Information Technology Medical Claims
Resume:
Naveen Kumar
******.*******@*****.***
Professional Summary
•Having around 10 years of professional experience in the Information Technology industry specializing in performing Database, Manual and Automation testing of Client/Server and Web based applications on different environments
•Strong experience working on SDLC (Waterfall Model & Agile) life cycles
•Expertise in Defect Reporting & Tracking and compiling Defect Metrics using HP Quality Center 10.0, HP ALM 12.01
•Expertise in developing Test Estimations, Test Plans, Test Cases/Scenarios, Test Procedures, Test documentation and analyzing Test Results to produce accurate Test Metrics
•Skilled in System Testing, Regression Testing, Data Validation testing, Black Box Testing and White Box Testing
•Experience in Functional/Non-Functional Testing, Regression Testing and System Integration Testing (SIT) in waterfall, Iterative and Agile development environment
•Worked in agile methodology, coordinating with the development for quick resolution of Issues on timely basis
•Solid testing experience with healthcare domain(Medical claims, dental claims, pharmaceutical(RX Claims) and vision claims.
•Worked with Provider data model, Claims data model and Member Data model.
•Experienced in understanding and validating the SSIS transformations, Informatica mappings as per the source to target mapping document.
•Solid Back End Testing experience by writing and executing SQL Queries.
•Experienced working with PHI and sensitive data.
•Solid Testing experience with Excel, .CSV, TXT, XML, JSON and SFTP.
•Experienced in API testing using Fiddler.
•Experienced in validating frameworks like Junit, TestNG.
•Experienced in validating performance of the application using LoadRunner
•Worked on Dimensional Data Modeling using Star and Snow Flake Schema.
•Experienced working on Data Masking, Data Archiving and Electronic Data Interchange.
•Experienced in validating SSRS Reports, SAP Reports,Power BI Dash Boards as per the company standards.
•Having experience on handling Medical Claims which comes through a source called Facets Application and QNXT which are the products of TriZetto and having knowledge about its benefits configuration.
•Having experience on handling RX claims like CVS, Walgreens, Kroger and Walmart
•Worked on different medical claims like Professional, Institutional.
•Having Experience on HEDIS related Data sets, HEDIS measures,enrollments and Value Based Attributions.
•Expertise in Risk Assessment for the Test Design & Scenarios and providing on time mitigations to meet the schedules
•Good understanding of system workflows, computing and verifying Software Metrics and ability to communicate with both technical and non-technical teams
•Quick learner in understanding the client’s needs / enhancements, co-ordinate with the technical team to deliver the customize products on schedule
•Good knowledge in web services testing using Fiddler
•Expertise on identifying various test scenarios and possess strong ability to handle multiple tasks and prioritize them
•Excellent analytical and problem-solving skills, planning and organizational skills and strong interpersonal skills.
Areas of Expertise:
•Agile, Waterfall and Iterative methods
•Defect tracking and reporting.
•Test methodology.
•Systems, Regression and Ad-hoc testing
•UAT and Exploratory Testing.
•Ability to handle multiple projects.
•Onsite-Offshore Coordination.
Educational Qualification:
•Master of Science in Computer Information Systems, 2015- 2016, Wilmington University, Wilmington, DE, USA.
•Bachelor of Technology in Computer science & Engineering, 2006-2010,
Jawaharlal Nehru Technological University, Hyderabad.
Professional Experience:
Employer: Strategic Resources International. May 2016 - Till Date
Client:CareSource, Dayton, Ohio.
Quality Analyst/ETL lead Tester / Application Testing. August 2016– Till Date
Environment: SSIS,Informatica,Informatica IDQ, SSRS, Python,Tableau,MDM,PowerBI, Fidler, Quality Center, Jira, Agile, TOSCA, Oracle, SQL,alteryx,Unix,Teradata, SQL Server,Microsoft Azure, ADF, IBM DB2, Snowflake, Dbt, Kafka and service now.
CareSource is nationally recognized for leading the industry in providing member-centric health care coverage to a wide variety of consumers in Ohio, Kentucky, Indiana, Georgia and West Virginia. It is of the nation’s largest Medicaid managed care plans, but today also offers a lifetime of health coverage to more than 1.5 million members including offerings on the Health Insurance Marketplace and Medicare Advantage plans.
Responsibilities Include:
•Actively interacted with the Business users, product owner and the developers in the agile team to understand the test scenarios.
•Created a Test Strategy, Test Plan and Test Cases.
•Created and mocked up test data and designed test cases according to data mapping STM (Source to Target) document.
