Candidates About

 

Ruchi Marwaha

 

Professional Summary:

            •           8+ years of varied experience in Business Analysis across various domains including Personal Insurance, Health care, Medical Billing and Claims PROFESSIONAL Management

 

            •           Domain expertise in Personal Insurance Health care insurance and Claims Analysis and Management

            •           Experienced in interacting with business users to identify their needs, gather requirements and author Business Requirement Documents (BRD)   and, Functional Requirement Document (FRD).

            •           Extensive experience in creating user stories both business and technical.

            •           Experience as a Data Analyst / ETL/ BA, with Progressive responsibilities in data analysis with focus on financial reporting, and Data warehouse (DW), business intelligence (BI).

            •           Good working knowledge of HIPAA ICD10 and HIPAA transaction requirements.

            •           Experience with Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 270/271, 276/277, 834, 835, 837, 997, and NSF formats for interfaces and images to third part vendor applications.

            •           Vast experience of working in the area of data management including data analysis, gap analysis and data mapping.

            •           Strong understanding of medical coding and transition from ICD 9 – ICD 10

            •           Experience with claims process and adjudication in the Medicare, Medicaid and Private Insurance Sectors.

            •           Adept at writing Data Mapping Documents, Data Transformation Rules and maintaining Data Dictionary. 

            •           Extensive experience in Data warehousing, creating Fact Tables, Dimension Tables, star and snowflake schema modeling.

            •           Excellent experienced in data Extraction, Transformation and Loading (ETL)

            •           Solid experience in Claims Processing 837 transactions and remittance 835 EDI files

            •           Adept with different methodologies which include Agile, Waterfall and Rational Unified Process (RUP)

            •           Well versed in Requirement Gathering through techniques such as JAD sessions, Interviews, Document analysis and Reviews

            •           Expertise in documenting Non-functional requirements in a Traceability matrix (RTM), (Tracking and managing:  that controls numerous artifacts produced by the teams across the deliverables for a project.

            •           Use case Specifications, the complete System requirement specifications (SRS).

            •           Experience in creating and running SQL queries.

            •           Design and development of Use Cases, Activity Diagrams and Sequence Diagrams using UML

            •           Experience in UML 2.0, MS Visio, Rational Rose, Rational Clear Case, Rational Requisite Pro, Rational Clear Quest, MS office Suite (MS Word, MS Excel, MS Visio, MS Project & MS SharePoint)

            •           Involved in meetings for Test Planning, Test Preparation, Test Execution and Issue Resolution and Report Generation to ensure that all aspects of a Project are in Compliance with the Business Requirements

            •           Reviewed Test plans to make sure all the requirements have been covered and corresponding test cases have been created

KEY TECHNOLOGIES & TOOL EXPERIENCE

            •           UML Tools     :                      Rational Rose / Microsoft Visio,

            •           Rational Tools :                       Clear Case/ Clear Quest, Requisite Pro, SharePoint

            •           Databases        :                       Oracle, DB2, MS Access, SQL Server , Teradata

            •           Methodology  :                       Waterfall, RUP, SDLC, UML, Agile, SAFe

            •           Web Design    :                       HTML, DHTML, XML

            •           Front end tools :                      Microsoft Project, MS Visio, Informatica,Toad,Rally,SOAP, Wireframes, Mockups

            •           MS Office Tools         :           MS Outlook, MS Word, Ms Excel, MS Access, MS PowerPoint

            •           Operating Systems      :           Windows 98/2000/XP/Vista/7, Mac OSX

 

                                             

Travelers , Hartford                                                                             February 2016- Present

Sr. Business System Analyst

The Travelers Companies is an American insurance company. It is the second largest writer of U.S. commercial property casualty insurance and the third largest writer of U.S. personal insurance through independent agents. Travelers is incorporated in Minnesota, with headquarters in New York City and its largest office in Hartford, Connecticut. I am involved in 2 projects one (AIA) which is delivered last year where we add functionalities to the current auto and Property insurance like adding new features for the customers for 2 states Arizona and Organ . Elicit, analyze, specify and communicate business, system and implementation requirements and handled the defects before delivering project successfully. And now I am in other project (Q2) which is extension of the last project adding   more states like Colardo,Oregan and Wisconsin for the new features and functionalities for customers.

