Health Insurance Quality Analyst
Resume:
Smitha Raveendran Satheedevi
Tyler, TX 75701
Mob: +1-903-***-****
**.**********@*****.***
Professional Summary
Highly experienced professional with 20 years of expertise in both software testing and claims processing, specializing in the life and health insurance sectors. Proven track record of ensuring the quality of software systems while also efficiently processing and managing life and health insurance claims. Adept at problem-solving, collaborating with cross-functional teams, and streamlining processes to improve operational efficiency. Strong communication skills, leadership experience, and a passion for continuous improvement in both technical and operational environments.
Professional Experience
Role: Testing Lead
Tata Consultancy Services— [Kochi, Kerala]
July 2018 – Mar 2025
Lead the design, development, and execution of test cases for various life and health insurance applications.
Perform manual and automated testing, ensuring software meets both functional and non-functional requirements.
Collaborate with development teams to identify, document, and resolve defects, contributing to overall software quality.
Ensure compliance with regulatory standards in the testing of insurance software platforms.
Develop and maintain test plans, test scripts, and other testing documentation for various life and health insurance systems.
Mentored junior testers, providing guidance on testing methodologies and best practices.
Coordinate User Acceptance Testing (UAT) with business teams to validate system requirements.
Contribute to improving testing processes by implementing new tools and technologies, reducing test cycles by 20%.
Role: Quality Analyst
Tata Consultancy Services— [Bangalore, Karnataka]
Aug 2017 – July 2018
Travelled to Austria for transition.
Led the transition of ABS application processes, including the creation of training materials and conducting knowledge transfer sessions.
Ensured smooth project delivery by maintaining accurate asset documentation and daily trackers.
Role: Quality Analyst
Tata Consultancy Services— [Bangalore, Karnataka]
June 2014 – Aug 2017
Conducted root cause analysis and gap analysis, recommending process improvements for enhanced software quality.
Ensured a 100% team efficiency by addressing bottlenecks and optimizing team performance.
Conduct gap analysis and mapped areas of improvements; monitor process improvement projects towards increasing efficiency, productivity and reducing timelines.
Maintain & analyze utilization tracker of team members and ensuring all examiners are achieving over 100% of their targets.
Make sure the incidents under Service Desk queue are managed and actioned on time.
Handling several reports as per the requirements(e.g.: VSAT Trending, OSAT/DSAT Analysis, Call back trackers, DSAT follow-ups, Issue Not resolved instances, etc)
Acknowledge for increasing the number of first call resolution
Senior Claim Processor – Life Insurance
Tata Consultancy Services. — [Bangalore, Karnataka]
Mar 2009– June 2014
Processed and adjudicated claims for life and health insurance policies, ensuring timely and accurate payments to policyholders.
Evaluated insurance claims, reviewing medical and policy documents, verifying eligibility, and determining benefits owed.
Maintained compliance with state and federal regulations while processing claims.
Collaborated with internal teams to resolve discrepancies and improve claims processing workflows.
Trained and mentored new staff on the claims processing system and claims adjudication procedures.
Acted as a liaison between policyholders and the company, providing excellent customer service.
Streamlined the claims submission process, reducing processing time by 15%.
Senior Claim Processor - Health Insurance
Hinduja Global Solutions — [Bangalore, Karnataka]
Oct 2003 – Feb 2009
Assisted in the processing and documentation of life and health insurance claims, ensuring that claims met all necessary criteria.
Entered and updated claims data into the system, ensuring accuracy and timeliness.
Communicated with policyholders and healthcare providers to request additional documentation and clarify information.
Worked with senior claims processors to resolve issues, improve processes, and enhance the customer experience.
Supported the claims department with administrative tasks, ensuring smooth operations.
Key Skills
Software Testing (Manual & Automated)
Claims Processing (Life & Health Insurance)
Test Case Design & Execution
Defect Tracking & Management
Quality Assurance & Compliance
Life & Health Insurance Policies
UAT (User Acceptance Testing)
Test Automation Tools (e.g., Selenium, Maven, JMeter, Postman etc.)
Regulatory Standards (HIPAA, etc.)
Cross-Functional Team Collaboration
Problem-Solving & Troubleshooting
Process Improvement
Data Analysis & Reporting
Excellent Communication & Customer Service Skills
Education
Bachelor of Commerce in Financial & Management Accounting
Bangalore University — [Bangalore, Karnataka]
Graduation Year: [2002]
Certifications
• Diploma in Information System Management
• Azure Fundamentals
• Software Testing (STG)
• ITIL Foundation Certification
• Software testing skills (Manual Testing, Java Oops Concept, Mobile Testing, Automation testing, Selenium web driver, Performance Testing, Web Testing & API Testing).
Technical Skills
Test Automation Tools: Selenium, JUnit,
Programming Languages: Java,
Testing Platforms: Azure Devops, JIRA,
Operating Systems: Windows
Database: SQL, MySQL
Professional Development
Attended workshops on Agile methodologies and Test-Driven Development (TDD)
Participated in continuous improvement initiatives at both software testing and claims departments
Completed course on Agile Software Development:
Completed course on Generative AI
Completed course on Agile Product Owner Role: Foundations
Completed course on Learning Selenium
Introduction to Prompt Engineering for Generative AI (2023)
Languages
English (Fluent)
Malayalam (Native)
Kannada (Intermediate)
Tamil (Intermediate)
Hindi (Fluent)
Personal Details
Date of Birth: April 30, 1981
Visa Details: CR1(Immigrant Visa)
Passport Details: Z7561404
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