**A Mara Road, Lake Hiawatha

New Jersey – *****, USA

Email: adtmw5@r.postjobfree.com

Mobile: +1-908-***-****

https://www.linkedin.com/in/shaikafrozkalapahad

Shaik Afroz Kalapahad

EXPERIENCE SUMMARY:

Over 15 Years of Diverse Experience in Business Analysis, Requirement Analysis, Design, Estimation, Strategy development and Quality Assurance with Healthcare, Integrated Eligibility and Child Welfare System

Strong industry experience of more than 11 Years of working primarily with U.S. health care (Payers, Providers, State Govt, RCM and PBM)

3 Years extensive experience in Implementation of a broad-based integrated eligibility (IE) solution for the State of West Virginia including Healthcare, Human Services domain specifically family assistance programs, Child Welfare (CW), and Child Support enforcement (CS)

Extensive experience in different platforms- Web, Mobile, Salesforce, Facets and Mainframe.

Extensive experience in Agile and Continuous integration tools using GIT, Jenkins, and Dockers.

Experience working in teams following Agile development methodologies (Iterative, Scrums, SAFe, Kanban).

Experience in developing end to end automation using Selenium Webdriver/ IDE/Grid, Cucumber and Sauce Labs.

Experience in creation and development of Automation framework using Selenium and Java and hands-on on ATDD/BDD, Keyword Driven Frameworks.

Expertise in understanding Software Requirement Specification and writing Feature Files as per User Stories.

Possess Good Knowledge with different types of Functional Testing (System Testing, Regression Testing, Smoke Testing, End to End Testing, UAT, PAT, Integration and Business Partner Testing)

Possess good knowledge with different specialized testing (Usability Testing, API Testing, Accessibility Testing, Security Testing and Cross browser, Mobile Web, Database Testing using SQL Queries.

Proficient in analyzing and translating business requirements to technical and functional requirements

Well acquainted with different Healthcare domains (Claims, Medicaid, Provider, Commercial, Exchanges, Care Coordination, PBM).

Expertise in pricing flows of various claims like Participant and Non-Participant Physician and Facility, Ambulance, Medical, Shared Savings Program, Home Health Care.

SME in Claims Adjudication and Healthcare Electronic Data Interchange formats like 837P, 837I and 835

Experience in leading and managing teams. Handled multiple roles- Test Lead, Quality Architect, QA

Experience in QA Framework Architecture and QA Optimization techniques

Good understanding of Quality Management System.

Expertise in designing and executing test cases based on Business requirements and Functional Specifications Documents.

Expertise with ALM and RALLY Test Management Tool and Jira

Good Experience in planning and implementation of deployment activities

Extensive knowledge on UHG’s proprietary applications and tools.

Certified Scrum Maser [CSM], AHM250, Health Insurance Exchange

SKILLS:

CMMI level 5 Process standards

Waterfall & Agile process model

Test Automation Frameworks – BDD (Cucumber), TestNG.

Test Estimations

Shift Kanban, Rally

Web Services, API testing, REST services

Salesforce Admin, Salesforce Testing

HP ALM/QC, Selenium

Oracle, SQL, C, Java

Jenkins, Maven, GitHub

HTML, Java Script

SOA, ETL testing, SOAPUI, Rest Assured API Automation, Postman

Medicaid & Medicare, ACA, HIPPA

Oracle 9i, DB2, SQL, MySQL and MS Access

PROFESSIONAL EXPERIENCE:

Employer : United Health Group (Optum)

Title : IT Quality Consultant

Period of employment: 09-April-2007 – Till Date

Project Information:

Project :1 : Statewide Automated Child Welfare Information Systems (SACWIS)

Application : People’s Access to Help (PATH)

Client : West Virginia Department of Health and Human Resources (DHHR)

Duration : April 2020 – Till Date

Location : Basking Ridge, New Jersey - USA

Roles : IT Quality Consultant

The State of West Virginia Department of Health and Human Resources (WV-DHHR) has taken a pivotal forward- looking step to transform its legacy systems to a new and modern PATH (People’s Access to Help), to provide automated technology solutions to state and local child welfare agencies that support service delivery and practice for the safety, permanency and well-being of children and families.

Understanding the requirements and gathering the Test data, analyzing the impact on each of the modules.

Participate in walk-through, inspection, review, and user group meetings for quality assurance.

