Expertise in the field of information technology, senior business analyst with a focus on business analysis in data analysis, data transformations, data mapping, and quality analysis.

 Created problematic complaints in the system for processing dental claims. Tracked the development of all open insurance claims. Arranged healthcare records, treatment schedules, and referrals. Vision and optional dental coverage are subject to additional limitations and waiting periods. Create monthly ad hoc reports to determine lead generating potential and the status of ongoing investigations. Implementing fraud detection tactics and referring referrals to law enforcement for follow-up action saved the Medicare program approximately 5.5 million. Prior to submission to CMS, HHS-OIG, and FBI, a thorough evaluation of all referrals for administrative action is conducted. EDW Warehouse & HEDIS Quality & Commercial Analytics (60% Remote Working) produced thorough reports on various agencies and governing bodies as needed.  Adequate data quality that is guaranteed and maintained in accordance with corporate procedures, laws, and data governance standards. Attending to Medicare-eligible members and teaching them about their Medicare Insurance alternatives during the Annual Enrollment Period Highlighting the advantages of various firm’s plans and guiding customers in selecting the best one for their needs and budget. Helping members complete the enrolling in a plan procedure.

 In charge of gathering business requirements and documentation, defining the project's scope, and putting business rules into effect. Writing functional requirement specifications (FRS) and user requirement specifications is your responsibility (URS). Using Rational Rose and the UML approach, I analyzed the business requirements and divided them into high- and low-level use cases, activity diagrams, and state chart diagrams, which defined the data process models. Develop an idea for the To Be system, comprehend the As Is system, and create system process maps. Create user acceptance test cases and BRDs. Under excellent GxP Quality Standards, identified, explored, realised, analyzed, specified, and documented business processes and uses case scenarios. SIHO serves as the main point of contact for IUHP about its Fully Insured product range. In charge of supervising the SIHO claims system's installation of new and renewed employer groupings. New benefit plans and programmers to enhance procedures were put in place to boost productivity and cut down on physical labor. Tracked releases, stories, epics, tasks, and defects using JIRA. Spent a lot of time working with the Oracle database to construct business reports and extract data. Practical experience in carrying out software development projects utilising techniques like Waterfall, Rational Unified Process, and Agile/Scrum Developed the configuration document for a special configuration for a range of user groups, including marketing, R&D and sales, research analysts and investigators. Created a permissions and user access matrix for the clinical trial papers. Created and implemented validation standards for testing GMP, GCP, and GLP sensitive transactions. Employed waterfall and RUP as examples of SDLC (System Development Life Cycle) techniques. Completed a thorough study of the requirements, which included data analysis and gap analysis.

 Throughout the project, only RUP techniques were used. Improved product quality by upgrading the pre-existing test scripts and developing new scripts for the client application to work with new versions and patches. Data Stage tasks were developed to extract, convert, and load data from a variety of sources, including relational databases, application systems, temporary tables, flat files, etc. into data warehouses. Participating in the mentoring of specific projects utilising the new SDLC based on the Agile Unified Process, particularly from the project management, needs Jira assignments that were tracked. Assisting in the conceptual and logical model definition for the data warehouse and data modeling. The application was created using the agile software development process. Using a GMP procedure, I estimated the ethylene/propylene polymer ratio and wrote an analysis report based on it. I also developed functional test cases, documented them, and ran the test script in the Facets system. Worked with diagnosis codes, procedure codes, provider types, service types, and specialty codes. Conducted JAD sessions for open and outstanding issues with management, SME, vendors, users, and other stakeholders. Participated in new relational or multi-dimensional databases' development, design, and deployment, including user requirements analysis

 Work together with the hospital, administrators, supervisors, and other specialized support staff. Demonstrate communication and inter personal skills in relation to interactions with patients. Learn about the practice of medicine in the tropics. Enhance your ability to operate in this atmosphere. Encourage dissemination of accurate information regarding medical facilities and services throughout the nation. Collaborated with other medical professionals to deliver comprehensive treatment for challenging cases. Devoted weekly hours as a doctor on call at a nearby hospital to help out the staff. Collaborated with other experts to share knowledge and strategize about the best treatment options. Recognized life-threatening situations and crises and sent patients right away to the hospital for timely treatment. Used open-ended questions and active listening to provide patients with high-quality treatment. Consulted with experts to get insight into patient conditions and identified patients in need of more treatment.

 Requirements were gathered for the service verification and claims transaction extraction projects through JAD sessions, interviews (both group and private), and discussions with users and stakeholders. Using MS Visio, I produced the use case diagrams, activity diagrams, class diagrams, and sequence diagrams. assisted with electronic data exchange and worked on creating the use cases and business requirements for Facets batch operations Understanding of database architecture and experience using Epic to produce complicated reports Extensive expertise developing Clarity Reports for the HB and PB module. Extensive experience writing Clarity Reports for the ASAPAND him module. Reviews data to verify data integrity, correctness, and validity. Add data from Clarity to the data ware house. Excellent problem - solving knowledge of managed file transfer principles, problems, and file transfer protocols (FTPs, SFTP, etc.) Used BI and ETL tools (Business Objects Data Integrator) to assist in the creation, modification, and customization of reports for Physicians Network utilising RWB and Crystalversions8, 11, and 13. Taught staff members about any potential issues with Crystal Reports, SQL, and BO, including but not limited to CTEs, unions, stored procedures, and lag/lead. Examined and fixed data problems and inconsistencies in financial reconciliations The project protocol was developed in conjunction with a multidisciplinary team that included doctors.