Identified, refined, and accurately articulate the business objectives and value proposition of assigned initiatives..

Ensured the solution (people, process and technology) meets the program and/or project objectives and is aligned with business and IT strategic direction.

Participated in the development of a compelling business case that measure and communicate proposed project benefits.

Collaborated with project leads to determine how requirements will be approached and managed for a particular project.

Worked with project leads to develop requirements work plans, identify task dependencies, develop estimates and determine resource skill requirements; support risk management and change management activities.

Provided support and mentoring to other analysts and team members to facilitate a better understanding of requirements techniques, processes and deliverables required to support successful project delivery.

Took responsibility for the success of the Requirements Definition Process for assigned work with limited supervision; Elicit, analyze, specify and communicate business, system and implementation requirements

Ensured the requirements are unambiguous and understandable by both business users and solution delivery teams.

Work with stakeholders to prioritize requirements effectively based on business value, risks and constraints.

Effectively identifies and manages requirements conflicts and issues to resolution

Ensured that requirements are understood and approved by all stakeholders.

Measures and tracks quality of business systems analysis work.

Ensured the test strategy and test plans adequately cover the requirements. Assist in defect resolution.

Simultaneously support multiple initiatives as assigned.

Perform other duties as assigned.

 

 

 

 

 

 

 

 

 

Cigna HealthCare,Bloomfield                                                               July 2015- January2016

Sr. Business Analyst:

Cigna  is a global health service leader dedicated to helping people improve their health, well-being and sense of security. The project is to consulate small data warehouses into one big Cigna Corporate warehouse and to shift from waterfall methodology to agile. Responsible for review of business capabilities and requirements in order to define data needs and objectives of portfolio projects and enterprise data management. Includes data analysis of business and user needs and documentation of data and mapping requirements. Coordinates with both business and IT partners to ensure business, data needs and views are properly represented throughout the project lifecycle. Participate in testing activities to ensure traceability of requirements. Coordinate communication regarding implementations.

Responsibilities:

            •           Identify and document total data needs for strategic enterprise programs:. I worked closely with business stakeholders, portfolio project teams, and application SMEs to identify and document the total data needs of strategic programs for Enterprise Data Management processes

            •           Develop business use cases, business and data requirements, and related documentation in support of Enterprise Data Management. I worked closely with business owners and stakeholders at multiple levels in the organization to understand, prioritize, synthesize, and document data needs for enterprise programs and MDM assets.

            •           Understand and inventory the business processes and business decisions which are enabled by EDM

            •           Provide data expertise:  Partner with application SMEs to gain a deep understanding of source data as well as transformation, cleansing, or aggregation rules that impact MDM.

            •           Acts as the liaison between business owners and IT: In addition to the partnership with business owners, also partner with other roles including Architects, Designers, Developers, and Testers to ensure enterprise data needs are met.        

            •           Worked closely with systems analysts to ensure functional specifications are properly accounting for business needs. Facilitated meetings, as necessary, to review captured business needs and obtain approvals.

            •           Transferred knowledge to production support team and matrix partners -- provided documentation that can be referenced for cross-training and issue resolution.

            •           Performed data Validation for Provider’s with reference to business requirements and logic captured in STM (source to target Mapping) documents.

            •           Maintain TDE(total data elements) and  regularly update TDE  with STM documents changes.

