Sr. Business Analyst Agile Product Owner Project Management

Abhilash Mamilla

Sr. Business Analyst Agile Product Owner Project Management

609-***-**** ************@*****.*** LinkedIn

PROFESSIONAL SUMMARY

Certified Agile Product Owner (PSPO 1) and Sr. Business Analyst with 10+ years of experience in Healthcare IT, specializing in insurance payer systems, claims processing, and regulatory compliance.

Skilled in managing full project lifecycles, from requirements gathering and sprint planning to UAT, regression testing, post-deployment support, and resolving production issues.

Strong in translating complex business needs into clear, actionable user stories and scalable solutions.

Proficient in creating business requirement documents, functional specifications and comprehensive project documentation to support stakeholder alignment and development accuracy.

Experienced in enhancing claims workflows including pre-pricing, prior auth, adjudication, COB, and payment automation.

Experienced in Medicare/Medicaid processes and HIPAA-compliant system enhancements.

Collaborate effectively with stakeholders and cross-functional teams, including IT, business, and compliance, to ensure project success.

Well-versed in tools such as Jira, SQL, Power BI, and Excel to support data-driven decision-making and continuous improvement.

Collaborate with UI/UX teams to translate business and functional requirements into wireframes and screen mockups that ensure clear, user-friendly interface design and support effective development.

SKILLS

Business Analysis: Requirement gathering, BRD, Use cases, GAP & SWOT, RTM.

Agile & SDLC: Scrum, Sprint Planning, Backlog grooming, User stories, Epics.

Testing: UAT, Regression, Defect Tracking, and End User Support.

Technical tools: Jira, SQL, Power BI, MS Excel, Word.

Domain: CMS, Healthcare Payer & Provider (Medicaid, Medicare, COB)

CERTIFICATIONS

Professional Scrum Product Owner 1 (PSPO 1)

PROFESSIONAL EXPERIENCE

Client: Elevance Health June 2019 – Present

Role: Sr. Business Analyst Atlanta, GA

Project Details: Worked within the Claims Interface Group at Elevance Health on the development and enhancement of Claims Intake Workflow (CIW) applications to ensure alignment with HIPAA regulations and compliance across Medicare, Medicaid, Coordination of Benefits (COB), and Member Policy Benefits programs.

The project focused on automating claims processing at the pre-adjudication stage and modernizing the claims adjudication platform to improve accuracy and reduce manual efforts. Actively collaborated with customers, internal stakeholders, and cross-functional teams to design, implement, and optimize scalable business systems and technical solutions that met evolving compliance and performance standards.

Role Description:

Led Business analysis for the CIW application supporting Medicare, Medicaid and COB enhancements aligned with HIPAA regulations.

Support the full product development lifecycle of the Claims Intake Workflow (CIW) application within a healthcare payer environment.

Gathered requirements via workshops, interviews and brainstorming sessions.

Developed and maintained comprehensive documentation including Business Requirements Documents (BRDs), user stories, and functional specifications.

Submitted change requests and enhancement tickets based on evolving business needs and compliance updates. Conducted User Acceptance Testing (UAT) and regression testing, coordinating with QA and development teams to ensure successful deployment.

Utilized SQL to extract, analyze, and manage healthcare data for insights and reporting.

Acted as a liaison between business, IT, and data teams to troubleshoot issues, provide end-user support, and facilitate resolution of defects.

Delivered training materials and knowledge transfer sessions to support system rollouts and adoption of new features. Provided mentorship and technical guidance to junior team members on CIW functionality, Agile best practices, and domain-specific processes.

Contributed to process improvements that resulted in a 30% reduction in manual claim processing time through automation and workflow optimization.

Client: Health Logics May 2016 – May 2019

Role: Business Analyst Hyderabad, IND

Project Details: The project aimed to enhance the payment posting user interface, focusing on improving overall user experience and ensuring compliance with updated regulatory guidelines. A key objective was to strengthen the security and integrity of health information submitted during the claims process, while maintaining strict data privacy and accuracy standards.

Role Description:

Assessed Explanation of Benefits (EOB) records submitted by providers and supported decision-making processes related to claim reimbursement.

Consistently met Service Level Agreements (SLAs) and Turn-Around-Time (TAT) targets by delivering high-quality, high-volume outputs.

Partnered with operations teams to streamline the extraction of EOB data from the Master Patient Index (MPI) system. Performed system functionality and process testing, documented results, and presented findings to stakeholders.

Acted as a Subject Matter Expert (SME) in the development of user guides, release notes, and training documentation. Delivered responsive customer service by addressing provider inquiries promptly and professionally.

Managed project delivery across all phases of the Software Development Life Cycle (SDLC) using Agile/Scrum methodologies. Worked cross-functionally with internal teams and external stakeholders to design, develop, and implement critical applications.

Leveraged SQL to extract and validate EOB data from internal systems, supported claims analysis, error reduction, and reporting accuracy.

Consistently achieved 100% SLA compliance and maintained an average TAT of 24 hours for high-volume claims processing.

Contributed to a 15% reduction in claims processing errors by implementing streamlined EOB verification processes.

Client: Centene October 2014 – May 2016

Role: Associate Business Analyst Hyderabad, IND

Project Details: Focused on healthcare data analysis and operational workflow optimization. Played a key role in the successful migration from the Q Care platform to the Burgess claims processing system, helping the team adapt to the new platform by providing hands-on support, knowledge sharing, and training.

Collaborated closely with business users and technical teams to explain key features and functionalities of the new system, ensuring a smooth transition. Actively gathered feedback from end users and stakeholders to identify opportunities for post-migration enhancements, streamline workflows, and improve system usability.

Role Description:

Acted as a Business Analyst supported the migration from Q Care to the Burgess claims processing platform, with a focus on Medicaid claims and operational process improvements.

Worked closely with business users and technical teams to gather and document requirements, clarify system functionalities, and support platform adoption.

Provided training, implementation support, and end-user guidance to facilitate a smooth transition to the new platform. Developed the user documentation, training plans, and post-rollout support materials to drive knowledge transfer and user confidence.

Partnered with stakeholders to collect feedback, identify gaps, and propose enhancements for the newly implemented platform. Contributed to workflow design and system configuration improvements based on hands-on analysis and user experience insights.

Conducted feasibility studies, GAP, and SWOT analyses to evaluate platform readiness and recommend future-state optimizations. Supported modules including claims adjudication, pre-pricing, COB, payments, and adjustments to ensure business continuity.

Facilitated effective communication between internal teams, and end users to ensure alignment, clarity, and successful delivery.

Identified and resolved 30+ critical system gaps, leading to a 20% improvement in operational efficiency post-migration.

EDUCATION

Bachelor of Science in Biotechnology

Kakatiya University, Warangal 2012

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