Jessica Claire
  • , , 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:

Healthcare IT Professional Healthcare Lead Business Solution Architect/ Product Manager with 10+ years of experience in healthcare applications implementations, business requirement analysis, enterprise solution delivery, under budget, and at finest quality with minimal impact. Well-versed in process orientation and financial aspect toward cost reduction and enhancement. Key achievement: Partnered with various departments to ensure that all requirements goes through sprint process to avoid multiple code branches for different clients. Ultimately resulting in a single platform with all enhancements named MHK2.0 and help the organization to upgrade any client with ease.

  • Technical Skills:
  • Application Roadmap solution
  • Complex Problem solving
  • Critical Thinking
  • Gap Analysis
  • Troubleshooting
  • Business Process Improvement
  • Experience in Integrated Solution:
  • Care Management
  • Utilization Management
  • Population Health
  • Pharmacy Part D
  • Part B
  • Grievance & Provider Dispute
  • Medication Therapy Management (MTM)
  • Tools and Software:
  • MS Office Tools
  • Microsoft Visio
  • MySQL
  • Project Management Tools
Lead Business Solution Architect/ Product Manager, 09/2018 - Current
  • Extensively interacted with the stakeholders, compliance team, security and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations
  • Worked with cross-functional teams through project lifecycle phases, including requirements gathering, design, and deployment
  • Implemented multiple million dollar projects including; CVS and Aetna merger, Scan LTSS project, Texas Medicaid implementation etc…
  • Managed numerous product implementation at multiple client site including; OneHome, HNE, FHCP, Magellan Heath, CVS, Aetna, WellCare, Centene, BSC, BCBSMA, Point32Health, Cigna etc…
  • Implementing Integration solution including; CM, UM, Pharmacy Part D and Part B, Grievance, MTM, Provider Dispute, Provider and Member Portals
  • Working with multiple clients on Integration and Interface projects to support EDI 278 (Prior Auth), 837 (Claims), HL7 and real-time API or batch interface implementation
  • Used Soap UI and Postman to test API request & responses
  • Worked on requirements for Rules engine, UI interface, data mapping, workflow enhancements, auto-tasking, SSO and process improvements with automation
  • Develop clinical TO-BE workflows based on the client's AS-IS workflows.
Healthcare Sr. Business Analyst, 06/2018 - 09/2018
Adbakx City, STATE,
  • Partnered with Emids and myNEXUS project team, developed a new home health services platform to deliver offline solution for nurses to conduct survey and provide care by making visitation
  • Elicit Healthcare requirements using various sources/techniques including interviews, brainstorming sessions, workshops, site visits, business process flows, scenarios task, system analysis and document analysis
  • Details User stories including User Interface prototype, attributed Domain Model, Business Rule specifications, Interface/Integration specifications and workflow diagrams.
Healthcare Business System Analyst, 04/2013 - 06/2018
ZeOmega City, STATE,
  • Implemented Population Health System at various client location including; Florida Blue, AmeriHealth Caritas, Community Health Choice, Cardinal Innovations, Group Health Corporation (now Kaiser), MDwise & HealthSmart
  • Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle
  • Worked with modules of Care management such as; Utilization management, Case management and Disease management
  • This further stretches out to Medical Referrals, Intake, Authorizations, Appeals and Physician Reviews
  • Worked with EMR and ADT to HIE system integration to translate the HL7 and C-CDA feed into xml to display Lab Results, Problems, Allergies, Medication, Clinical Summary in Patient Portal and Provider Portals
  • Worked with Delivery Managers, Subject Matter Experts, IT professionals, and Software developers to define project scope and objectives
  • Worked with various tools including Extract, Transfer & Load (ETL), WSO2, Postman for Restful (Web-Services) testing and Single Sign-On (SSO) for Integration and Interface data load.
Healthcare Business System Analyst, 09/2011 - 04/2013
Tekenergy City, STATE,
  • Involved in the development of Eligibility Integrity and Access Integrity suite to make revenue cycle management smarter, better and faster
  • It is designed to help a healthcare facility achieve "meaningful" outcomes in less time and at lower costs
  • Extensively worked on 270 & 271 EDI X12 5010 to improve the current Eligibility and Benefit application and launch a stand-alone Eligibility Application
  • Constantly working with development team on Object-Oriented Modeling and Relational Database to maps the properties and subsequent fields
  • Produce visual models for the application using MS Visio to create Sequence, Workflow Diagrams and Activity Diagrams.
Education and Training
Masters of Business Administration (MBA): Information Technology, Expected in 04/2012
The University of Dallas - , Texas
Bachelor of Business Administration (BBA): , Expected in 06/2007
Chaudhary Charan Singh University - ,
Leadership Development by Harvard Business Publication HIPAA Certified Pre-MBA Certification

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School Attended

  • The University of Dallas
  • Chaudhary Charan Singh University

Job Titles Held:

  • Lead Business Solution Architect/ Product Manager
  • Healthcare Sr. Business Analyst
  • Healthcare Business System Analyst
  • Healthcare Business System Analyst


  • Masters of Business Administration (MBA)
  • Bachelor of Business Administration (BBA)

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