Rajeev Rathore

adaui4@r.postjobfree.com

adaui4@r.postjobfree.com

860-***-****

Looking only for C2C position

Summary

Strategic, results oriented and innovative IT Product Owner (Certified Professional Product Owner PPO I), Scrum Master (Certified Professional Scrum Master PSM I), Business Analyst/Business Systems Analyst, having 8+ years of experience with unique blend of business and technical skills to lead infrastructure and software initiatives for business growth and development. Lead cross-functional project teams and established a close-working relationship with stakeholders, business partners, and technical staff, ensuring alignment between solutions being delivered and business goals. Leverage analytical, problem-solving, leadership, and interpersonal skills to deliver IT projects that support enterprise-wide technology change, new product development, cost reductions, security/ regulatory compliance, and customer satisfaction.

Key Proficiencies

Over 8+ years of experience as IT Product Owner, Scrum Master, Business Analyst and Business Systems Analyst in Healthcare and Property and Casualty insurance

Strong understanding of Business Requirement Elicitation, Gathering, Analysis and Documentation

Thorough experience in conducting Joint Application Development (JAD) sessions with clients and cross functional teams

In-depth work experience in Software Development Life Cycle (SDLC) using Waterfall and Agile Scrum methodology

Strong knowledge of STLC (Software Test Life Cycle), Test Strategy and Defect Life Cycle

Thorough experience in eliciting business needs and converting them into system specifications

Through involvement and participation in all phases to develop Requirements Management Plan, Vision, Software Requirements Specification (SRS) and Business Glossary documents

Strong knowledge and experience in conducting system analysis, business and system process design, diagramming data and process mapping, applying Unified Modeling Language (UML)

Performed test planning, prepare test plans and traceability matrix, perform user acceptance testing of work products and document them

Proficient in the documentation of system and business requirements and specifications, design and development of use-case scenarios

Expertise in Sprint planning using story points and reviewing burndown chart to see the progress of the scrum team

Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse. Excellent knowledge of Data Warehouse concepts and worked on data migration projects

In-depth knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI) and ICD-9 to ICD-10, HCPCS coding

Worked with (ACS) X12 5010 and (ASC) X12 4010A including the various Claims Transactions such as: 837 (submit medical claims), 835 (medical claim payments), 270 (benefit/eligibility inquiry), 271 (benefit/eligibility response), 276 (claim status request), 277 (claim status notification),278 (Authorizations and Referrals) and 834 (enrolment)

Extensive knowledge on the various health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO (Preferred provider organization), HMO (Health maintenance organization), and POS (Point of Service).

Expertise in performing and understanding of the all the Manual Testing Methodologies

Hands-on experience in assisting QA teams in Smoke Testing, Sanity Testing, Functional/System Testing, Regression Testing, Positive/negative Testing and User Acceptance Testing (UAT)

Helped QA team in creating Test Strategy, Test Plan, Test Scenarios and Test Cases from Functional Requirement Specifications

Experience in writing SQL Queries for Data Mapping, Data Integrity and Data Validations

Hands on experience on writing SQL codes on RDBMS-SQL Server, Oracle and DB2

Provided support to UAT team to ensure timely deliveries

Excellent working knowledge in Project Life Cycle and clear understanding of Project Management

Excellent business communication and presentation skills. Adapt at creating, editing, and coordinating extensive communication networks to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts

Team player, energetic, result-oriented, fast learner, excellent communication skills with strong research capabilities

Technical Skills

Software Languages

JAVA, Python

Operating Systems

Linux, Windows XP/7/8/10, MacOS

Management Tools

Rational Requisite Pro, JIRA, HP ALM

Internet Technologies

XML, HTML5, CSS3, JavaScript

Project Methodologies

Waterfall, RUP, Agile Scrum

Design Tools

Microsoft Visio, Rational Rose

Databases and DB Languages

Oracle, SQL Server

Data Analysis Tools

SQL, R, Tableau, SAS

Others

MS Office, MS Excel, MS Access, SharePoint, MS PowerPoint, MS Project

Work Experience

Commonwealth Care Alliance (CCA) Healthcare, Boston, MA Sep 2018 – Present IT Product Owner/Business Analyst-Claims

Project-1:

The project was to configure and activate all inactive Authorization Rules as per the Benefit Rules Matrix of the company for Claims Processing in health claims engine and recover the the estimated revenue loss of $85 million annually.