Conduct in-depth reviews of Business and Functional requirements along with Technical Specifications for gap analysis and access document quality

Responsible for QA delivery of the application at all the testing phases (Smoke, System, System integration, Regression, UAT data support, Conversion, E2E Etc.)

Participate in User Stories Review/Requirement Analysis/Scrum meetings and walkthrough meetings with Stakeholder, Business teams, Dev teams and understanding existing and changing Business Requirements.

Responsible for all Management activities which includes Project planning & execution, Test estimations, quality control activities, risk management, resource management, stakeholder management, stake holder management etc.

Managing a team of 10 quality engineers including Manual, Automation at Onsite & Offshore.

Presided over daily scrum calls, defect tracking and resolution calls and reported status to the management.

Played a scrum master role and handle of team 9 members within a team.

Test SME for Child Welfare, Child Protective Services, Guardian Assistance Program, Foster care Management Payments, EBT Processes, Benefit Issuance, Payments & Child Care provider modules.

Work with Configuration team, Operation and Maintenance (O&M) team to ensure the environments are readily available for testing.

Preparing Test Scenarios & Cases for testing a requirement end to end, also mentoring QA’s for creating test scenarios and Test cases & identify the test scenarios for regression testing.

Preparation of Release level system test plan and System and Integration Testing.

Performed salesforce testing on Provider Management module which is built on salesforce.

Participate in the status/team meetings and defect triage meetings. Provide inputs and implement the process that reduces the defect leakage in production.

Preparing Test result summary report, Test planning and execution report. Will upload in ADR for approvals from required.

Involved in Automation Testing tools like Selenium and Postman creation whereas other team members are not much experienced in this area.

Execute automated smoke test cases using Selenium tool.

Update automated test cases as per the changes in the new project enhancements.

Automate the identified test cases for regression using the Selenium automation tool.

Involved in providing Knowledge Transition for the new team members.

Supporting the UAT team for the data setup required for their validation

Project: 2 : West Virginia Integrated Eligibility solutions (“WV-IES”)

Application : Public Portal for WV-IES

Client : West Virginia Department of Health and Human Resources (DHHR)

Duration : March 2019 – April 2020

Location : Basking Ridge, New Jersey - USA

Roles : IT Quality Consultant

WV-IES is a web-based self-service solution, which allows residents and community partners of State of West Virginia to apply for benefits, complete reviews of current benefits, screen benefits, and view benefit information. Public Portal enables individuals to apply and screen eligibility potential for programs such as West Virginia Children Health Insurance Program (WVCHIP), Medicaid for Pregnant Women and Children (PWC), Supplemental Nutrition Assistance Program (SNAP), Medicare Premium Assistance Programs, School Clothing Allowance (SCA), and Low-Income Energy Assistance Program (LIEAP). The Public Portal online application also allows individuals to screen eligibility potential for Temporary Assistance for Needy Families (TANF) and other Medicaid coverage groups. It also includes a Community Partner view that is designed for Community Partners who enter applications and reviews on behalf of clients.

Serve as the Single Point of Contact (SPOC) for systems interfacing with the West Virginia Project programs to resolve queries and thereafter conducting Root cause analysis to analyze reasons for multiple issues and queries.

Perform integration testing to verify that there is no breakage in the existing functionality using advanced automation tools and techniques.

Perform deployment activities and support testing and implementation efforts without compromising any business needs for successful deployment to ensure no rollback of releases and with zero bugs.

Analyze the scope of the end-to-end testing that requires to be performed over the application with new changes being implemented

Experience interacting with clients daily and understanding the client needs

Review requirement documents with management and project team to demonstrate how the existing system requirements are related to new system requirements proposed by business and analyze the impact of those changes

Conduct walkthrough sessions between Stakeholders, BA, and QA SME and interact with the BA and Business teams to work on requirement analysis and design internal application architecture and its integration with other applications

Work on Services Oriented Architecture (SOA) principles to ensure effective communication between interacting systems using his expertise on web services on REST Application Programming Interface (API).

Responsible for Cross Browser Testing with SAUCE LABS for different supporting browsers for coverage of cross browser testing, which ensures users can use all kind of browsers including Chrome, Firefox, Safari, or IE.

