently being used for Health Assessments for Good Life and other wellness initiatives

Care Radius upgrade strengthens the system from a business process improvement and regulatory compliance perspective. Business stakeholders have recommended we upgrade Care Radius to stay competitive in the marketplace. This is the first significant upgrade offered since Care Radius went live. HealthNow worked closely with EXL Service (Vendor) to develop portions of the upgrade.

Responsibilities:

Led a team of six Testers.

Prepared detailed Master Test strategy and created Test Plan based on BRD and Use Cases.

Conducted Review meetings for Requirement Analysis and Gap Analysis.

Conducted weekly Status meetings with Test team. Developers and Business Users.

Drafted test cases based on Technical specifications and Functional design docs

Performed testing on Eligibility File (including all Member types – HNAS, HN and non-Member)

Created Test cases And performed testing for SSO – logging in through HNAS, HN WNY and HN NENY sites and SSOing to Cafewell)

Performed HA testing in Cafewell website for all Member types, including Good Life Members

Verified Biometric Data to Cafewell– including Hooper Holmes (HH) and Patient Verification Forms (PVF)

Tested Care Management data sent from Welltok to Care Radius non-Good Life CME

Created Conceptual, Logical and Physical Data Models.

Created Data Mapping between the source and target systems including the business/Transformation rules

Developed SQL queries to setup test data and review test results.

Drafted test cases to meet acceptance criteria in user story.

Created test members in Facets for test scenarios.

Created CM/DM cases in Care radius and tested those cases updated in facets after the CIS schedule job run

Verified Preauthorization’s and Referrals that are created in Care radius are moved to UM application in Facets

Verified Claims are matching with Referrals and Preauthorization’s that are moved to Facets from Care Radius

Automation was tested by submitting CIS-72 jobs to trigger each function

Performed regression testing for UM

Performed regression testing on CM/DM.

Performed Testing for Care Affiliate application.

Validated the YTD and MTD amounts for the EyeMed Vision Claim project.

Used Beyond compare tool for comparing the data between two files.

Created Inpatient, Outpatient and Professional claims.

Drafted and Executed test cases and test scripts in Quality Center.

Mapped Requirement with Test cases and also linked defects with Test cases.

Logging & re-testing defects and assigning them to the developers/responsible persons and participating in the defects management lifecycle.

Involved in Daily scrum meetings, sprint planning and review meetings

Environment: ALM, Facets 4.71/5.10, PEGA, Oracle 10g, Sybase, UCDS, Ondemand,SOAPUI, XMLSPY, MS Office, Microsoft Outlook 2010,Tiger,Streamline,Pega,ContentManger.

Employer: Health Now BCBS, Buffalo, NY

Client: Health Now BCBS, Buffalo, NY Feb 2016-OCT 2016

Role: QA Analyst II

Projects: Care management Replacement, Facets upgrade

HealthNow New York Inc. (BCBSWNY) is a health insurance company operating in Western New York offering in Individual and group medical, dental, vision and life insurance, Medicare and other government programs and pharmacy benefit management. I was involved in project Care management Replacement

Responsibilities:

Created benchmarks in Tiger to get the claims into Facets.

Compared Payment details on 835 X12 with Payment details on Pay span.

Developed SQL queries to setup test data and review test results.

Drafted test cases based on Technical specifications and Functional design docs

Drafted test cases to meet acceptance criteria in user story

Created CM/DM cases in Care radius and tested those cases updated in facets after the CIS schedule job run

Verified Preauthorization’s and Referrals that are created in Care radius are moved to Facets

Verified Claims are matching with Referrals and Preauthorization’s that are moved to Facets from Care Radius

Automation was tested by submitting CIS-72 jobs to trigger each function

Performed regression testing for Facets 5.0 upgrade

Performed regression testing on UM for facets R8

Created Inpatient, Outpatient and Professional claims.

Drafted and Executed test cases and test scripts in Quality Center.

Mapped Requirement with Test cases and also linked defects with Test cases.

Logging & re-testing defects and assigning them to the developers/responsible persons and participating in the defects management lifecycle.

Involved in Daily scrum meetings, sprint planning and review meetings

Environment: Quality Center 10.0, Facets 4.71/5.10, PEGA, Oracle 10g, Sybase, UCDS, Ondemand,SOAPUI, XMLSPY, MS Office,Tiger,Streamline,Pega,Content Manger.

Employer: Scepter Technologies

Client : Health Now BCBS, Buffalo, NY June 2012 –Feb 2016

Role : Sr QA Analyst

Projects: 1) Project Transform 2) Kaleida Joint Venture 3) Facets 5.0 upgrade 4) Wellness 5) Good life 6) Facets R8 7) EOB redesign

HealthNow New York Inc. (BCBSWNY) is a health insurance company operating in Western New York offering in Individual and group medical, dental, vision and life insurance, Medicare and other government programs and pharmacy benefit management. I was involved in seven projects of BCBSWNY. 1) Project Transform 2) Kaleida Joint Venture 3) Facets 5.0 upgrade 4) Wellness 5) Good life 6) Facets R8 7) EOB redesign 8) OOP Max

Responsibilities:

Validated claims are pricing according to Benefit matrix created for new Kaleida products

Created claims in Tiger (in-house claims system) according to the Requirement and verified the claims are going to the New Customer care Pega work baskets created for Kaleida.

