project manager sr business systems analyst resume example with 14+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:
Accomplished PM/BA skilled in achieving operational efficiency in the health care Insurance and Pharmacy Benefit Management. Performed Business process improvement, data analysis. Experienced in Government Healthcare Insurance related projects (PBM Implementations, Medicaid Expansion) and other data-conversion projects. Experienced in data mapping and user acceptance testing, as well as solving complex problems in high-pressure environments. Excels at cultivating, managing and leveraging client relationships.
  • Project Management: Custom Software Development, Database Design (RDBMS), Account Management, Change Strategy, Strategic Planning, System, Migrations/Integrations, Enterprise wide Implementations
  • IT Project Lifecycle: Requirements Analysis, ROI Analysis, Costing & Budgeting, Project Scheduling, Testing/QA/Rollout/Support, Six Sigma, Waterfall & Agile
  • Value-Added Leadership: Cross-Functional Supervision, Team Building & Mentoring, Client Relations & Presentations, Business & IT Planning, Contract Management, Vendor Management, Onsite Coordination
  • Domain Expertise: Health Insurance (Commercial, Medicaid, Medicare, Exchanges, Pharmacy), Clinics (ESRD, Dialysis, QIP Five Star Rating, Crownweb submission)
  • Skills: Project Management, Project Charter, Scope, Scheduling, QA/QC, Policy & Procedures, Six Sigma
  • Business Architecture:       Analysis, Business Case, Business Requirements, Functional Requirements, Entity-Relationship, and Cost-Benefit Analysis Technical Delivery:             Business Requirement, Technical Design, Test Plan, Implementation Plan, Defect Tracking, Prioritizing, Root-cause analysis, Incident Management, SLA. Databases:                       Oracle 11i, SQL Server 2012, MS Access, Db2 Operating Systems:  UNIX, Windows 7 Process Flow:  UML, Rational Rose, MS Visio Tools: Rational Suite – Clear Quest, Rose, Requisite Pro, Visual Source Safe, Microsoft SharePoint, Team Foundation Server, JIRA, Mercury Quality Center, CA – Service Center. Productivity Software:  Microsoft Project, Visio, MS Office
Project Manager /Sr Business Systems Analyst, 09/2015 - Present
Iqvia Holdings Inc New Port Richey, FL,
  • Health First Health Plan (HFHP) is switching its PBM vendor from CATAMARAN to Express Scripts Inc.
  • ESI) and moving all its pharmacy benefits operations to ESI from 1st Jan 2016.
  • The Project is to migrate the Member / Groups / Benefits / OOP/ Rebate Data maintenance between HFHP and ESI and provide training and assistance to the HFHP associates during the implementation period.
  • The DST Health Systems is the Technology Vendor for the HFHP and providing all the backend support for PBM vendor switchover.
  • Coordinated with multiple stakeholders of the projects (ESI , HFHP and Technology Vendor (DST health solutions)) during implementation meetings and assigned work to development team Prepared Projects plan and defined the schedule of the project.
  • Prioritize change requests identified and make sure to adhere to the timelines promised.
  • Managed project risks, issues/problems, and activity progress to ensure project goals are achieved.
  • Assist with problem resolution or risk mitigation as needed.
  • Provided status report on a weekly basis to the senior management on the project status and health.
  • Developed and managed work breakdown structure (WBS).
  • Conducted project status meeting to track the progress of the project.
  • Project reporting - communicated project status to management and stakeholders.
  • Conducted JAD sessions with business and elicited the Coordinated with Testing team to manage the Test cases Wrote BRD and Data Mapping documents for the Commercial, Medicare and Exchange data exchange Eligibility files.
  • Defined the Requirements for the Inbound and Outbound RX and Medical Accumulator and Group Structure / Benefits Plan Level (BPL) of the Member and Wrote BRD and Mapping documents for the development Team.
  • Environment: SQL Server, Microsoft Word, Excel, PowerPoint, MS project, SharePoint, Visio.
Project Manager / Sr Business Systems Analyst, 04/2015 - 08/2015
TEKsystems Inc City, STATE, FMC is being rated on their quality measure by the CMS and being penalized for bad rating. The QIP SAS conversion project calculates the five star rating before the data submitted to CMS to avoid penalties and provides information to Business for appropriate decisions   Managed and reviewed the existing process and prepared scope and vision document of the project. Prepared Projects plan and defined the schedule of the project. Conducted project status meeting to track the progress of the project. Project reporting – communicated project status to management and stakeholders. Risk, issue and resolution – mitigated risk, managed issues and provided resolutions to stakeholders. Conducted JAD sessions with business and elicited the requirements. Reviewed existing SAS code and prepared data flow diagrams to define the technical specifications. Wrote BRD and FSD to get sign off from stakeholders. Environment: Oracle, SAS, Informatica, Microsoft Word, Excel, PowerPoint, MS project, SharePoint, Visio
