Karnika Singh Baghel
Virginia,VA
Overview
12
12
years of professional experience
Work History
Senior Software Engineer
FEPOC, Reston
05.2019 - 12.2024
- Project: EPOC is the operating center under BCBS dealing with Federal employees across the United States
- In my 5+ experience here, I have worked on various projects like Year End Benefit, Audit remediation which gave opportunity to learn in depth of Claims Processing (Professional and Facility Claims)
- In addition to this I worked on Medicare and Medicaid program, AEOB, Member Transition,837 Response Request file, Retro Enrollment, change in member enrollment, PSHB project
- Participated in discussions of the project with the core team
- Involved in functional and regression testing
- Worked with project analysts and developers to develop and execute test plans
- Used Jira for test cases creation and execution
- Monitor, maintain, and provide reports for bugs and defect resolution to the team
- Retest test cases where bugs/defects have been raised
- Provided regular feedback to the Scrum team for any issues found during the development lifecycle
- Work with cross-functional teams to identify and develop test cases for functional and performance testing
- Used Jira for project and bug tracking
- Performed manual web services testing using Postman and SoapUI
- Automated web services testing in Eclipse framework
- Identified weaknesses in QA Processes, Web testing and Automation and suggested & implemented improvements
- Involved in updating protractor/playwright and karate test automation framework built using Selenium, Cucumber, TestNG, JUnit and Maven
- Used Jenkins CI/CD pipelines to execute automation suites on different platform browser combinations in parallel
- Create/execute/update automation scripts for UI Shakeout and Regression
- Develops and executes moderate to highly complex scripted automated tests
- Used Bitbucket for version control for application and web services automation
- Used Eclipse and Visual Studio Code as an IDE
- Used Mainframe DB2 for 837 processing
- Used RocketShuttle to perform end-to-end database testing
- Environment: JavaScript, JQuery, XML, Typescript, HP ALM, Selenium, Cucumber TestNG, Junit, Maven, Jenkins, Bitbucket, Git, Jira, VSC, Eclipse, Postman, SoapUI, DB2, UDB, Rocket Shuttle, SSMS, Mainframe
Quality Assurance Analyst
BCBS, Nebraska
09.2016 - 01.2019
- Project: To test the application that was used for checking the eligibilities, claim processing and claim status
- My responsibility was to process the EDI (Electronic Data Interchange) database primarily for EDI820/834,835/837
- Developed Test Plans, Test Cases for the Facets Modules and claims processing system
- Adhered to the Agile methodology for all phases of the testing life cycle
- Participated in daily stand ups and bi-weekly sprint meetings with the scrum team
- Tested and validated HIPAA Transactions according to the test scenarios such as270/271,276/277,837/835 transactions
- Tested the interface between the database and the application
- Defined test automation strategy, designed automated tests, created automated test cases, test plans and executed tests using Selenium
- Participated in requirement walkthroughs and the creation of the test plan
- Performed manual testing of the claims system and application
- Built functional test cases and executed scenarios using Selenium
- Developed the automation scripts in Java for back-end testing using Selenium and executed the Junit tests
- Executed all Selenium (Java) test scripts on different browsers and checked for compatibility
- Prepared Test Cases based on business requirements and business rules for HIPAA EDI Transaction834,276/277,270/271,837/835
- Tested all HIPAA5010 transactions and validated the database to file elements
- Analyzed5010 standards for837P EDI X12 transactions, related to providers, payers, subscribers and other related entities
- Performed testing within the Cucumber framework, using Gherkin language to translate code effectively to functional teams
- Tested compatibility of application for dynamic and static content under various cross browsers using HTML IDs and XPath in Selenium
- Tested Web services (SOAP and REST) and XML using SoapUI for the local WSDL / with URL; created and ran test cases, and performed load and security testing
- Maintained Traceability matrix and Test Matrix
- Created and maintained SQL Queries for back-end testing
- Performed manual back-end testing using PL/SQL to connect to an Oracle database on a UNIX server
- Performed Sanity Testing and Smoke Testing
- Investigated software bugs and reporting to the developers using Quality Center Defect Module
- Analyzed system requirements and developed detailed test plan for testing
- Supported the UAT co-ordination with the Business and prepared the valid business scenarios for testing
- Tracked and reported defects using ALM/Quality Center
- Generated defect reports using Quality Center for the developers
Quality Analyst
Health Now
10.2015 - 07.2016
- Project: Test Facets application modules including Enrollment, Membership and primarily Claims
- Analyzed system requirements and developed detailed Test Plan
- Performed Manual Testing for the EDI transactions
- Performed data validation and mainframe testing in interactive mainframe environment
- Participated FACETS Implementation by performing end-to-end testing of FACETS Billing, Claim Processing and Subscriber/Member module
- Tested the HIPAA EDI834,270/271,837/835 transactions according to test scenarios and verified the data across different modules
- Analyzed and validated ANSI x12837-835 EDI Transaction
- Worked on coordination of benefits (COB) in a claim processing
- Ran the scripts on multiple environments (QA, UAT and Production) to ensure that requirements were met
- Created new and modify existing SQL server queries, views, packages, and ETL jobs
- Performed requirement validation for Enterprise Data Warehouse (EDW) with the state stakeholders
- Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports
- Wrote Test scenarios and test cases for testing the migration of EDI4010 to5010 and the processing of member enrollment and benefits, (834) batch jobs corresponding to the claims (837)