Created benchmarks in Tiger to get the claims into Facets.

Compared Payment details on 835 X12 with Payment details on Pay span.

Developed SQL queries to setup test data and review test results.

Drafted test cases based on Technical specifications and Functional design docs

Drafted test cases to meet acceptance criteria in user story

Submitted Eligible HRA claims through the Preventure database will process through the reimbursement database into Facets 4.71

Validated the process of entering an HRA in Preventure to ensure only eligible HRAs are processed into the reimbursement database.

Validated the process of an HRA/PCP/GYM claim passing from the reimbursement database to Facets 4.71

Validated EOB’s in OnDemand that were created when a subscriber and/or spouse/domestic partner is eligible for the HRA/PCP/GYM benefit

Validated the UCDS issues a check to the subscriber when a subscriber and / or spouse/domestic partner is eligible for the HRA/PCP/GYM benefit.

Tested Ineligible products were to ensure a subscriber and/or spouse/domestic partner will not receive the wellness HRA/GYM/PCP benefit.

Verified database properties and updates as changes were made to HealthNow, College, and ‘Other’ Groups that participate in The Good Life for Groups that require Spouses and those which do not.

Validated Compliance Tracking, Eligibility List, Compliance Tracking Abbreviated, HRA Survey vs Imported, PVF HH Bio Entries, Plan Change, Pilot Metrics / Scorecard Internal, and Task Balance

Validated Biometrics in two ways - manipulating the Hooper Holmes file and clicking Load Biometrics in the Admin UI or manually through PVF entry in the Admin UI.

Validated deductible and out of pocket accumulation for OOP government mandate.

Performed regression testing for Facets 5.0 upgrade

Performed regression testing on UM for facets R8

Created Inpatient, Outpatient and Professional claims.

Drafted and Executed test cases and test scripts in Quality Center.

Mapped Requirement with Test cases and also linked defects with Test cases.

Logging & re-testing defects and assigning them to the developers/responsible persons and participating in the defects management lifecycle.

Involved in Daily scrum meetings, sprint planning and review meetings

Environment: Quality Center 10.0, Facets 4.71/5.10, PEGA, Oracle 10g, Sybase, UCDS, Ondemand,SOAPUI, XMLSPY, MS Office,Tiger,Streamline,Pega,Content Manger.

Employer: Scepter Technologies

Client : Excellus BCBS, Rochester, NY Nov 2011 –May 2012

Role : Sr QA Analyst

Project: Testing iFacets 4.71 Application.

The project is to test iFacets 4.71 Hospital Claim Processing+ITS, Medical Claim Processing+ITS and Provider Modules. Validating Netowx pricing between TOPPS system (Legacy system) and iFacets (New system)

Responsibilities:

Analyzed, developed, configured, and implemented the business requirements and system functionality to support the accurate administration of the requirements.

Gathered and documented requirements related to CHP,FHP,Medicare and Commercial claims for iFacets 4.71

Responsible for testing Hospital and Medical claims and related pricing calculations for different regions such as WNY (Western New York) and CNY (Central New York).

Creating new groups and new members for testing iFacets4.71.

Drafted and executed test cases for CHP Claims, FHP Claims, Medicare claims and Commercial Claims for iFacets 4.71.

Validated the pricing of the claims by using Hospital Agreements and also using Medical Agreement Configurator application in iFacets

Performed Gap analysis on current system and documented recommended approach. Worked as part of a team to analyze validity of process flows for future enhancements and documented test scenarios.

Managed the configuration activities, including the identification and resolution of configuration for iFacets 4.7 issues.

Used RQM(Rational Quality Manager) Test Management tool for Test Planning, Test design, Test execution

Performed Bugs reporting, reviewing and Defect Tracking using IBM Rational Clear Quest

Environment: RQM, IBM Rational Clear Quest, iFacets 4.71, TOPPS, Sql server2008, Sybase, Lotus notes 8.5.

Employer: Scepter Technologies

Client: AEGIS Insurance Services, INC, East Rutherford, New Jersey May 2011- Oct 2011

Role: Sr QA Analyst

Project: Downstream policy writing System

The project is to Test Downstream policy writing System which is implemented in Pega. This application is used to create quotes and polices for insurance plans.

Responsibilities:

Designed and developed of test plans. Tested the Underwriter scenarios in the Next Gen Policy writing system

Performed Daily Requirement review meeting with the UAT Team and Underwriting Team

Performed User Acceptance Testing from the end user perspective

Design reviews with UAT team for the feature work.

