WORK EXPERIENCE
UM staff are responsible for working/completing the UM cases that they have been assigned to. The health
plan may have policies that set the priority for clinical reviewers to use when deciding which cases to work first.
UM staffs are responsible for monitoring Internal Communications sent/received on UM cases and completing
those communications
Responsibilities:
Understanding of Health Care Domain business functionality
Active participation in maintaining Framework.
Test data generation
Writing automation test scenario
Creating function libraries
Running automation suits
Preparation of test cases.
Logging Defects.
Preparation of weekly reports.
Resolving Queries
Project 2:
Work Unit Syntel
Client Trizetto (QNXT)
Name of the Project Fallon
Duration Sep '11 to Nov '12
Team Size 4
Role Test Engineer
Project Description:
QNXT(TM) is a state-of-the-art, object oriented, rules-based software application that can manage most lines
of business known in the US health insurance market. QNXT manages relationships between the payer
organization, its members, and providers, including the management of complex benefit plans and provider
contracts, referrals, cases, claims, payment, call tracking, and financial reporting.
Responsibilities:
Understanding of Health Care Domain business functionality.
Execution of workflow of the application.
Preparation of Execution reports.
Execute the test cases and uploaded in the QC.
Logging Defect in the QC.
Resolving Queries.
Test data generation
Writing automation test scenario
Creating function libraries
Running automation suits
Project 3:
Work Unit Syntel
Project Description:
Facets is Trizetto enterprise-wide software solution for health plan administration. This state-of-the-art platform,
with deeply integrated applications, automates processes across your entire enterprise and drives greater
cost-efficiencies. Facets also help your organization support the consumer-directed products demanded by
today's retail healthcare market and deliver advanced care management capabilities.
It is the industry-leading software solution for health plan administration - proven again and again to be the
choice for current and emerging business needs.
Validation of 4010-5010 changes in all Transactions.
Validation of X12 to Facets for 837I and P; 835; 834; 270-271; 276-277 Transactions.
Responsibilities:
Understanding of Health Care Domain business functionality
Preparation of X12 files
Compliance checking
Validation of X12 for 837I and P; 835; 834; 270-271; 276-277 Transactions
Working for different clients like WHA, UAT
Project 4:
Work Unit VSpace Software
EDUCATION
B.Com
Pune University - Pune, Maharashtra
2004 to 2005