Lalna Divakaran

Lead Business Systems Analyst / Product Manager with extensive experience driving product strategy, roadmap execution, and enterprise solution delivery in healthcare and payer environments. Skilled in defining product vision, synthesizing business needs, and transforming them into prioritized backlogs, actionable user stories, and measurable outcomes. Adept at engaging stakeholders, fostering inclusive decision-making, and influencing cross-functional teams to align on strategy and deliver high-value solutions. Strong background in SAP ECC Sales & Distribution, claims processing systems, and EDI integrations, with proven ability to balance technical feasibility, regulatory compliance, and business objectives. Recognized for executive presence, mentoring junior talent, and championing diverse perspectives to drive innovation.

• Drive roadmap execution by defining user stories, acceptance criteria, and prioritized backlogs that balance business value, user needs, and technical feasibility.
• Partner with commercial, operations, and compliance teams to shape value propositions, align product positioning, and influence strategic product direction.
• Synthesize insights from user feedback, regulatory changes, and operational data to recommend product enhancements and inform roadmap priorities.
• Facilitate cross-functional workshops to align stakeholders on product vision, strategy, and delivery timelines, fostering diverse perspectives and inclusive decision-making.
• Present product roadmaps, KPIs, risks, and release updates to executive leadership, ensuring transparency and executive alignment.
• Conduct impact analysis and capacity planning across enterprise platforms (SAP ECC Sales & Distribution, FACETS, and payment systems) to ensure readiness and scalability.
• Collaborate with engineering, QA, and data teams in Agile/DevOps environments to deliver high-quality product features and enhancements.
• Apply design thinking methodologies to empathize with users, prototype solutions, and iterate features based on feedback.
• Champion architectural decisions for EDI transaction processing (834, 837, 835, 270, 271), improving scalability, compliance, and accuracy.
• Automate SAP backend processes using Winshuttle/D4SAP to reduce manual workload and increase operational efficiency.
• Investigate claims adjudication and payment processing issues, validating data consistency across FACETS and EDI transactions.
• Lead UAT strategy and execution, ensuring defect-free deployments and mitigating release risks.
• Establish and monitor KPIs to track feature adoption and program success, reporting progress to leadership and business stakeholders.
• Mentor junior analysts, fostering collaboration, faster onboarding, and a culture of continuous learning and innovation.

• As an Encounter System Analyst III at Caresource, the focus was on enhancing system capabilities and ensuring data integrity within the healthcare domain. Responsibilities included:
• Responsible for overseeing the entire IT process, monitoring production runs and working with other teams to ensure that encounters are submitted to CMS (Centers for Medicare and Medicaid Services).
• Work with IT Dev / Programming resources to ensure the requirements will be incorporated into the design and also testing document.
• Performed UAT (User Acceptance Testing) and provide final approval for any process change (IT ticket or project) implemented for the CMS.
• Responsible for submitting Medicare Advantage chart review records and RAPS encounters to CMS.
• Participate in user story grooming sessions involving various participants from IT and multiple departments
• Proficient in using FACETS claims processing system tool to understand how the claims were paid, understanding subscriber and provider details.
• Proficient in using EDIFECS claims processing tool to understand how the claims are processed and submitted to CMS/State.
• Accountable for the encounter's performance metrics
• Performed gap analysis. Identified gaps in the encounter processing system by analyzing state/CMS rejections and internal fallouts
• Monitor and track Encounter Data Processing System and risk adjustment claims for CMS and Ohio Market. Worked with various internal teams and CMS to submit every encounter that could drive additional revenue.
• Review and analyze new State/CMS programs to identify potential process and system impacts and propose enhancements.
• Review and approve BRD (Business Requirement Document) and FSD (Functional Specification Document) documented by IT team. Perform UAT (User Acceptance Testing) and provided final approval for any process change (IT ticket or project) implemented for the Missouri line of business.
• Draft comprehensive reports to document bugs and IT architectural flaws.
• Oversaw major new enhancements to existing software systems
• Work with other department like claims, configuration etc. to resolve encounter edits and external rejections.
• Mentor other analysts within the team to improve their technical and functional skill and to provide guidance.

• Manage a team of 4 onshore and 13 offshore Quality Assurance Analyst resources
• Understand the business requirements and worked along with business system analyst to perform impact analysis.
• Participate in requirement meetings with business and story pointing on need basis for each sprint.
• Provide estimated work hours and milestone for testing efforts assigned to that sprint
• Prepare weekly status reports and escalates any issues in testing to higher management.
• Works closely with offshore QA team and assists in resolving issues they may encounter while performing testing activities
• IT point of contact for business escalation
• Manage project escalations and provide update to senior management appropriately.
• Expert in creating and executing automated software test plans, cases and scripts using selenium.
• Participate in JAD sessions with IT and Business partners.
• Prepare test plan, test scenarios and test cases by reviewing business requirements and user stories.
• Perform backend validation by writing SQL statements on SQL Server
• Perform validation in the backend (Database) using SQL to verify whether the members' details are being updated based on the carrier files received.
• Capture, log and track defects using TFS.
• Conduct triage calls to review, discuss and prioritize defects within Business teams.
• Create requirement traceability for the test scripts
• Creating reusable, extendable and sustainable automation suite using selenium
• Validate the various reports requested by business users.
• Perform UI (User interface) testing validation to ensure that the business functionality is implemented according to the user stories.
• Prepare 837/835 EDI files based on test scenario.
• Prepare 277 EDI response files based on the 837 EDI files submitted and validate the status of each claim

• Understand the business requirements and work along with business system analyst to perform impact analysis
• Provided work estimates (LOE) and milestone for different testing efforts
• Participated in JAD sessions within IT.
• Participated in test strategy discussions.
• Prepared test plan, test scenarios and test cases by reviewing business requirements, functional specification documents and technical specification documents.
• Prepared test plan and test cases for regression testing on need basis. Conducted peer review of test plans,test scenarios and test cases. Prepared 834/837 EDI files based on test scenario
• Prepared and validate outbound 837 Institutional/Professional/Dental files.
• Performed backend validation by writing SQL statements on SQL server database.
• Validated X12 files using Transaction Manager.
• Performed XML data mapping as needed during test preparation. Coordinated testing efforts with state department.
• Captured, logged and tracked defects using Quality center/ALM. Conducted triage calls to review, discuss and prioritize defects within Business team.
• Provided support for User Acceptance Testing.
• Created requirement traceability for the test scripts.
• Prepared weekly status reports and escalates any issues in testing to leads.

• Developed a test plan and strategy that identified potential risks and issues before deployment, resulting in a successful launch
• Monitored system performance and identified potential issues before they became major problems, resulting in improved system stability
• Implemented a bug tracking system that improved the accuracy of bug reports
• Developed a regression testing suite that identified potential issues with existing features and ensured the system was bug-free