Sr Business Systems Analyst, 05/2008 - 04/2015
WellCare Inc. City, STATE, WellCare provides Medicare and Medicaid managed-care health plans to its members. Wellcare Health Plans, Inc. is the holding company for subsidiaries WellCare, Staywell, HealthEase, Harmony, and 'Ohana.    CMS Audit 2015 Process Automation                                                  The CMS Audit 2015 Process Automation Project developed a new user-friendly application for the pharmacy business group to extract data from the existing members’ prescription-drug-related database in the file format mandated by CMS.  Led the effort to gather member data from the various IT departments (DMR, Appeals, and Enrollment). Performed the gap analysis to find the identified changes in the existing applications Wrote BRD/FSD to describe the requirements and functionality of the application Conducted requirements-gathering session to elicit complex requirements from SMEs and key stakeholders. Wrote technical design document for development team to use to write the code in SQL and SAS for backend. Coordinated with QA to perform the offshore testing. Provided status reports to management team of the project. Tracked assigned tasks of the development teams. Resolved conflicts during the multi-stakeholders scenarios. Environment: ORACLE, SAS, MySQL, PLSQL, Cognos, Microsoft Word, Excel, PowerPoint , MS project, SharePoint , Visio   DER Modification Release 3 DER Workflow tracks prior authorizations (coverage determinations) required for special formulary and non-formulary drugs. WellCare gets these authorizations by fax and web submission. Upon receipt, the pharmacy business has 24 to 72 hours to approve or deny the authorization, based on line of business (Medicaid or Medicare) and urgency of need. Based on the decision, the members and providers are notified by automated or manual calls, faxes and letters. As part of Release 3, the DER application added functionality to provide partial approvals, withdrawal and dismissal on a requested drug. Wrote BRD/FSD/TDD to describe the requirements, functionality and design of the DER application changes. Conducted requirements gathering session to elicit complex requirements from the pharmacy technicians and key stakeholders. Coordinated with QA to perform the offshore testing.  Environment: ORACLE , SAS , MySQL, PLSQL, JAVA, JBPM, Spring     PBM- Pharmacy Benefit Management Application changes The Pharmacy Benefit Management Application gets member eligibility data from member database systems and produces the member eligibility files in text format for CVS and Walgreens for these business segments: Medicare Members data for CVS Pharmacy (stores), Medicare Members data for CVS mail order Pharmacy, Medicaid Members data for Catamaran (Walgreens), Health Information Exchange (HIX) Members Data to CVS and Catamaran. Managed production scheduled automated jobs to make sure member data was being correctly transmitted to vendors Supported application during break down Provided PBM SME-support to development team    Wrote BRD/FSD/TDD to describe the requirements, functionality and design of the changes in the PBM application. Coordinated with QA to perform the offshore testing.  Environment: Oracle, SAS, PLSQL   Health Insurance Exchange (HIX) Integration Project Responsible for managing outstanding risks, issues and defects and ensuring these were successfully addressed and closed. Managed complex multi-party relationships involving pharmacy business, Pharmacy IT, Enrollment IT, DELL and Accenture to ensure that the responsibility for resolving issues was correctly identified and action taken by the appropriate parties. Responsible for analyzing migration business requirements and devising appropriate solutions. This included technical requirements, member- experience issues, legal, regulatory and compliance requirements and operational-exception processes. Managed the successful integration of HIX Pharmacy benefits-eligible membership to existing applications.  