Business Analyst
Send a job offer directly to this candidate
Hi, my name is Ashish and I’m a Business Analyst with over 5 years of experience specializing in business requirement gathering, process modelling and Data analysis. I’ve worked extensively with payers and providers, focusing on claims adjudication, prior authorization automation, and EDI integrations, especially with 837 files and HIPAA-compliance systems.
In my current role at United Health Group, I’m part of the Claims Adjudication IT team, working on a PEGA-based case management system that processes claims submitted via multiple channels—including EDI 837 files, provider portals, and paper forms.
I was responsible for automation of EDI 837 Batch Processing and automation of Paper claim intake for virginia market. Earlier, these Paper Claim forms were sent manually, and the intake process was time-consuming. We help build a system where paper forms could be scanned, read, and automatically processed into PEGA Application.
In all above role, I was responsible for gathering and documenting business and functional requirements by conducting meetings with stakeholders. I translated Stakeholders needs into clear and actionable requirements. This included defining detailed business rules, file structures, naming conventions for EDI files, and the validation logic for checking mandatory fields such as member ID, ICD, and CPT codes.
I was responsible for creating all the core documentation for the project, including the Business Requirements Document (BRD), Functional Requirements Document (FRD), and well-defined user stories in JIRA to support Agile development.
Throughout the project, I worked very closely with various cross collaboration team such as QA, SFTP and PEGA developer teams to ensure the data flow was implemented correctly—from secure file intake to case creation in PEGA. I also defined the rules for generating ACK files that included clear rejection reasons, helping providers easily understand and correct issues like missing diagnosis or procedure codes.
As part of the Agile team, I participated in all key ceremonies including daily stand-ups, sprint planning, backlog grooming, reviews, and retrospectives. I used JIRA to manage user stories, track development progress, and log defects. All project documentation, meeting notes, and requirement versions were maintained in Confluence for easy collaboration and audit tracking.
For testing, I coordinated User Acceptance Testing (UAT) by preparing test cases, validating end-to-end scenarios, and working closely with QA and provider teams to ensure everything functioned as expected. I also used SQL to validate data during testing phases—for example, to check member eligibility from the FACETS database or confirm that claim details matched what was received in the EDI file I used SQL queires.
Overall, I acted as a bridge between business and technical teams, ensuring that the solution met both operational goals and compliance standards. Looking ahead, I’m eager to apply my skills in a new environment where I can help solve complex business challenges and continue learning