Project-2:

The project was to develop a web-based application named Revenue Reconciliation 2.0 for reconciliation of revenue between capitation amount company receives per member from the State of Massachusetts and the company spends on each member in healthcare.

Responsibilities

Acted as a primary communicator and link between stakeholders and cross functional teams to make sure there’s buy-in from stakeholders on all major decisions and strategy and clear instructions and deliverables for the developers

Acted as the leader responsible for maximizing the value of the product created by a scrum development team and acted as a business strategist, product designer, market analyst and project manager

Developed vision and strategies for the product and presented this to stakeholders and helped development team to meet their goals during the sprint.

Did understand and anticipated the client’s needs to more effectively manage the development process

With the vision, strategy, and product priorities set, spent a significant amount of time overseeing the actual development of the product. Played active role throughout each event, including planning, refinement, review, and sprint.

During the planning stages, worked with stakeholders to identify and organize the steps required for the next iteration, and then worked on refining the processes, identified areas for improvement and supported the sprint

Owned and managed the product backlog. Created the list of backlog items and prioritized them based on the overall strategy and business objectives. Mapped out project dependencies to inform the necessary sequence of development

Because the product backlog was changing frequently, so made the list accessible and available to all stakeholders (particularly developers) to ensure optimized performance and project outcomes

Prioritized needs, juggled the triangle of scope, budget, and time, and prioritized according to the needs and objectives of stakeholders

Worked with stakeholders to identify and organize the steps required for the next iteration and then conducted meetings with team to refine the process, identified areas for improvement, and supported the sprint

Was accountable for each stage of the development process and the final product. Played primary role in inspecting and evaluating product progress through each iteration. Made the judgment calls on the performance, deciding if the team needs to go back to the drawing board or if they can move on to the next steps

Used various tools during the project-MS Visio, MS Project, MS Excel Jira, SQL, HP ALM, Balsamiq during the project

Anthem Healthcare, Norfolk, VA Feb 2017 – Aug 2018 Business Analyst/Scrum Master

Worked on Member Liability Estimate (MLE) project and Real-Time Claim Adjudication (EDI 837). Project was to build a provider facing capability to allow the providers to look up cost share information (Member Liability Estimate (MLE)) for the service to be rendered to an Anthem member, based on the coverage a member has with Anthem. In order to generate the cost share information, we are “pseudo” adjudicating a claim in real-time using the information supplied by the provider across all claims systems and later on leveraging same to do real time claim adjudication.

Responsibilities

Worked with Scrum Master in helping team to transition from Waterfall to Agile Methodology

Led daily stand-up meetings in the absence of scrum master

Worked with Product owners on prioritizing Product Backlog, creating Sprint Backlog and managed User stories

Participated in sprint planning, daily scrums, testing, retrospectives and sprint reviews.

Worked with outside organizations and business partners to coordinate cross-team dependencies to meet project objectives

Captured and Traced Project requirements using JIRA

Created Business requirement document (BRD) and Technical requirement document (TRD) as it relates to receiving data, data quality and data profiling

Defined the scope of the project, wrote user stories, designed documents and business requirements in support of requirements

Guided the development teams to break down large and complex user stories into simplified versions for execution

Entered and updated Issues (Epics, Stories, and Tasks) onto JIRA Agile application

Identified and worked with Scrum Master to remove obstacles that will keep the team from achieving their goal