This involved coordinating activities performed by DELL, Accenture and pharmacy business to ensure all regulatory requirements met before the integration Managed relationships with key stakeholders at all levels within Dell, Accenture, pharmacy business and third-party vendors (CVS, Catamaran). Ensured that all integration requirements were captured, risks and issues were identified and resolved and that key pre-integration activities were executed. Determined requirements for go live testing and provided troubleshooting support during the launch of the HIX Integration project. Wrote Business / Functional / Technical requirements for the projects in the area of Pharmacy Benefit Management (PBM). Studied SAS /SQL code to define the technical design specification Provided support to development team to coordinate with business, QA, infrastructure support team Led JAD session to define the complex requirements and suggested solutions Performed code verification for changes to existing application code Worked with QA and checked in the requirements in HP ALM Performed validation for business stakeholders during critical issues and deployment Provided support to development team during the code release by managing the pre-requisites and post-requisite activities during the planned and Sev 2 release windows. Suggested strategic initiatives to improve existing processes and resolve the ongoing issues Provided support to the management team during the project life cycle by providing the Visio diagram and other documentation. Suggested consolidating the various projects for PBM into single request for faster delivery.   Windsor Integration Project (Medicare) Windsor PBM and MOOP (member-out-of-pocket expenses) application projects. Wrote BRD, FSD and participated in the other project-related activities.   New Jersey Healthfirst Integration Project (Medicare and Medicaid – Duals) Participated in the PBM and MOOP-related activities and wrote BRD, FSD and supported the project members during both the release and post-production cycles. New Business Integration - NY FIDA Project (Dual Members) –Supported project during the release cycle. CVS Mail Order Project (Medicare)– Supported project during the release cycle Name:  CVS Mail Order Project (HIX) – Wrote TSD and supported project during the SDLC process. Maintained good relationship with business partners by meeting their expectations. Communicate partnership goals effectively to build relationships with different business groups. Consulted with business stakeholders in the early stages when their decisions and actions affected IT area. Encouraged business partners to learn the new combined process (IT & Business) to improve organizational effectiveness. Maintained clear, logical, effective interaction to commutate concerns, issues and repercussion of customer decisions to partners. Demonstrated strong written/verbal communication and presentation skills while working on the projects. Drafted messages to fit the business-domain expertise of the audience and the nature of the issues under discussion. Provided detailed information to clients and offered recommendations based upon best practices. Study facts, constraints, issues, dependencies to decide the future course of action Successfully completed the assigned projects on schedule by taking ownership and sail them through QA and UAT process Supported post-production issues with higher priority and help the team for their resolution. Managed assigned work priorities according to project’s goal.   Kentucky Medicaid Expansion WellCare has expanded its new business in the Commonwealth of Kentucky starting from Feb, 1 2012 to implement Medicaid insurance. During this period following tasks were executed to deliver the project Developed many BRDs for Kentucky Medicaid Expansion Project with high quality and within tight deadlines: Provider File BRD, (2) TPL Outbound File BRD, (3) Periodicity Letters BRD, (4) DER Add LOB BRD, (5) Denial Letters BRD and others   D-SNP Eligibility Automation Project WellCare updates eligibility of their members through Passport file received from PASSPORT.COM for the DUAL (Medicaid & Medicare) membership. This project will update the eligibility of members from the Passport file in the code system. Provided solution and wrote Technical Requirements for the project and received the following comment from the Vice President. “Thank you for your work on the D-SNP eligibility automation project.  This was a cornerstone of the corrections we had to make to be in compliance with our D-SNP eligibility checking.  I know you guys put this on the fast track, but you were still thoughtful and thorough even while moving extremely quickly.  You made sure everything was technically correct, but helped us work through a number of business issues along the way.  In short, you were an excellent example of how IT can be a true business partner.    Hawaii Medicaid Expansion WellCare has launched the new business in the State of Hawaii starting Feb, 1 2009 to implement Medicaid insurance. During this period the following sub-projects were executed to deliver the task. ID Card Process (Enrollment): Wrote Business Requirements for the ID Card distribution to the Members, Conduct JAD session with business HOH (Head of Household) Welcome Kit Process: Wrote Business Requirements for the Welcome kit sending process to the Head of Household of the family. Coordinated with Product Management to define the Layout of HOH  Providers Setup (Encounters): Wrote requirements for the synchronization of provider data from State of Hawaii. Catastrophic Claims: Analyzed the solution and wrote Technical Requirements for the Re-insurance agency of state of Hawaii. Periodicity Letter: Wrote Technical specifications for Generating the Letter. Medicare & Medicaid Nightly Reconciliation: Drew Visio Diagram & Wrote Technical specifications for Nightly Recon Project.
