Sr Business System Analyst Resume Example

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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:

Business Analyst offering 8 years delivering cost-effective, high-performance technology solutions to meet shifting organizational demands.

  • Excellent communication skills, writing skills as well as presentation skills. Experience working with business users as well as senior management.
  • Solid understanding of all phases of Software Development Life Cycle (SDLC) methodology (such as requirement, analysis, design, data modeling, business process modeling, implementation and deployment).
  • Broad knowledge of Test plans, Test cases and test scripts from the Requirements Document.
  • In-depth knowledge of Rational Unified Process (RUP); risk engineering, data modeling and mapping, and design using UML (Unified Modeling Language), Rational Rose and Visio.
  • Good knowledge of Oracle and SQL.
  • Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
  • Capable of managing multiple projects simultaneously.
  • Exceptional problem solving and sound decision making capabilities.
  • Experience in writing queries/scripts for data analysis ad QA report testing.
  • Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.
  • Experience in User Acceptance Testing, Smoke Testing, Regression Testing Performance Testing and Functional Testing.
  • Experience working in Medicare and Medicaid projects.
  • Experience in conducting SWOT Analysis, Cost Benefit and ROI Analysis.
  • In-depth experience in financial analysis, Financial modeling, Research, Accounting, and good knowledge of Assets, Liabilities, Equities, Fixed Income and Taxation.
  • Created Requirements Traceability Matrix to keep the stakeholders informed of the progress of the project.
  • Strong expertise in Health Insurance Claim process, social services, Medicaid and banking.
  • Belief in team work, dedication, and professional ethics within the working environment.
  • Extensive experience in conducting Joint Application Development (JAD) sessions for project definition involving analyzing requirements, creating prototypes, user interface, database schema and system design.
  • Well versed with HIPAA, Facets, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
  • Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD).
  • Organized, goal-oriented, self-starter, and ability to master new technologies, manage multiple tasks while following through from start to completion.
  • Flexibility in adaption to a wide range of work environments.
  • Good in requirement gathering including Joint Application Development (JAD) and requirement analysis.
  • Extensive experience in working in a Customer - oriented environment.
  • Ability to inculcate new relevant skills with ease in a time sensitive frame.
  • Analysis done to determine if the system abides by the HIPAA regulations.
  • Experience in writing Use cases and Functional Requirement Document.
  • Knowledge of ISO, Six Sigma and CMM standards.
  • Business Analysts' Skills: UML, Use cases, activity diagram, data mapping, JAD session, Business modeling process and functional diagram
  • Methodologies: Agile-Scrum, Waterfall model, Prototype model
  • Design Tools: Enterprise Architect, MS Visio, Rational Rose, Advanced problem solving abilities
  • Others: MS Word, MS Excel, MS PowerPoint, MS Access, MS Project, MS Outlook, SharePoint, Business Objects, MS Visio
  • Databases: Toad,oracle, MS SQL Server (2000 /7.0),IBM DB2
  • Business Intelligence platforms: SAS EG 7.1, COGNOS
  • Testing tools: DOORS ,Rational Robot, Rational Requisite Pro, Rational site Load, Test Manager, Rational Clear Quest, Rational Clear case.
  • Web Applications: HTML, XML, Java Script, Oracle 8i/9i/11i, SQL Server and VB Script
Professional Experience
Sr Business System Analyst, 04/2011 to Current
Bickford Senior LivingIrvine, CA,

Regulatory Reporting Claim Project: To deliver 18 Professional and Institutional claims reports for Myers and Stauffer who audited the Medicaid claims and encounters submissions of WellCare.

  • In depth analysis of EDI’S 835, 837, 834, HIPAA 4010, 5010, claim adjustments, claim processing from point of entry to finalizing, claim review, identified and reported claims processing problems, their source and providing alternative solutions using best practice model and principles.
  • Develops requirements tractability matrix to be used in software development and QA testing within SAS EG. Worked with business users to document current end to end work flow processes and collaborates with users in identifying, defining, and documenting process improvement options and alternatives, as directed by business needs Identifies required information fields and develops data dictionary.
  • Involved in creating the BRD/FSD Dev support and performing the QA testing. Project delivered on time and successfully passed the regulatory audit.