Served as a liaison between Clients and Technical Staff to resolve any conflicts

Wrote SQL queries on SQL Server data base to evaluate inbound data

Created SQL queries to pull data for testing and data validation for presenting it to downstream and upstream users

Analyzed Production Claims Issues and Claims Impact Ability to document current Configuration Build

Provided data analysis of data as requested by the business prior to Audit

Reviewed data to ensure data integrity, accuracy and validity

Performed ad hoc reporting functions for special needs and requests

Reporting and dashboarding analytical results to client through Tableau

Humana Healthcare, Louisville, KY Oct 2015 - Jan 2017 Business Analyst

The project was to develop a Mobile Application for providing healthcare analytics and have a seamless interaction between patients and Healthcare Sales Reps/BDRs. The application was also useful for sending renewal reminders, emails, blog on healthcare tips and generating excitements among customers for achieving rewards programs for maintaining wellness.

Responsibilities

Defined the scope of the project, gathered business requirements and documented them

Utilized Agile Scrum methodology to configure and develop process, standards and procedures

Interacted with the product owner to understand the core purpose of the project and groomed the product backlog along with Product Owner and prioritized user stories for sprints

Developed roadmaps by transforming stakeholders’ input (user stories) into a high-level project proposal in the initial planning stage

Identified high-level business requirements, functional and non-functional requirements to accomplish the user stories provided by the product owner

Participated in providing high level solutions and design development of the new updated system. Wrote and promoted the vision for the system

Involved in detailing project mission, Data process Flow Diagrams and timelines

Created wireframes for the enhancements made to the application for the development team

Maintained the change notification request document and communicated with the developers in each iteration review meetings

Assisted the Project Manager to develop both high-level and detailed application architecture to meet user requests and business needs

Formed a bridge between the Product Owner, Scrum Master and different teams with effective presentations and communication

Created User Stories and Use Cases to help IT and QA team to get a better understanding of the application

Prepared Business Workflow models that covers "How" business processes will be accomplished

Prepared Workflow diagrams, analyzed AS IS and TO BE scenarios, designed new process flows and documented the business process and various business scenarios

Conducted Impact analysis of changing requirements and negotiated with users based on the analysis results

Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance testing

Ensured the quality assurance, client documentation and user acceptance testing were successfully accomplished and approved of

Played an active role in training users and providing support on any issues by providing user manuals, training guides etc.

Wrote SQL queries on SQL Server RDBMS for data mapping required for developers to write codes

Evolent Health, Chicago, IL Feb 2014 - Sep 2015 Business Systems Analyst

The project was to upgrade the existing claims processing system which will automatically recognize, and process medical claim forms submitted online as well as by paper. The system primarily aimed at handling Medicare / Medicaid insurance claims and process exceptions. The claims data was validated with a Data warehouse which had all the member benefit information stored. I worked in the Agile Scrum Framework for the project.

Responsibilities

Involved in interviewing business users, SMEs, end users and gathering requirements, reviewing and then documenting them in a standard template

Served as liaison between the Business, Data Modelers and the ETL team to ensure that the data warehouse was implemented according to the business needs. Interacted with the Business Intelligence team to understand the designing of the new data warehouse

Created the Business Requirement Document and then wrote the Functional specifications based on the high-level requirements which were documented into the Functional Requirement Document

Delivered business and technical solutions on time by collaborating with the business and prototyping teams

Assisted the Solutions Architect with the development of logical designs of the solution

Developed close working relationship with Product Management organization to understand product roadmaps, strategies, and goals with the intent of aligning customer-specific architectures with Information product strategies

Solved business and technical issues by developing prototypes and ad-hoc technical solution

Assisted the project manager to develop both high-level and detailed application architecture to meet user requests and business needs

Conducted session meetings with the BA team and SMEs for extracting the exact business needs about the new data warehouse. Also conducted review meetings to make any necessary changes to the documented requirements

Used SQL to query the existing data warehouse. Required data was exported to an excel sheet which was then provided to the Business Intelligence team for their analysis purposes