Lead EDW Business Analyst , 04/2008 - 11/2008
BCBS FL- Life & Specialty Venture City, STATE, LSV is subsidiary of Blue Cross Blue Shield of Florida and provides life insurance and other specialty products to its members Performed data profiling in the source systems required for LSV system Documented the complete process flow to describe program development, logic, testing, and implementation, application integration, coding. Worked with internal architects to assist in the development of current and target-state enterprise data architectures Worked with project team representatives to ensure logical and physical data models were developed in line with corporate standards and guidelines. Involved in defining the source-to-target data mappings, business rules and data definitions. Responsible for defining the key identifiers for each mapping/interface. Responsible for defining the functional requirement documents for each source-to-target interface. Documented, clarified, and communicated requests for changes with the requestor and coordinated with the development and testing team. Documented data quality and traceability documents for each source interface. Designed and implemented data integration modules for Extract/Transform/Load (ETL) functions. Participated in data warehouse design. Worked with various ETL, data warehousing tools and concepts. Documented the complete process flow to describe program development, logic, testing, and implementation, application integration, coding. Worked with project team to ensure that logical and physical ER/Studio data models were developed in line with corporate standards and guidelines. Environment: Oracle 10g/11g, MS Access 2007, MS Excel 2007, MS Word 2007, MS Outlook 2007, Crystal Reports, PowerPoint 2007, SharePoint.
Development Manager/ Business System Analyst, 07/2002 - 08/2003
UPMC Health System City, STATE, University of Pittsburgh Medical Center (UPMC) is an $8-billion global nonprofit health enterprise with 50,000 employees, 20 hospitals, 400 outpatient sites and doctors’ offices, and a 1.3 million-member health insurance division.   Prepared scope documents for RFP to purchase customized solution for identity management and context sharing. Performed the gap analysis and identified the needs and requirements using structured approach of requirement gathering using Rational RequisitePro. Analyzed workflow (requirements, analysis, design, implementation, testing) and system needs for conversion and migration of the existing applications to the new system. Defined and designed the web-based system for collecting the information using an online form. Environment: ASP, VB, IIS, SQL Server 2000
Master's: Computer Application, Expected in July 1988
Agra University - ,
Status - Computer Application
Bachelor of Economics: , Expected in July 1985
Rohilkhand University - ,
Status -
Account Management, go live, Agile, approach, ASP, agency, Automation, Benefits, Budgeting, Business Case, CMS, Cognos, COM, CA, Contract Management, conversion, Costing, Crystal Reports, clients, Client Relations, CVS, data-conversion, data integration, data warehouse, Databases, database, Database Design, data warehousing, Db2, Delivery, DELL, Dialysis, documentation, ESRD, ETL, senior management, fast, faxes, fax, Functional, HP, IIS, Informatica, Insurance, JAVA, Layout, Team Building, Leadership, legal, Letters, logic, managing, meetings, Mentoring, MS Access, MS Excel, Excel, Exchange, Mail, MS Office, MS Outlook, PowerPoint, MS project, Microsoft Project, Microsoft SharePoint, SharePoint, SQL Server 2000, Windows 7, windows, MS Word, Microsoft Word, migration, MySQL, Enterprise, OOP, Operating Systems, ORACLE, PLSQL, organizational, Presentations, presentation skills, problem resolution, processes, Process Improvement, Product Management, program development, coding, progress, Project Management, Quality, QA, Express, Quest, Rational Rose, RDBMS, reporting, Requirement, Requirements Analysis, requirements gathering, requirements-gathering, RFP, SAS, Scheduling, SDLC, Scripts, Six Sigma, SLA, Software Development, Visual Source Safe, specification, SQL, SQL Server, Strategy, strategic, Strategic Planning, structured, Supervision, System Analyst, troubleshooting, UML, UNIX, validation, Vendor Management, verbal communication, Visio, vision, VB, Workflow, written

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Resume Overview

School Attended

  • Agra University
  • Rohilkhand University

Job Titles Held:

  • Project Manager /Sr Business Systems Analyst
  • Project Manager / Sr Business Systems Analyst
  • Sr Business Systems Analyst
  • Lead EDW Business Analyst
  • Development Manager/ Business System Analyst


  • Master's
  • Bachelor of Economics

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