Abinaya Ramamoorthy

With over 5+ years of IT experience in the Healthcare industry, I specialize in Stakeholder Management, Requirements handling, On-Offshore partnership, Client Relationship Management, and enhancing Customer Experience. My expertise lies in Business Analysis, EDI (834/837), ACA/COBRA, and proficiency in SQL & JIRA. I excel in Claims Handling, ensuring compliance with SLAs, and preparing claim reconciliation reports.

Additionally, I possess strong skills in EDI & Data Management, Requirements Gathering, Documentation, Workflow Diagram creation, and proficient in Analysis & Problem-Solving. Returning after a maternity break, I am eager to leverage my skills and expertise in a challenging role.

Senior Business Analyst - Optum

(2023-11 - 2024-02)

• Successfully implemented US healthcare clients in the system, streamlining the onboarding process and ensuring seamless integration.
• Proficient in managing 837 and 835 files for claims, ensuring accuracy and compliance with healthcare regulations.
• Specialized in claims handling and adjudication, resolving issues efficiently and minimizing errors.
• Managed reports effectively, ensuring accuracy and timely delivery of essential data for decision-making.
• Conducted training sessions for new hires, imparting knowledge and skills essential for efficient claims management.

Senior Analyst - Wipro

(2022-06 - 2023-08)

• Managed plan setup, eligibility/census files, and outbound vendor file exchanges, ensuring smooth operations in the healthcare domain.
• Collaborated with major healthcare vendors (Anthem, BCBS, Aetna, Optum, Kaiser) to maintain accurate data exchange and compliance.
• Performed root cause analysis of claim and data issues, driving corrective actions that reduced recurring errors.
• Prepared claim reconciliation reports, ensuring 100% adherence to SLA timelines for claim file submissions.

Software Test Engineer - Congruent Solutions

(2021-11 - 2022-05)

• Proficient in manual testing across SDLC.
• Skilled in test case design, execution, and defect tracking.
• Hands-on experience with API testing with Postman tool.
• Intermediate knowledge of SQL queries and database testing.
• Experienced in preparing test plans, scenarios, and documentation.
• Familiar with Agile methodologies and collaborative team environments.
• Focused on delivering high-quality, defect-free applications.
• Quick learner with strong analytical and problem-solving skills.

Analyst - Wipro

(2019-02 - 2021-11)

• Streamlined processes to improve efficiency.
• Managed plan setup, eligibility/census files, and outbound vendor files in the healthcare domain.
• Collaborated with major healthcare vendors such as Anthem, BCBS, Aetna, Optum, Kaiser, etc.
• Identified root causes of issues in claims and data, and recommended corrective measures.
• Prepared claim reconciliation reports to ensure compliance with SLAs for claim file submissions.
• Gathered client requirements and translated them into functional documents.
• Created workflow diagrams to support documentation processes.

MBA/PGDM - Bharathidasan University, Trichy (2018)

B.Tech/B.E. - Anna University (2016)