Analyze the scope of the end-to-end testing that requires to be performed over the application with new changes being implemented

Ensure there is no disruption with existing functionality while interacting with sub-systems by attending configuration sessions and JADs with BA and other stakeholders and retrieve information on understanding the new requirements at a granularity level

Implement quality improvement plans, test optimization techniques, and tests data process improvements, which saves times and ease validations efforts.

Perform Test execution covering functional and non-functional aspects of the requirements

Prioritize requirements, define test procedures, and prepare test strategy creation and execution of test cases, develop tracking mechanisms, defect management, and end-to-end UAT testing. Lead root cause analysis for the risks identified during project and suggest expected risks and risk mitigation strategies to proactively find a solution

Project: 3 : OptumRx Portals

Application : Rx Portals, PAS, Rx Claim, IRIS

Client : OptumRx, USA

Duration : July 2017 – March 2019

Location : Eden Prairie, Minnesota - USA

Roles : Onshore Test Lead

OptumRx is a Pharmacy Benefit Management system which administrate prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans and the Federal Employees Health Benefits program and State government employee plans. It develops and maintains the Formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufactures, and processing a paying prescriptions drug claim. It offers the best possible clinical outcomes and Meaningful service at a lower cost. It Provides consumers with cheapest medications, options to search for drugs, online ordering of drugs, provider and pharmacy search, Drug Pricing, and lower cost alternatives.

Improve the operational systems, processes, and policies in support of organizations mission -- specifically, support better management reporting, information flow and management, business process and organizational plan between Onshore and Offshore.

Responsible for End-to-end delivery of Healthcare Products

Guiding the team and organization ho how to use Agile/Scrum Practices

Responsible for running all Scrum ceremonies (Sprint Planning, grooming, Sprint review, Retrospective and Demo.

Worked closely with Product owner to prioritize product backlog.

Track and report upon testing activities, including testing results, test case coverage, required resources, defects discovered and their status, performance baselines, etc.

Promote teamwork and responsiveness of individuals in their areas of responsibility through support and coach

Hold regularly scheduled one-on-ones with team leaders & team members to address operational problems.

Monitoring & evaluating the quality of the work done by the associates, ensuring that constructive feedback is provided and guiding them to improve their performance.

Publicizing the team's progress and successes to make sure they are highly visible to product owner /stakeholders

Track and report upon testing activities, including testing results, test case coverage, required resources, defects discovered and their status, performance baselines, etc.

Reviewing and approving System/QA Test Plan, Test Cases and Test Results.

Creating Requirements Traceability Matrix / Capability Mapping Works

Provided knowledge transfer to new joiner about Project related and Selenium Automation Coordinating with stake holders.

Supported every production checkout and tested live scenarios while interacting with business

Worked on Maintaining the Automation regression test suite by adding new test cases and updating the old ones according to the change in functionality occurring release wise or sprint wise.

Monitoring and auditing of products to ensure high standards of quality.

Involved in gathering the business requirements.

Project: 4 : Polaris Program Level Testing, ICD 10, HIPAA new EOB and 835

Application : CIRRUS, NDB (Network Database), CDB (Consumer Database), TOPS (The Online Processing System), COMET and Claims Highway.

Client : United Healthcare (United Health group)

Duration : April 2014 – July 2017

Location : United Health Group (Optum ), Gurgaon/Bangalore, India

Roles : Associate Lead

Polaris-Cirrus is an integrated application, which currently supports the complete installation and administration of healthcare products for small businesses. Product Benefit Database is the traditional claim platform, which currently supports all UHG mid-size and large customer claims. UHG is undergoing claim platform changes, in which the traditional claim platform handling all mid-size and large customer claims will be migrated to Optum's Polaris-Cirrus, the most advanced technology-enabled solution for supporting benefit setup and claim testing for mid-size and large customer. The purpose of this project is to enable all activities related to benefit installation, plan and benefit setup validations, and claims testing to be performed on a single platform

Responsible for developing the strategies; analyzing and understanding the business process of reimbursement and claim adjudication systems (CIRRUS) and participate in the designing and validation of different business flows

Accountable for understanding complex business requirements and converting them to core UHG functional requirements, defining the scope of testing

Mentoring and guiding CIRRUS and Claims Highway teams.

Responsible for Development and maintaining the test scenarios for functional and End to End testing cycles.

Responsible for mentoring a project team in delivering solution to our customer with high quality and customer satisfaction.