- Performed Back-End Testing to check database integrity by writing SQL queries
- Set claim processing data for different Facets Modules
- Tested HIPAA regulations in Facets HIPAA privacy module
- Wrote test cases in Quality Center derived from the Design documents and generated a Traceability Matrix for testing purposes
- Created Traceability Matrix to ensure implementation of all functionalities, identify all test conditions and test data needs
- Performed ICD9- ICD-10 Conversion Analysis
- Uploaded the diagnosis codes, procedure codes to the related tables in test environment to verify the changes related to ICD9 – ICD-10 changes
- Prepared and maintained the Test Matrix, Requirements Traceability Matrix
- Participated in release meetings and participate in Retrospective session
- Conducted requirement upgrade and/or change request while doing UAT
- Collaborated with development team to ensure the application performance and stability and ensure the application completes the whole end-to-end process
- Followed the Agile methodology and participated in weekly status meeting with Development and Management Teams
QA Tester
CIGNA Healthcare
02.2014 - 08.2015
- Project: To analyze Facets interfaces
- My duties included working with claims module and processing them for various scenarios
- Project included ANSI x12270-271 EDI transaction and validating EDIs according to HIPAA code set834 enrolment and disenrollment in a health plan
- Documented EDIs according to code set X12835 Claim Payment and Remittance Advice Claims processing and837 Claim transactions
- Resolved errors with claims, benefits, provider contracts, and made modifications in the cleanup effort
- Validated the translated HIPAA files with the proprietary Common Claim Record implementations
- Tested and verified ANSI x12834/837/835 EDI Transaction
- Tested the HIPAA EDI834,270/271,837/835 transactions according to test scenarios and verify the data on different modules
- Implemented appropriate changes to records by resolving enrollment system rejects
- Reconciled various EDI transactions sets such as834 enrollment files,820 payment remittance files, ID card files, and Group XML files
- Supported the FACETS Implementation, conducted end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module
- Performed Use-Case analysis using UML to capture the dynamic aspect of the application
- Verified session logs to identify the errors occurred during the ETL execution
- Created maps to transform data from EDI to standard XML business documents, developed assessment of business and technical needs
- Set-up, coordinated and conducted system and UAT testing
- Analyzed current data stores and generated UML diagrams of logical and physical data
- Developed system and defined metrics to evaluate performance in innovation, customer satisfaction and employee participation
- Analyzed resource utilization using workload parameterization for improving performance of application under development
- Analyzed existing procedures and reported them to management to improve productivity
- Performed Business Process Modeling using Visio
- Analyzed and tested different modules of Facets such as Members/subscriber, commissions, provider, billing
- Identified, analyzed, and documented defects, errors, and inconsistencies in the application using ALM/ Quality Center
- Reported defects according to Defect Life Cycle
- Analyzed Membership/enrollment and billing-entered information on Facets to ensure correct eligibility, etc
QA Tester
Florida Blue
07.2012 - 01.2014
- Project: To test the claim processing application such as diamond to process/adjudicate claims
- The project involved validating834/835/837 and27X and forming the E2E process for all EDI transactions like837 and835
- Developed Test Scenarios and Test Cases based on Business requirement document and functional requirement
- Tested both Institutional and Professional claims
- Tested HIPAA EDI Transactions such as837(Institutional and Professional),835,834,270,271,276, and277 in various claims validation processes
- Performed applications analysis and testing which included claims processing as per EDI/ANSI-X12 transactions Standards
- Adhered to the Waterfall methodology through all phases of the testing life cycle
- Performed Integration/System/Regression testing of enrollment and benefits with Diamond
- Maintained and supported834,835 and837 HIPAA EDI transactions
- Responsible for testing EOB in accordance to business rules for claims processing
- Tested Claims, Providers, and Contracts and worked with Claims attributes, Provider attributes, enabling EOB
- Utilized Quality Center to write and execute test cases
- Conducted Integration Testing, Functional Testing, and UAT
- Used quality center for logging defects and defect Tracking
- Performed User Acceptance Testing (UAT) and documented in detail the defects using Quality Center
- Executed SQL queries to validate and update database and retrieve data for testing
- Validated XML Files
Education
Master’s - Software Engineering
Stratford University
Falls ChurchSkills
- Requirements Management Tools: Rational Requisite Pro, Rational Rose, MS Visio
- Defect Tracking Tools: Jira, Quality Center, Rational Clear Quest
- Languages/Standards: SQL, XML, HTTP, HIPAA4010/5010, ICD9/10, ANSIX12
- Healthcare Technology: Membership & Billing Group Enrollment, Facets, Configuration, EDI –834/835/837/270/ Claims Processing
- Testing Tool: Eclipse, Visual Studio, MS Project, Visio, Excel, Word, Outlook, PowerPoint
- Windows, DOS, Unix
- Oracle, SQL Server
- Testing and debugging
- Quality assurance
- Troubleshooting
- Team reporting
- Software development lifecycle
METHODOLOGY
Agile, Waterfall
Timeline
Senior Software Engineer
FEPOC, Reston
05.2019 - 12.2024
Quality Assurance Analyst
BCBS, Nebraska
09.2016 - 01.2019
Quality Analyst
Health Now
10.2015 - 07.2016
QA Tester
CIGNA Healthcare
02.2014 - 08.2015
QA Tester
Florida Blue
07.2012 - 01.2014
Master’s - Software Engineering
Stratford University
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