            •           Maintaining the score card according to the data elements coming from different provider source

 

1199 NBF Healthcare Union Organization, NYC,                               July 2013 – June 2015

Business Analyst:

The 1199SEIU Funds is the strongest and largest healthcare labor-management organization in the nation, providing a range of comprehensive benefits to 400,000 working and retired healthcare industry workers — members of 1199SEIU United Healthcare Workers East — and their families. I was involved in gathering business and system requirements on various projects including federally mandated CAQH CORE EFT Payment Process and Infrastructural Rules for 835 transactions to which all HIPPA covered entities must comply. This project was to identify and implement the various system changes required to support EFT and ERA and work with the third party vendor for setting up the EFT Enrollment process for the providers. I was involved in documenting BRD, FRD and I also participated UAT Testing.

The second project Executive Dashboard Reporting was to automate the current reporting process that was totally manual and to provide user interface to the users so that they can enter all the claims related key volume indices in one UI. Most of these projects were done using Agile Software Development Life Cycle, SDLC.

Responsibilities:

            •           Gathered requirements from the Subject Matter Experts and documented the business requirements in the BRS and system requirements in SRS.

            •           Participated in Stake holder discussions during initiation phase and assisted in preparing the preliminary scope statement.

            •           Facilitated face to face, teleconference and web-conference meetings for requirement gathering and discussions.

            •           Identified gaps in the business process and did extensive data mapping of EDI and paper claims for Executive Dashboard Reporting project.

            •           Created Vitech workflows for Pension Application Process and Employer Inquiry Process in MS Visio and updated the Vitech specs.

            •           Developed and designed Claims KPI matrix for discovering the performance and operational efficiency of claims adjudication process.

            •           Acted as liaison between functional business units and application team managers to assist in defining objectives, requirements, functions, and priorities of applicable business system related projects.

            •           Developed Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements.

            •           Developed and managed work plans, acted as the key client contact, handled scheduling, resource planning and allocation matters, ran status meetings and compiled various reports on the progress of the project.

            •           Evaluated all the information gathered from multiple sources, reconciled conflicts, decomposed high-level information into details, abstracted up from low-level information to a more general understanding, distinguished user requests from  the underlying true needs and distinguished solution ideas from requirements.

            •           Coordinated and facilitated user acceptance testing (UAT). Reported and documented any issues occurred during UAT.

 

eHealth- Health Insurance, San Jose, CA                                                          August 2011- June 2013

Sr. Business Analyst

The project was contributed to the early phase into conversion of ICD-9 to ICD-10 compliant with HIPAA 5010. (HIPAA) require that all health insurance payers in the United States comply with the EDI standards for health care as established by the Secretary of Health and Human Services. The Addenda version of the ANSI ASC X12 837/835 transaction set was selected as the HIPAA-mandated format for electronic Enrollment and disenrollment in a Health Plan. Along with that also managed claims processing for the entire enterprise of EDI X12 837/835 (I/P/D).            

Responsibilities:

            •           Assisted in identifying project scope, to conform to the regulatory compliance related to X12 837 (I/P) and 835.

            •           Responsible for soliciting and eliciting requirements for 4010-5010 conversions.

            •           Carried out Risk Assessment, GAP analysis and Impact Analysis for the 4010-5010-conversion project.

            •           Involved in one-to-one interview sessions and JAD sessions with stakeholders, SME’s and business owners to discuss the scope of the conversion.

            •           Produced for transaction sets 835 and 837 (I/P) a full gap analysis 4010 vs. 5010 against the documented application 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliancy.

            •           Involved in up-gradation of 4010 transaction to 5010 by conducting Impact Analysis and Risk Assessment and worked on the mitigation plan to avoid the risks.

            •           Tracking and addressing the problems on timely manner encountered on Acknowledgement 997, Claim Status Inquiry/Response 276/277, Remittance Advice 835, Eligibility Inquiry/Response 270/271, and Prior Authorization 278 claims.

            •           Worked as a liaison among stakeholders both business and IT side in order to elicit, analyze, communicate and validate requirements for changes to business processes.

            •           Involved in creating Reports and Documents like Requirements Documents, and Management Plan, Issue/Alternatives documents, Project Summary and Plans with formats like PDF, HTML, Excel and Word.