Creating (837I and 837P X12’s) test data for System and UAT (User Acceptance Testing)

Performing Impact Analysis before the start of QA timelines

Analyzing business requirements and writing end to end business scenarios.

Validating concurrent designs and correcting errors / suggest better designs.

Part of QA execution and responsible for ensuring quality deliverables from offshore team.

Create training documents on new implementations

Planning and carrying out deployment activities.

Build/Update tools that support the new upcoming changes which would minimize the effort and increase the productivity.

SME (Subject Matter Expert) for most of the critical and complex modules in TOPS adjudication, post-adjudication and 835 and cross applications like UDW, UFE, Imaging, CDB and pre-adjudication in NDB

Point of contact for all technical and functional issues faced by CIRRUS and TOPS teams

Prioritization of Business scenarios.

Act as a liaison between business analysts, technical staff, and QA team.

Responsible for reporting daily metrics and Weekly status to onsite and offshore Management.

Effective usage of Test Management Tool: ALM

Onshore/Cross applications/Business/UAT Coordination and support

Peer review of QA for testing done by other team members

Automation support for designing new tools to support System testing.

Involved in team appraisals and escalating team concerns to higher management

Project: 5 : TOPS (The Online Processing System)

Application : TOPS (The Online Processing System), Comet

Client : United Healthcare (United Health group)

Duration : Sep 2011 – Apr 2014

Location : United Health Group (Optum ), Gurgaon, India

Roles : Senior Test Engineer

“TOPS” is the system utilized by UnitedHealth Group for the administration, processing, and payment of most healthcare claims for large business customers. The Online Processing System (TOPS) is mainframe-based processing system that allows to process health insurance claims throughout the United States. TOPS contain regions in which data is stored. It interacts with two main applications CES and NDB in which data flow from one interface to other to process a clime.

TOPS is a claim processing application which generates almost 60% of UHG revenue. TOPS is rated 2nd most complex application architecture wise.

Analyzing and understanding the Requirement Specification.

Prepare detailed flow charts and diagrams outlining system capabilities and process.

Active participation in preparation of test cases based on customer requirements.

Walk through of test plans and test strategy to Development/SA and Business teams.

Identification of regression and functional test cases for automation.

Reporting daily project status in onshore calls and escalating issues as appropriate.

Responsible for logging the defects track the status and verify them when fixed.

Coordination between teams in UHG India and UHGUS (Onshore Biz/Dev./SA and offshore Dev./SA)

Analyzing and review of QA clarifications before writing up defects and hence reducing non-Value add defects

Providing Technical support and data required to build the automation tools for QA team.

Conducting functional and technical trainings on TOPS to new joiners

Helping Quality Assurance and Development department by providing various Metrics and data for the project (Schedule, Estimation, Defect’s data).

Prepared the weekly status reports and updated the status to the program management.

Extensively used descriptive programming in Quick Test Professional (QTP) for automating the Business Process Testing (BPT)

Assisted in Release Management tasks required to promote tested functionality from one environment to another

Environment: Quality Center (version 9), Quick Test Professional (version 9.5), MS Excel, MS Word, Data Loader, Windows 7, VB scripting, Requisite Pro, Clear case, SQL., DB2

.

Project: 6 : Claims Intake Systems- Optum Clearing House

Application : TOPS (The Online Processing System), Optum clearing House, Claims processing

Client : United Healthcare (United Health group)

Duration : Apr 2008 – Sep 2011

Location : United Health Group (Optum ), Gurgaon, India

Roles : Test Engineer

United Health Group (UHG) is an innovative leader in the US health care industry, serving more than 75 million people worldwide. As a leader in the health benefits and services industry, UHG offers exceptional service, broad capabilities, and enduring value in creating a modern health care system. The project main aim was to monitor and analyze the US health claims transaction involving complex and specialized claims.

These applications are used to incept process and transform claims information in various formats to Optum’s proprietary formats for further processing. Intake can happen in various formats – Electronic – X12(837I, 837P), Paper formats (UB92, NSF) or can be manually keyed (Via vendors

Different types of Claims processing validations and Verifications to ensure the business needs.

Interacted with Team leads and Developers.

Assisted in developing Test Plans based on business and functional requirements.

Involved in the development of test data.

Developed Test Cases based upon the Functional Requirements.

Executed Test Cases manually based upon Test Data to test the functionality of the application.

