Associate - QEA HC - Cognizant - Chennai, India
(2023-03)
Project Name: CVS Caremark
- Actively involved in the development of a clinical tool application that extracts data from RxClaim 'AS400', applies specific rules, and generates reports that are used for XREF migration.
- Review the ODM 'Operational Decision Manager' rules mapping document, and provide requirements to the automation team.
- Validate the data accuracy that is exported to myPBM and Benefit Plan Summary (BPS).
- Extract the existing plan benefits so that plans are activated on myPBM for the Client Plan requirement.
- Performed various benefit and functional testing of the new implementation 'NBI' and maintenance of business 'MOB'.
- Analyzed and understood the Client Requirement Document (CRD), Benefit Plan Summary (BPS), Clinical Plan Management (CPM), Utilization Management (UM), and Formulary, and created test cases for all Benefit Plans in scope.
- Created test cases, executed test cases in a client-specific application, and reported and tracked defects in Salesforce CRM.
- Performed various defect management and 5 'Why' root cause analyses, presented RCA to clients, and suggested improvement plans.
Programmer Analyst - Cognizant
(2021-07 - 2023-03)
Project Name: CVS Caremark, Domain: Quality Engineering and Assurance
- Coordinated testing with user stories. Developed test plans and defined end-to-end scenarios for test cases.
- Executed a structured test strategy. Categorized tests into Smoke, Sanity, and Regression. Provided insights into the software development lifecycle.
- Managed defects proactively using JIRA and SFDC. Ensured systematic tracking from discovery to resolution.
- Generated concise Test Reports. Facilitated clear communication with stakeholders.
Senior Process Executive - Cognizant
(2017-03 - 2021-07)
Project Name: Anthem Blue Cross, Domain: Healthcare
- Aligned testing with user stories. Developed test plans and identified end-to-end scenarios for test cases.
- Implemented a structured test strategy. Categorized tests into Smoke, Sanity, and Regression. Contributed insights to the SDLC.
- Proactively managed defects using JIRA and SFDC. Ensured systematic tracking from identification to closure.
- Prepared concise Test Reports. Facilitated clear communication with stakeholders.
Process Executive - Cognizant
(2015-08 - 2017-03)
Project Name: Anthem Blue Cross, Domain: Healthcare
- Oversaw billing and claims adjudication within the insurance sector, ensuring full compliance with organizational standards.
- Confirmed pre-authorizations and clinical notes in Colobus, updating relevant medical coding and practitioner details.
- Supported various US healthcare projects, utilizing Citrix to meticulously manage provider data updates and additions based on customer specifications.
- Addressed and resolved returned correspondence for members and groups, following defined protocols for effective delivery.
- Captured and maintained policy details for new and existing coverages, facilitating necessary alterations for policyholders.
- Executed requests for policy modifications, prioritizing accuracy and meticulous execution.
- Collaborated across functions to ensure alignment of provider payments with business regulations, thereby optimizing workflow