Created the design document for the NextGen Downstream Applications(Deliverable 4.1)

Worked on NextGen Downstream Applications,Creating test plans for Deliverable 4.1(Excess product)

Worked with the Testers for documenting the test plans.

Created different types of policies and added Coverage’s, Limits, Sub Limits, deductibles against the created policies.

Created user groups and setup the privileges for those groups, Exported and import the project file from different server and created customized report using Quality Center

Tested the application built on PEGA extensively

Created SQL and nested/conditional logic for test Data

Preparation of Test Plan, Traceability Matrix, Test Status Report, Test Execution Report, Weekly Summary Report and setting up Test Data.

Used Quality Center for storing the script and executing it.

Environment : PEGA 5.1, SQL server 2000, MS OFFICE, NextGen Downstream Application, Test Director, Toad.

Employer: Scepter Technologies

Client : Health Now BCBS, Buffalo, NY Oct 2010 –Apr 2011

Role: QA Analyst

Project: Facets upgrade from 4.41 to 4.71

The project was to upgrade the FACETS system from version 4.41 to 4.71 by April 2011. This project was supporting other BCBS initiatives HIPAA 5010 compliance and QA test organization process improvements. We worked on the tight schedule to upgrade FACETS to meet the other dependencies listed below.

Responsibilities:

Supporting the FACETS 4.71 upgrade through analyzing the new version functionality.

I was responsible for testing the: FACETS Applications: 1) NetworX pricing 2) Claims Processing 3) Utilization Management 4) Subscriber/Member 5)Provider

Breaking down the requirements to user & technical requirements for creating test cases/use cases.

Reviewing the test cases with business users and business analysts.

Creating, consolidating and executing SIT Test Cases and UAT test Cases using MS Excel or Quality Center

Worked on Inpatient, Out Patient and Professional Claims.

Used FACETS Workflow to route the claims according to the priority.

Created test cases for ICD translation and executed them.

Logging defects and participating in the defects management lifecycle.

Executing both Functional and Regression test cases for Provider, Group, Subscriber/Family and Member

Worked on test data creation through upstream processing – created claims in TIGER (in-house claims system).

Developed SQL queries on Sybase to setup test data and review test results.

Performed Backend Testing using SQL dbx (SQL Queries).

Worked on NetworX Pricing for Price validation between Qual and Prod environments in Facets 4.71.

Preparing sample Test Data and executing Test cases using Quality center.

Logging & re-testing defects and assigning them to the developers/responsible persons.

Prepared sample test data for UAT by SQL Queries.

Assisting end users during User Acceptance testing.

Conducting and participating Peer review meetings, Weekly project and Test Team meetings

Environment: Quality Center 10.0, Facets 4.41/4.71, PEGA, Oracle 10g, Sybase, Lotus notes 8.5, MS Office.

Employer: Pioneer Corporate Services INC

Client: McKesson, Pittsburg, PA Oct 2009- Aug 2010

Role: Jr Programmer

Project: Common Reporting Service and Test Harness

McKesson provides Pharmacy & Nursing Automation Solutions, services and products to health care providers from pharmaceuticals and supplies to sophisticated medical workflow solutions which help customers reduce costs, streamline processes and, most importantly, improve patient care and medication safety. Common Reporting Service is a system which interacts with the crystal reports to get the pharmacy, nursing and health care product based reports in the pharmacy automation and software. Test Harness installs the crystal report in intranet windows platform and uses web-services to make it internet.

Responsibilities:

Experienced in developing T-SQL (DDL, DML) statements using dynamically generated SQL.

Designed an OLAP with the help of ERWIN to visualize data structure.

Extracted and reviewed data from heterogeneous sources from OLTP to OLAP using SQL Server Integration Services (SSIS) 2005.

Created SQL server Analysis Projects and created OLAP cubes and dimensions for the analysis of sales in specific areas using SSAS.

Improved query performance and reduced down by cube partitioning.

Reviewed and changed the cubes in the data marts for product valuation based on the revenue opportunities using SSAS 2005.

Generated reports using SSRS 2005 as per business requirements.

Developed measures and dimension members using multi-dimensional expression (MDX) to meet additional needs that were calculated from existing measures.

Developed MDX expressions for cube calculations and KPIs.

Implemented the calculations to aggregate physical measures using management studio.

Identified and defined the scoped assignments using script commands.

Defined Referenced relationships with the measure groups and fact tables.

Managed and monitored the system utilization by using the query optimizer and checking the execution plan.

Extensively used Profiler to identify and repair database lockups, deadlocks, and other issues.

Established a sound backup and recovery policies and procedures.

Environment: MS SQL Server 2000-2005 Enterprise Edition, MS SSAS 2005, MS SSRS 2005, MS SSIS 2005, DTS, T-SQL, VB Script, Windows Server 2000,2003, Erwin 4.0



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