            •           Prepared UML diagrams (Activity diagrams, Sequence Diagrams, Use case diagrams) for Extensions.

            •           Involved with reviewing defects reported from UAT efforts and analyzed for root cause and took actions based on the findings.

            •           Identified the master file changes and builds needed to enable the 5010 format to be utilized.

            •           Conducted Business Process (As Is/To Be) sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.

            •           Gathered requirements for impacted system and business areas for ICD-10 and their needs to embrace the changes.

Environment: MS Visio, .NET, MS Office, MS Access,  Mercury Quality Center, ARGUS, MedDRA,J2EE, HTML/XML

 

Coventry Health Care, Downers Grove, IL                                                               Sept 2010 -August2011                         

Position: Business/ Systems Analyst

Coventry provides a full range of products and services, including group and individual health insurance, Medicare and Medicaid programs, and coverage for specialty services such as workers’ compensation and behavioral health care. This project intended to comply with HIPAA 5010 standards. It required the analysis of EDI transactions 837P, 837I and 835 based on HIPAA 4010 and mapping them in order to comply with HIPAA 5010 standards.

Responsibilities:

            •           Worked on analysis of the Facets claims processing application in order to gather requirements to comply with HIPAA 5010 requirements.

            •           Analyzed HIPAA 4010 and HIPAA 5010 standards for 837P, 837I and 835 transactions and prepared gap analysis document for each transaction.

            •           Utilized RUP methodology during the project life cycle and worked together with RUP mentors at the location.

            •           Wrote high level and low level business requirements for the project.

            •           Supported developers with creating database objects like Tables, Triggers, and Indexes using T-SQL Management Studio.

            •           Analyzed the existing data model and provided suggestions and recommendations

            •           Worked with the solution architect in order to understand the existing data model and modify the data model to accommodate the required 5010 changes.

            •           Dealt with data mapping issues between various source systems and staging area and data marts

            •           Worked with data mapping team to create data maps for data integration task i.e. transformations.

            •           Utilized Mercator as an EDI mapping tool to map the claims data that passes through the EDI gateway to the Facets claims processing application.

            •           Conducted meeting with the EDI team and other stakeholders team members to discuss the requirements

            •           Responsible for transforming data from OLTP to OLAP data sources using SSIS.

            •           Involved in meetings with product manager, project manager, onsite and offshore team members to resolve issues and roadblocks during the project.

            •           Used Rational Requisite Pro for overall Requirements Management and to build the Requirements Traceability Matrix.

            •           Involved in identifying the integration points within the organization as required for the project, involved in preparing test cases and UAT.

            •           Provided business and technical suggestions and recommendations during the project life cycle.

            •           Worked closely with the business team, development team and the quality assurance team to ensure that requirements are understood as intended in order to achieve the desired output.

            •           Involved in performing several database tuning tasks and built reports using PL/SQL.

            •           Extracted large volumes of data from legacy systems and uploaded into the Oracle database using SQL*Loader and PL/SQL.

            •           Ran SQL queries to check the results of the involved database.

Environment: MS Visio, Excel, MS office, Rational Rose, Dreamweaver, Rational Unified Process (RUP), ETL, Agile, SQL Server, Informatica.

 

Eagle Insurance, Chicago, IL                                                                                   June 2008 – Aug 2010

Business Analyst

Eagle Insurance has expanded into a broad variety of business over the years; their main focus is property-casualty insurance, personal auto and homeowners insurance. The project's scope was to build an Internet based application for online claims management, which would allow customers to submit online claims for Worker's Compensation (Property and Casualty) and the Non-worker's Compensation.

Responsibilities:

            •           Obtained business requirements from business users and stakeholders using JAD sessions, brain storming sessions, focus groups and personal interviews to get a better understanding of the client’s business process.