•Experience in Data integration of various data sources with Multiple Relational Databases like Oracle, SQL Server, Snowflake, MS Excel, MS Access and Flat Files.
•Experienced working with huge volumes of data, analyzing record sets for Data Quality, Data Validation and Metrics using SQL and PL/SQL.
•Involved in creating Automation framework from scratch by using Sql Stored Procedures,Python
•Experienced in writing SQL Stored Procedure to automate the Test Cases which handles Integration and Regression Testing.
•Solid Back End Testing experience by writing and executing SQL Queries and also automated using TOSCA.
•Experienced in understanding and validating the SSIS transformations, DataStage, Informatica, Abinitio mappings as per the source to target mapping document.
•Validated the Medicaid and Medicare member records and their eligibility details in the Databases using SQL Queries.
•Interacted with multiple databases like Tera Data, Facets and SQL server while migrating data to SQL Server 2016.
•Actively participated and performed data validation during Informatica to SSIS data migration from multiple sources.
•Executed ETL jobs to load the data from source to target and validated Informatica log files
•Experiencd working with OSI PI Historian /PI Vision/PI Connectors.
•Experiencd working with UA Expert, OPC UA, OPC DA and OPC AE Simulators.
•Experienced Working with Rockwell PLC.
•Worked on Dimensional Data Modeling using Star and Snow Flake Schema.
•Experienced working on Data Masking, Data Archiving and Electronic Data Interchange.
•Experienced in validating SSRS Reports, Power BI Dash Boards as per the company standards.
•Having experience on handling Medical Claims which comes through a source called Facets Application which is a product of TriZetto and having knowledge about its benefits configuration.
•Having experience on handling pharmacy claims like CVS, Walgreens, Kroger and Walmart
•Worked on different medical claims like Professional, Institutional.
•Possesses extensive knowledge of transformation rules verification processes and data sample comparisons.
•Having Experience on HEDIS related Data sets, HEDIS measures and Value Based Attributions.
•Worked with Provider data model, Claims data model and Member Data model.
•Performed smoke and regression testing by using SQL.
•Interacted with development team for clarifications
•Executed SQL test cases and reporting defects.
•Executed the web-service test cases using Fiddler.
•Performed trouble shooting when the nightly jobs failed.
•Tested UI/UX Applications compatibility on different browser versions (IE, Firefox).
•Extensively worked with End-to-end testing for User Acceptance Testing (UAT).
•Collaborated with business owners in validating the data in certification Environment
•Used Jenkins to deploy the builds to test environments.
•Collaborating with Change Management team to deploy the changes all the way through production.
•Dealt with the Bug life cycle phases like Defect analysis, bug tracking and Retesting is performed and maintained the status of reports.
•Lead the showcase meetings for all the sprint releases.
Askio Infotech services and pvt ltd, Hyderabad, India. September 2013– November 2014
Client:Sun Trust Bank.
QA/SQL Tester
Environment: DataStage, Business Objects, Win SQL, Quality Center, Waterfall Model, Oracle, SQL, SQL Server, and Microstrategy.
Responsibilities Include:
•Reviewed the Business Requirement Documents and the Functional Specification.
•Created test case scenarios, executed test cases and maintained defects in internal bug tracking systems
•Developed and executed various manual testing scenarios and exceptionally documented the process to perform functional testing of the application
•Developed advanced SQL queries to extract, manipulate, and/or calculate information to fulfill data and reporting requirements including identifying the tables and columns from which data is extracted
•Testing the source and target databases for conformance to specifications
•Developed Test Plan, Test Cases, Test Data and Test Summary Reports and followed Agile/Scrum process.
•Designed and prepared scripts to monitor uptime/downtime of different system components
•Participated in weekly meetings with the management team
•Involved in the Implementation of QA testing Process, and involved in documentation of Test Scenarios, Test Cases, and Test Scripts for Various Applications.
•Performed the back end testing by using SQL Queries and verified the data integrity.
•Coordinated with the developers to resolve defects.
•Involved in documentation in order to maintain and run scripts for future enhancements.
•Worked with team in developing selenium automation scripts.
•Updated the automation scripts based on changes made to the application.
•Closely worked with developers and System Engineers to nail down the technical problems.
•Reported the bugs, Email notifications to the developers using the Jira Defect Tracking Tool.
•Monitored Jira to close the bugs/cases as and when developers fix the bugs.
•Performed Integration testing to verify the data interface between various application modules.
•Worked with collaborative testing with developers as per the SCRUM meeting
•Performed Root Cause Analysis for the reported issues
•Extensively used Rally for all the projects.
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