Performed extensive Regression Testing of enhanced modules and bug fixes.

Tracked Defects and reported to the Developers logging a Change Request.

Reporting alarm messages received from network elements to concerned personnel.

Installing patches and testing the new functionality introduced

Analysis for making system compliant with HIPAA and EDI claims

Worked on different EDI healthcare transactions like 837 for submitting claims, 835 for payments, 270/271 for health care benefits and eligibility, 276/277 for claims and 278 for referrals, pre-certification, and authorizations

Enhanced the scripts to read test data from the excel files, defined environment variables, functions, and performed keyword driven testing using Quick Test Professional (QTP).

Environment: Quality Center (version 9), Quick Test Professional (version 9.5), MS Excel, MS Word, Data Loader, Windows XP, VB scripting, Requisite pro, Clear Case., DB2

Project: 7 : TOPS (The Online Processing System), Claims Payment System

Application : TOPS (The Online Processing System), Summary Check, Payment Engine

Client : United Healthcare (United Health group)

Duration : Apr 2007 – Apr 2008

Location : United Health Group (Optum ), Gurgaon, India

Roles : Associate Test Engineer

These applications are used to process claims payment feeds coming out from adjudication systems and generate Explanation of Benefits, Provider remittance advice, 835’s, Checks and Electronic funds transfer. These applications house rules for claims information summarization, overpayment recovery, Bulk payments, marrying information of claims payments from multiple sources, generating information for Treasury and capitation payments

Creation of Test Plan, Test Scenarios, Test cases/Data Preparation, Test Execution, Analyzing Expected and Actual results to gain assurance to meet business requirements.

Providing timely update on the progress and issues being faced to the stake holders.

Timely updating the project lead about the project status

COE’s delivered- Inpatient Hospital, Outpatient Hospital, Copay, Deductible, Out of Pocket

Monitor and analyze the US health claims transaction involving complex and specialized claims.

Deliver and facilitate training to Global Audit Team for auditing high dollar claims.

Worked on different EDI healthcare transactions like 834 for Benefit Enrollment and maintainance,837(P, I, D) for submitting claims, 835 for Claim payments, 270/271 for health care benefits and eligibility inquiry and response, 276/277 for claims status request and response.

Claim validation and Pending/Denied Claims Analysis for the Health plans Medicaid programs.

Actively involved in analyzing claims based on eligibility checks such as preauthorization, member validation, provider validation, duplicate claims, bundled & unbundled claims, benefit eligibility, Group and Plan eligibility, age, and sex verification etc.

Addressed all aspects of the claim processing lifecycle, starting from identifying a claim right up to closure.

Actively involved in provider verification as INN, OON, or Fraud Providers.

Actively involved in auditing that correct payment has been made to provider based on COB, Copay, Deductible, Accums have been updated correctly.

Actively involved in checking Correct Check Extracted for electronic payment to provider.

Involved in checking post payments letters to providers (EPP) and members (EOB).

Involved in auditing Vision claims, Dental claims, medical claims, Inpatient claims, Adjusted claims, Medicare, and Medicaid claims.

Involved in verifying information from CMS1500 professional claim forms and UB-92 hospital claim forms.

Coordinate with the Operations team to identify low performers and accordingly prepare remediation plans for them.

Actively involved in leading a team of 25 claim associates from different areas to prevent claims adjudication errors.

AFFILIATIONS:

Professional Affiliations Project Management Institute (PMI), Member since 2018

Member, Scrum Alliance, 2019 to Current-Certified Scrum Master

CERTIFICATIONS:

External ISTQB Foundation Level with 88%.

External AHM 250 Certification by AHIP (America’s Health Insurance Plans)

Profession Scrum Master (PSM 1) Certified.

SAFE Practitioner Certificate.

Salesforce Admin Certificate.

Six sigma White & Yellow belt Internal Certification.

SME Level-1 Certified in Claims

ETL Testing Professionals Internal Certified.

Health Edge Certified.

EDUCATION:

Post Graduate Diploma in Financial Management, Narsee Monjee Institute of Management Studies (NMIMS), Mumbai, India

Bachelor’s in computer application, Utkal University, Bhubaneswar, India

ACHIEVEMENTS:

Received Living Edge, Sustain Edge, Aquamarine Awards and Star Award on several occasions based on my performance across projects in UHG.

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