            •           Worked with the business to document and develop formulas for the calculation of premiums and losses statistics in the marts (eg. Written Premium, Earned Premium, Unearned Premium)

            •           Elicited, documented, modelled, validated and prioritized functional and non-functional requirements using interviews, data analysis, and different modelling tools.

            •           Actively involved in preparing and writing the business requirement documents, functional requirement documents and data mapping documentation.

            •           Performed in depth data analysis identifying data issues in legacy system and worked with business to develop resolutions to those issues.

            •           Used MS Project for status reporting and planning.

            •           Utilized MS Visio for designing Use Case Diagrams, Activity Diagrams and Sequence Diagrams, after accessing the status and scope of the project and understanding the business processes.

            •           Analyzed the as-is and to-be state of the project and performed Gap analysis, Impact analysis and SWOT analysis.

            •           Created data mapping documents for the movement of data from production databases to the warehouse and from the warehouse to the policy and claims marts.

            •           Used the guidelines and artifacts of the SCRUM methodology for project implementation and development.

            •           Assisted System Architects and Quality Assurance Analysts in creation of various tests.

            •           Assured that all artifacts are in compliance with corporate SDLC policies and guidelines.

            •           Assisted in deletion of defects and bugs, in order to meet specific requirements and deadlines for successful execution of the project.

            •           Worked as an SME for identifying the scope of End-to-End testing with different teams

            •           Coordinated UAT of the product with Business Users

 

PruLife UK Manila, Philippines                                                                                           June 2007-March 2008

Functional Analyst

Prulife Uk is one of the leading life insurance companies in the Philippines, with over 18 years of existence in providing relevant and innovative life insurance products design to meet the specific needs of public. Prudential plc has an extensive network of life insurance and mutual funds operations around the world, active in United Kingdom(UK) , Europe, The United States (USA) and 14 markets in Asia.I entered in this company as a Beginner but after working on an important project I found myself bit improved in context of employee prospective. The focus of the project was to upgrade the existing website to provide a wide range of features like policy value, rider information, billing option, beneficiary information and agent information for current policyholders and new customers. I worked on enhancements of the already available online products of Prulife as well as implemented new products like opening accounts online, policy value comparison, etc.

Responsibilities:

            •           Acted as liaison between Information Systems group and Business User group.

            •           Conducted business requirements, functional and technical walk-through meetings.

            •           Met with key business unit stakeholders to gather requirements and needs.

            •           Coordinated with SME's to gather requirements and document Gaps in functionality.

            •           Developed written requirements to clearly, define and detail the needs of the business unit. Requirements included screen design and process flow charts.

            •           Created and updated use cases, use case diagrams and work flows.

            •           I was Involved in the entire project life cycle from evaluation, installation, development, testing to production of end user reports.

            •           Defined user and system requirements for existing and proposed system during existing system integration and new system development initiatives.

            •           Worked with GUI team for designing the screens and assisted in developing mockup screens and prototyping of the user interface and usability testing.

            •           Designed the System Flow, Data Flow diagrams, using these as the base to obtain requirements and wrote Use Cases.

            •           Built catalog using Impromptu Administrator and created joins, custom folders for easy access and understanding.

            •           Assisted the business unit and teammates with resolving production issues.

            •           Used Flat Files at a very basic level for configuration of data storage.

            •           Managed Portia report writing for trading and operations business units. Managed import and reconciliation of historical performance data.

            •           Used MS SharePoint for the purpose of managing documents and for hosting websites which was used to access shared work spaces and documents.

            •           Experienced in creating training materials, SOP and handling documentation.

            •           Documented business processes and communicated potential business and systems impact based on analysis of the data.

            •           Tasked with documenting, storing, and sharing the issues and documentation using Rational Clear Case.

            •           Created Export Archives to deploy reports and packages from development to test environment.

            •           Assisted QA Team in designing the Test Cases, and collecting the Test Metrics.

            •           Documented functional and technical designs and user guides.      

Environment: MS Office, MS Visio, MS Project, MS SharePoint, Rational Clear Case, UML, SQL, Rational Rose.