FL MMA(Medical Management) Alere(third party Vendor) Reconciliation project: Alere Reconciliation project for the reconciliation of Alere's processing of WellCare's claims data (medical, pharmacy and lab).

  • Performed Gap analysis reporting of 'as-is' and 'to-be' business environments for reconciling and used Iterative approach to project deliverables, including JAD sessions and peer review.
  • Involved in gathering the requirement BRD/FSD, Dev support and performing the Testing of the reconciliation processing activity by 33% by automation.

ICD 10(Affordable Care Act): To upgrade Wellcare applications from ICD9 to ICD 10.

  • Involved in performing gap analysis, mapping, and gathering requirement for the upgrade of ICD9 to ICD 10 for the analytics department.
  • Created and presented Project Charter and Projects Roadmap-2015 for the Project kick-off presentation meeting.
  • Project management support through performance metrics and risks management logs.
  • Conducted demos of Pre-released applications on weekly basis, weekly check in meetings, user story review meetings, story time meetings, Iteration planning meetings, backlog grooming meetings.
  • Involved in creating architecture view/BRD/FSD for the ICDN 10 mapping for Affordable Care Act (ACA) and also well versed with ICD10, Facets.

CMS(center for Medicare/Medicaid) Audit Extract, Approved/Denied Reports: To automate data extracts for Enterprise Medical Management Application (Universe)

  • To gather requirements and to create BRDs/FSDs to support the CMS audit to ensure timely and accurate delivery.

Annual Enrollment project- Medicare/Medicaid Correspondence changes

  • 2011/2012:Involved in the gap analysis of all the correspondence changes Medicare/Medicaid.
  • Maintain daily workflow prioritization to ensure pipeline management meets required closing dates Involved in creating Business/Functional Requirement Document for all Medicare/Medicaid LOBs ( Line of Business) Worked on AEP (Annual enrollment Period) roll over correspondence.
  • Involved in creating new BRDs and FSDs for Medicare/Medicaid ID card and letters.
  • Working as a single point of contact for all CTS (corresponding tracking system) related production issue.
  • Managing every day production issues, UAT defects and assigning tasks to developers and QA.
  • Involved in coaching requirement to the developers and creating solutions of requirement based defects.
  • Analyze complex user requirements, procedures, and problems to improve existing System design.
  • Created and maintained Requirements Traceability Metrics which covered full trail of all Clients for system requirement to test cases.
  • Involved in Verification of all type of defect, and doing modification, closed, re-open based on observation of defects.
  • Involved in Interacting with technical and development for cohesive design and sharing of best practices.
  • Responsible for the design, development, and implementation of the test plans.
  • Involved in providing weekly report to upper management about the defects, new tickets, and change request and framework requirements.
  • Review and modify programs to ensure technical accuracy, security and reliability.

Health Exchange:

  • Involved in gathering requirements and creating BRD for HIX project and worked on weekly Customer Billing Transmission (CBT) Files received from Catamaran for pharmacy billing purposes.
  • Have worked on 34 new letters for Obamacare, Health Insurance Exchange (HIX) project for KY and NY State.
  • Worked on Health Insurance Exchange (HIX) ID card implementation, involved in creating logic to pull the member's data for the ID card as based on zip code and member's provider/premium.

OB (obstetrician) Census:

  • Involved in creating the BRDs/FSDs to improve WellCare contract compliance with the vendor and generating a daily report from WellCare that will provide the necessary communication to improve their member engagement.

