Naresh Khura

Product Specialist — Healthcare Business Analyst - Cognizant Technology Solutions - Hyderabad, India

(2023-07)

Supported a large-scale FACETS-based payer platform migration by leading requirement analysis and translating business needs into 15+ BRD/FRD functional specifications, accelerating sign-off cycles and reducing development rework through clear stakeholder alignment.
Validated end-to-end claims lifecycle — intake, pricing, adjudication, and settlement — for Medicare and Medicaid payer workflows by applying CPT, HCPCS, ICD-10, revenue codes, and modifiers against CMS regulations, ensuring regulatory compliance and reducing claims rejection rates.
Investigated complex Coordination of Benefits (COB), duplicate, and replacement claims that were driving high-volume production defects; performed deep-dive SQL data validation and data mapping across healthcare datasets, resolving critical adjudication failures and improving claims processing accuracy.
Coordinated full UAT program for healthcare claims edge cases across cross-functional stakeholder groups; authored comprehensive test scenarios, tracked 100+ defects in JIRA, and validated workflows end-to-end, achieving on-schedule sign-off for major payer system releases.
Collaborated with business stakeholders, developers, and QA teams to deliver system enhancements, supporting faster resolution of production escalations and improving overall FACETS platform performance.

Programmer Analyst Trainee - Cognizant Technology Solutions - Hyderabad, India

(2022-03 - 2023-06)

Designed and executed structured SIT, Regression, and UAT test cases for FACETS-based healthcare claims modules covering Medicare and Medicaid eligibility and benefits adjudication workflows, identifying defects early and reducing production incidents.
Authored and executed SQL queries for healthcare data extraction, validation, and defect traceability to investigate claims data discrepancies causing adjudication errors, contributing to measurable improvement in claims data accuracy and defect resolution time.
Maintained Requirement Traceability Matrix (RTM) and created Standard Operating Procedures (SOPs) for claims workflow processes, reducing analyst onboarding time and ensuring consistent process adherence across teams.
Partnered with analysts, developers, and QA teams to resolve claims processing issues, supporting continuous improvement of FACETS-based payer system performance and delivering high-quality healthcare payer solutions.

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