Principal Business Systems Analyst - Anthem Inc (Elevance Health) - Remote
(2026-01)
Working on digital healthcare transformation initiatives focused on AI-driven healthcare analytics, claims modernization, provider/member engagement, compliance reporting, and interoperability solutions across Medicare, Medicaid, and Commercial healthcare lines. Worked extensively with Salesforce, Oracle, SQL, Microsoft Power Platform, Tableau, REST APIs, and Generative AI technologies to streamline healthcare operations, improve claims processing efficiency, enhance member experiences, and support enterprise reporting and regulatory compliance.
- Led enterprise healthcare transformation projects involving Claims, Enrollment, Provider, Care Management, Member Portal, and Compliance reporting systems.
- Utilized Generative AI tools, including Azure OpenAI, ChatGPT, Microsoft Copilot, GitHub Copilot, and AI-powered analytics platforms to automate business analysis, healthcare reporting, requirement generation, workflow optimization, and data insights.
- Gathered and documented complex healthcare business requirements into BRDs, FRDs, process flows, use cases, user stories, and functional specifications.
- Worked extensively with healthcare payer platforms supporting Claims Adjudication, Member Eligibility, Provider Management, Prior Authorization, and Benefits Administration workflows.
- Collaborated with business stakeholders, product owners, architects, developers, QA teams, and healthcare operations teams to deliver enterprise healthcare solutions.
- Developed complex SQL queries, joins, views, and stored procedures for healthcare data analysis, reconciliation, reporting, and operational insights.
- Worked with Oracle databases and enterprise healthcare data models for claims processing, provider data management, member enrollment, and compliance reporting.
- Designed and supported REST API integrations, FHIR interoperability solutions, and healthcare data exchange workflows between enterprise applications and third-party vendors.
- Integrated Salesforce Healthcare Cloud solutions with healthcare operational systems to improve provider/member interactions, case management, and customer service workflows.
- Utilized Microsoft Power Platform, including Power BI, Power Automate, and Power Apps to develop healthcare dashboards, workflow automation, reporting solutions, and operational analytics.
- Created Tableau dashboards and visualizations for Claims analytics, Provider performance, Member utilization, denial trends, compliance metrics, and operational KPIs.
- Worked on healthcare EDI transactions, including 837 Claims, 835 Remittance, 834 Enrollment, and 276/277 Claim Status transactions for claims lifecycle management and reporting.
- Supported Claims Processing & Adjudication workflows involving CPT codes, ICD-10 diagnosis codes, HCPCS codes, reimbursement rules, pricing logic, and policy coverage validations.
- Conducted data mapping, data migration, reconciliation, and validation activities across Claims, Provider, Encounter, Enrollment, and Member datasets.
- Collaborated with UI/UX teams to enhance Provider and Member Portal user experiences, workflow usability, accessibility standards, and digital engagement solutions.
- Facilitated Agile/Scrum ceremonies including sprint planning, backlog grooming, story refinement, daily stand-ups, retrospectives, and release planning activities.
- Utilized JIRA and Azure DevOps for backlog management, sprint tracking, defect management, release coordination, and Agile delivery governance.
- Performed System Integration Testing (SIT), User Acceptance Testing (UAT), regression testing, and production validation for healthcare applications and reporting solutions.
- Supported CMS, HIPAA, Medicare, and Medicaid compliance initiatives including audit support, data traceability, reporting validation, and regulatory documentation.
- Drove process improvement and intelligent automation initiatives that reduced manual effort, improved healthcare operational efficiency, enhanced reporting accuracy, and accelerated delivery timelines.
Sr. Business Systems Analyst - Cigna Healthcare - Plano, Texas
(2021-10 - 2025-12)
Led enterprise healthcare payer initiatives focused on Medicare compliance reporting, AI-driven healthcare analytics, claims adjudication, EDI integrations, and healthcare data transformation using QNXT, SQL, Oracle, Azure DevOps, and Generative AI solutions. The project focused on scalable ODAG/CDAG reporting, healthcare data governance, intelligent automation, and operational efficiency across Medicare and Commercial healthcare lines.
- Led end-to-end delivery of CMS Medical Management compliance reporting (ODAG/CDAG) for Medicare Advantage and Commercial healthcare lines.
- Worked extensively with the QNXT core administration platform for Claims, Member, Provider, Enrollment, Eligibility, and Encounter processing.
- Utilized Generative AI tools, including Azure OpenAI, ChatGPT, Microsoft Copilot, and AI-assisted SQL automation tools to support healthcare data analysis, reporting automation, requirement documentation, and workflow optimization.
- Applied AI-driven analytics and intelligent automation techniques to improve healthcare reporting accuracy, operational efficiency, and compliance monitoring.
- Developed and optimized complex SQL and Oracle queries, joins, views, stored procedures, and healthcare data transformation logic for enterprise reporting solutions.
- Analyzed healthcare EDI transactions, including 837 Claims, 834 Enrollment, 835 Remittance, and 276/277 Claim Status transactions for claims validation and reconciliation.
- Supported Claims Processing & Adjudication workflows involving CPT codes, ICD-10 diagnosis codes, authorization rules, reimbursement processing, pricing logic, and policy coverage validations.
