TEST ARCHITECT II SOFTWARE TESTINGClient: Blue Cross Blue Shield Association (BCBSA), USA; Domain: HealthcareLed the testing and integration of the Care Coordination Technical Infrastructure (CCTI), which linked members’ healthcareneeds with critical services across the continuum of care. Implemented advanced AI, ML, NLP, and cloud-based solutions(AWS, Azure, Google Cloud) to enhance the efficiency and accuracy of healthcare claims adjudication, improving servicedelivery. Utilized cloud platforms (AWS, Azure) to scale the solution, ensuring high availability and security of sensitive healthcaredata.Streamlined healthcare coordination, improving care management for millions of Federal Employee Program (FEP)members. Collaborated with stakeholders to translate healthcare requirements into actionable test strategies, ensuring regulatorycompliance with complex and business requirements. Played a pivotal role in preventing healthcare service disruptions for millions of individuals under tight deadlines. Provided leadership to offshore teams, ensuring consistent alignment with project objectives and enhancing theircapabilities through training on AI and cloud technologies.Key Accomplishments:------------------------ Designed and deployed an AI, ML, and NLP-powered automation framework that reduced claims validation time from 20days to 2 days, validating 200 million claims within this period.Led the implementation of AI solutions that minimized manual intervention from 30% to 5%, allowing the team toadjudicate 3 million claims per day, directly contributing to enhanced healthcare outcomes.Delivered significant cost savings through the automation of healthcare processes while enhancing service delivery forpatients and healthcare providers.

Managed the testing and enhancement of Elevance Health’s claims processing system, with a focus on modernizing the platform using AI, ML, NLP, and cloud technologies. This project streamlined administrative processes and improved claims accuracy while also enabling compliance with new healthcare regulations. Designed and led the development of AI and ML-driven automation frameworks for claims adjudication, significantly reducing error rates and improving processing accuracy across multiple platforms (EPDS, FACETS, WGS/ISG Legacy). Utilized AWS and Snowflake to enable real-time data processing, improving the system’s ability to handle complex healthcare claims while ensuring high performance and scalability. Optimized provider migration processes by leveraging NLP technologies to automate data extraction and validation, ensuring seamless integration of healthcare provider data. Developed process improvement strategies that contributed to claims adjudication and enhanced overall system stability.Key Accomplishments:-------------------------- Spearheaded the development of the C19 Navigator and C19 Enterprise Dashboard, enabling U.S. healthcare leaders to make data-driven decisions during the COVID-19 pandemic. Developed APIs that conform to the FHIR standard, improving healthcare data interoperability and enabling secure access to patient records at nationwide Centers for Medicare and Medicaid Services. Led the creation of the Patient Access API, adopted by 64% of health plans, providing patients with easy access to their clinical and medical information. Successfully implemented a remote monitoring system for hospitalized patients, achieving a 46% patient adoption rate, which reduced the need for face-to-face interactions during the pandemic. Recognized internationally by The Business Fame and Indian Achievers for healthcare data sharing and interoperability.

Led the development of a Customer Data Mart as part of Walgreens’ loyalty program, focusing on integrating healthcare and retail data into a single consolidated view. This project required the use of cloud-based data warehouses and advanced data validation processes to ensure the accuracy of customer information across multiple systems. Interpreted functional specifications through detailed walkthroughs and meetings, translating requirements into AI and cloud-enabled testing frameworks. Played a crucial role in preparing the Validation Master Plan, Test Scripts, and Traceability Matrix, leveraging machine learning techniques to improve test execution efficiency. Managed the planning and execution of validation activities, ensuring that AI-powered tools were used to enhance data accuracy and system reliability. Monitored project progress and defect management, utilizing cloud-based testing environments to enable real-time collaboration with offshore teams. Conducted daily interactions with stakeholders, providing updates on testing progress and ensuring that all project objectives were met through automation frameworks. Produced key documentation such as Design Reviews, Post-Execution Reviews, and Closure Reports, ensuring that all validation efforts were aligned with AI and cloud strategies.

Led the Non-ICD10 Claims Upgrade release for WellPoint, focusing on enhancing the claims system to support compliance and provide a consistent source of healthcare data. This involved integrating various data sources into the EDWard system, leveraging cloud infrastructure for scalability and security. Attended release planning meetings to identify key projects for deployment, ensuring that AI and NLP technologies were incorporated into the testing processes for improved claims validation. Provided testing estimates and schedules, ensuring that cloud-based platforms were leveraged for scalability and efficiency. Conducted detailed business and technical requirement analysis, collaborating with offshore teams to implement AI-driven testing frameworks that improved claims processing accuracy. Coordinated defect management, using automation tools to streamline issue identification and resolution while ensuring alignment with AI and cloud strategies. Led defect triage calls with business and development teams, ensuring rapid resolution of issues using NLP-driven solutions. Updated daily execution reports, ensuring transparency and continuous improvement in the testing processes.

Led multiple enhancements to Nordstrom’s customer knowledge data warehouse aimed at generating actionable insights from customer purchase behavior. The project focused on improving the accuracy and efficiency of customer lifecycle reporting to support Nordstrom’s business strategies. Analyzed functional specifications and facilitated documentation walkthroughs to translate requirements into comprehensive testing plans. Prepared and implemented the Validation Master Plan, Regulatory Risk Assessment, and Traceability Matrix, ensuring seamless alignment with project objectives. Planned and oversaw validation activities, delegating tasks to the offshore team and ensuring the accurate execution of test cases. Coordinated with the onsite team for clarifications on requirements and allocation of tasks, leveraging automation frameworks to streamline testing processes. Created and maintained the Traceability Matrix, mapping test cases to functional specifications to ensure full coverage. Verified that the tested application adhered to the Validation and Test Plan, ensuring that all startup criteria were met before deployment. Communicated testing progress, challenges, and results through Daily/Weekly/Monthly status reports to stakeholders, ensuring transparency and timely issue resolution.

Led data enhancement initiatives for WellPoint’s claim processing system (Diamond 950), which included integrating new states into the existing system. The project aimed to comply with HIPAA mandates, requiring healthcare providers to obtain a National Provider Identifier (NPI) for electronic transactions. Conducted an in-depth analysis of functional specifications through detailed walkthroughs and meetings, ensuring a clear understanding of project requirements. Developed test scenarios based on functional specifications, ensuring alignment with business and regulatory requirements. Created and executed test data for various scenarios within the application, ensuring that the system met functional and technical requirements. Managed defect reporting and verification, ensuring timely identification and resolution of issues. Facilitated knowledge transfer sessions for team members, ensuring they were well-versed in project requirements and best practices. Captured objective evidence on Operational Qualification (OQ) script executions, ensuring adherence to validation protocols. Authored key documentation, including Validation Summary Reports, Traceability Matrices, and Closure Reports, ensuring all deliverables met quality standards. Continuously updated skills and knowledge through training programs, staying current with industry trends and technologies.