Ensured Medicare claims are being coded accurately by Providers to ensure appropriate risk score are assigned to members

Developed the user flow diagrams for business process of the company using Microsoft Visio manipulated and extracted data and Business objects used for reporting

Used JIRA for issue management, sprint optimization, resource management, capacity planning, generating analytical and progress reports like Burndown Charts

Grange Insurance, Columbus, OH Aug 2012 – Jan 2014

Business Analyst/Business Systems Analyst

The System implemented Guidewire Claims Center, Policy Center and Billing Center which exclusively serves the P&C insurance on which insurance carriers run their business. The project was to replace the Claims Legacy system by Guidewire Center application to increase operational efficiency and reduce claims costs.

Responsibilities

Worked as Business Analyst for the project to gather and document verification requirements for Policy, claim center and billing center

Researched and Analyzed Business needs and ways to improve property and casualty specifically policy contracts and processes administration

Gathered requirements for the Guidewire Worker's Compensation, Personal Auto and Commercial property in Claims Center

Collaborated with the business team in the creation and completion of project charters and project scope for Guidewire Policy Center and Claim Center

Captured business requirements in form of user stories using JAD sessions, brain storming sessions, focus groups and personal interviews to understand current policy administration system and ensured coverage on business values, story points and acceptance criteria

Identified gaps in existing Policy Administrating Systems and Guidewire Policy Center and diligently designed “As-is” and “To-be” process, in scope and out of scope documents

Did Troubleshoot overlap and data quality issues by looking through the office of existing policy administration's data lineage, systems, and triggers for signs of bugs and malfunction

Involved in project to configure claims system to incorporate worker's comp claims data from various legacy systems as the responsibility for the administration of the state's Worker's Compensation Security Fund was transferred to the organization

Performed data integration and data mapping and data extraction management along with data cleansing while migrating data from legacy system to Guidewire Policy Center with Guidewire Data Hub

Elicited, documented, modeled, validated and prioritized functional and non-functional requirements using interviews & data analysis for insurance policy lifecycle i.e. right from policy creation to policy renewal

Helped the product owner in creating product backlogs and Sprint Backlogs

Collaborated with the Scrum Master and Scrum teams in Estimation and Velocity planning. Also, participated in conducting Sprint Planning, Daily Stand Up, and Sprint Review & Retrospective meeting

Managed sprints i.e. burn down charts, project velocity, sprint backlogs and product backlogs using JIRA

Created detailed diagrams such as Use Case Diagrams, Data Flow Diagrams (DFD's), Activity Diagrams, Sequence Diagrams, Entity Relationship (ER) Diagrams and Workflow Diagrams for integrating Policy Center and Claim Center data

Set up definitions and process for scoping, document test cases, test phases included integration testing, end to end testing and user acceptance test (UAT) and documenting the results for policy underwriting rules, rewriting rules, policy rate making and pricing

Analyzed and ensured efficient transition of all technical design documents and developed various SQL packages to provided support to application developers

Extensively involved with the ETL team for ETL process and worked in the SSIS environment

Work Experience-India

Sternhagen Germany (Acrysil Ltd.) Delhi, India Jan 2011 – Jun 2012

Business Systems Analyst

Responsibilities

Worked with the business community to define business requirements and analyzed the possible technical solutions

Co-authored business requirements document (BRD) with project teams. Extracted, discussed, and refined business requirements from business users and team members

Conducted workflow, process diagram and gap analysis to derive requirements for existing systems enhancements

Collaborated with the QA team to ensure adequate testing of software both before and after completion, maintained quality procedures, and ensured appropriate documentation is in place

Helped the testing team documenting the system requirements and testing system development

Designed and implemented basic SQL queries for QA testing and report data validation

Education

MBA & MS in Business Intelligence Analytics & Systems

MBA in International Business

Certification in Professional Scrum Master (PSM I)

Certification in Professional Product Owner (PPO I)

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