- Integrated healthcare data across QNXT, MHK (MedHOK), EDI systems, enterprise reporting platforms, and Data Warehouse environments.
- Performed advanced data validation, reconciliation, root cause analysis, and quality assurance across Claims, Eligibility, Provider, Encounter, and UM datasets.
- Implemented AI-assisted reporting and automation workflows to streamline compliance reporting, reduce manual effort, and improve turnaround time.
- Supported Medicare compliance initiatives involving appeals, grievances, denial management, determination outcomes, and turnaround time (TAT) reporting.
- Collaborated with UM/CM, Claims, Enrollment, Provider, Compliance, EDI, and Data Warehouse teams to support enterprise healthcare operations and regulatory reporting.
- Utilized Azure DevOps and Agile/Scrum methodologies for sprint planning, backlog management, defect tracking, release coordination, and production support.
- Supported CMS audits and compliance reviews by providing data lineage, traceability, audit documentation, and healthcare reporting evidence.
- Ensured compliance with CMS, HIPAA, Medicare, and internal healthcare regulatory standards while driving healthcare process improvements and reporting enhancements.
Business Analyst/System Analyst - United Health Group/Optum - Minneapolis, MN
(2019-05 - 2021-09)
Worked on enterprise healthcare modernization initiatives focused on Claims, Medicare/Medicaid compliance reporting, Utilization Management workflows, EDI integration, and healthcare data standardization using Facets, SQL, Oracle, and integrated payer platforms across 11 states.
- Worked extensively with Facets core administration system for Claims Adjudication, Member Eligibility, Provider Configuration, Enrollment, and Benefit Setup.
- Gathered and translated healthcare business requirements into BRDs, FRDs, process flows, user stories, and functional specifications.
- Developed complex SQL queries, joins, stored procedures, and data validation logic for healthcare reporting and compliance initiatives.
- Supported Medicare and Medicaid compliance reporting aligned with CMS regulations, including appeals, grievances, determinations, and turnaround time (TAT) reporting.
- Analyzed and validated healthcare EDI transactions, including 837 Claims, 835 Remittance, 834 Enrollment, 820 Premium Payments, and 276/277 Claim Status transactions.
- Worked on Claims Processing & Adjudication workflows involving CPT codes, ICD-10 diagnosis codes, authorization rules, policy coverage, and provider reimbursements.
- Performed data validation, reconciliation, and root cause analysis across Claims, Encounter, Eligibility, Provider, and Member datasets.
- Collaborated with Utilization Management (UM), Care Management (CM), Claims, Enrollment, and Compliance teams to support operational and regulatory reporting.
- Supported healthcare data integration and migration activities between Facets, downstream applications, reporting systems, and Data Warehouse environments.
- Participated in System Integration Testing (SIT), User Acceptance Testing (UAT), regression testing, and production validation activities.
- Utilized Azure DevOps and Agile/Scrum methodologies for sprint planning, backlog management, defect tracking, and release coordination.
- Ensured compliance with CMS, HIPAA, Medicare, and Medicaid regulatory standards while supporting production issues, audit requests, and reporting enhancements.
Business System Analyst - Walmart - Georgia
(2017-01 - 2019-04)
- Collaborated with business users, stakeholders, and SMEs to gather, analyze, and document business requirements, BRDs, FRDs, use cases, and process workflows for enterprise retail and supply chain applications.
- Performed detailed gap analysis, data mapping, and source-to-target transformation activities for Data Warehouse, reporting, and enterprise analytics initiatives.
- Developed and executed complex SQL queries for data extraction, validation, reconciliation, reporting, and operational data analysis across multiple systems.
- Configured and enhanced ServiceNow workflows, dashboards, business rules, and incident management processes to improve operational efficiency and tracking.
- Created test plans, test cases, and supported SIT/UAT, regression testing, and defect resolution activities to ensure successful project delivery.
- Utilized Agile/Scrum methodologies with Azure DevOps and JIRA for sprint planning, backlog grooming, user story management, and release coordination.
- Built interactive dashboards, KPI reports, and business reporting solutions using Business Objects and enterprise reporting tools to support data-driven decision-making.
- Facilitated JAD sessions, stakeholder meetings, and cross-functional workshops while ensuring data governance, compliance standards, and continuous process improvements.
Business Analyst - JPMC - India
(2014-08 - 2015-12)
- Collaborated with business users, SMEs, and stakeholders to gather, analyze, and document business requirements, functional specifications, BRDs, FRDs, use cases, and process workflows for enterprise banking applications.
- Performed detailed data analysis, gap analysis, data mapping, and source-to-target transformation activities for Data Warehouse and enterprise reporting initiatives across banking and financial domains.
- Developed and executed complex SQL queries for data extraction, validation, reconciliation, reporting, and production data analysis across multiple systems and databases.
- Worked extensively with Agile/Scrum methodologies using Azure DevOps and JIRA for backlog management, sprint planning, user story creation, defect tracking, and release coordination.
- Supported SIT, UAT, regression testing, and production validation activities while collaborating with cross-functional teams to ensure successful project delivery and regulatory compliance.