Sr Business Analyst, 07/2009 to 04/2011
W.R. Berkley CorporationHarrisburg, PA,
  • Analyzes existing software for incorporation of desired enhancements.
  • Performs detailed reviews and analysis of program changes, new equipment, new technology, and other factors and trends impacting existing systems in order to facilitate the development and conformance of system modifications.
  • Supervised all lab assistants, guiding them with student project development.
  • Involved in resolving day-to-day operational issues affecting online prospects, students, and graduates Played key role in reporting and analytics efforts for online team.
  • Worked with the Online Operations (DOO) team to identify reporting needs and create daily, weekly, monthly reports.
  • Analyze data in an effort identify opportunities for revenue, cost savings, and process improvement.
  • Created Use Cases and UML diagrams to capture the activity of a user using the system Responsible for the design, development, and implementation of the test plans.
  • Monitoring on-line systems, answering student inquiries supervising the lab sessions with Statistix 9.0 software for analyzing the data.
  • Teaching the concepts of data collection, summary statistics, and statistical inferential techniques and to help students to use these concepts to real data to use sample information to make inferences about populations of interest.
  • Refining my skills of Quantitative Reasoning and for the following dimensions: Critical Thinking, Inquiry-based Learning, Scientific Process, and Quantitative Literacy by teaching students.
Sr Business Analyst, 2005 to 03/2009
ExelonHoltwood, PA,
  • Gathered documents regarding HIPAA compliance, Local County and state compliance regulations.
  • Designed UAT test scenarios and wrote corresponding scripts after following through each test condition.
  • Read, understand and analyze the Business Requirement Specifications or Service Centre Tickets submitted by the business stakeholders.
  • Actively participated in business requirements gathering sessions to understand user needs which helps for system analysis.
  • Help stakeholders to identify possible system enhancements or fixes before it goes to a formal process to get approval by upper management.
  • Created estimates of the work effort required to support the impacts of the project.
  • Created As-Is and To-Be Process Flow Diagrams to provide complete understanding of the current system and system that would be impacted due to changes requested by business.
  • Facilitated Kick-off meetings to set expectations, validate analyst teams understanding about the business requirements, and timelines for project deliverables.
  • Conducted and participated JAD/JAR sessions with various business partners, SME's, End Users, for requirements gathering and analysis based on the business needs.
  • Responsible for capturing and documenting Meeting Minutes from JAD/JAR sessions and Team Meetings.
  • Managed the scope of a release/Sprint, drafting user stories, coordinating validation with the QA team members, supporting the team during iterations and serving as Scrum Master.
  • Created the burn down chart to manage the resource allocation as a Scrum Master.
  • Used Visio, Configuration Management tool, to maintain different builds of the application with descriptions about all changes and versions.
  • Perform integration testing, defect tracking, conflicts handling, and finally UAT support.
  • Worked with large number of XML files to transport data between systems and to generate PDF's (Proposals, Group Application Forms etc) in a Document Control Engine (DCE).
, to
Masters of Management Information System (MIS): Buisness, Expected in 2011
University of South Florida - Tampa, FL
GPA: GPA: 3.7/4

GPA: 3.7/4

Course Work emphasis in Datawarehousing,Datamining,Financial accounting and Project management.

Bachelor: Computer Science and Engineering, Expected in 2005
Uttar Pradesh Technical University - ,
GPA: GPA: 3.8/4.0

Computer Science and Engineering GPA: 3.8/4.0

Course Work in Software development.


EDI Transactions,Agile,Data Mapping,Business case, Business modeling, Business Objects, Business Plan development,Critical Thinking, data dictionary, Databases, documentation, sequence diagrams, ICD 10 facets, Java Script, Managing, Market, Meetings, MS Access, MS Excel, Exchange, MS Outlook, MS PowerPoint, MS Project, 2000, MS Word, Works, oracle, Oracle 8i, process improvement, processes, project development, Project management, Proposals, QA, Quest, Rational Rose, Reporting Requirement, requirements gathering, SAS EG, software development, MS SQL Server, SQL Server, statistics, supervising, System design, system analysis, Teaching, Toad, Process flows,UML, upgrade, validation, VB Script, view, Visio, Web Applications, workflow, XML.

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School Attended
  • University of South Florida
  • Uttar Pradesh Technical University
Job Titles Held:
    • Masters of Management Information System (MIS)
    • Bachelor

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