Business analyst
Resume:
Rajeev Rathore
*********************@*****.***
******@*********.***
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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