Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Poornima Mani

South Windsor,CT

Summary

Dynamic professional with a proven track record at Cigna-Evernorth Services Inc., adept in Quality Assurance and fostering strong relationships. Excelled in fast-paced environments, ensuring compliance and efficiency in claims processing. Skilled in Agile Methodology and Database Testing, demonstrating a keen ability to improve processes and maintain high standards in healthcare claims management.

Overview

15
15
years of professional experience
1
1
Certification

Work History

Claims Representative

Cigna-Evernorth Services Inc.
05.2023 - Current
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
  • Reviewed and approved Medical claims based on the required supporting documents and business rules.
  • Reviewed Medical claims for coverage limits, exclusions and other conditions that may have an impact on the claim.
  • Verified claims for Coordination of Benefits to avoid duplicate payments.
  • Validated claims for member's benefits using Benefit Access application. Hands on working experience in Medical, Medicare Claims.
  • Effectively used MS Excel(macros),OneNote to organize claim processing information.

PARAPROFESSIONAL EDUCATOR

VERNON PUBLIC SCHOOLS
10.2022 - 12.2022
  • Provided support during classes, group lessons, and classroom activities.
  • Contributed to a positive classroom culture by establishing strong relationships with students and maintaining open communication with families.
  • Monitored student classroom and outdoors activities to promote student safety.
  • Oversaw students in classroom and common areas to monitor, enforce rules, and support lead teacher.
  • Assisted classroom teacher in supervising snack time and indoor and outdoor play.

ASSOCIATE - PROJECTS

COGNIZANT TECHNOLOGY SOLUTIONS
11.2009 - 01.2014

Project 1: - CIGNA - Cigna for HealthCare Professional (Aug 2010 - Jan 2014)

  • Operated under Agile and Scrum frameworks to complete releases and well- organized sprints.
  • Conducted Sprint/Integration/Regression testing and submitted observations to development team.
  • Prepared Test plan and Test Strategy for Integration Testing.
  • Developed/Suggested testing protocols in agile testing environment, working effectively with offshore development teams.
  • Worked with CPT/HCPCS Procedure codes and ICD9/ICD10 Diagnostic codes to understand Claim processing.
  • Developed technical root cause analysis and corrective actions for problems detected in Regression testing.
  • Hands on experience on web services testing using SOAP UI and POSTMAN including data mockup.
  • Created & Tested Business Workflow scenarios by analyzing user trends from Tealeaf logs. Performed UAT/BAT in the acceptance test region.
  • Prepared weekly status reports, monthly status reports including quality metrics like Defect Removal Efficiency (DRE),Defect Rejection Ration (DRR) and defect trends.
  • Met tight deadlines to satisfy client demands and project timelines.


  • Project 2: - WellPoint - Medisys - Senior Enrollment System
  • Worked in Waterfall methodology.
  • Participated in JAD sessions for requirements discussion.
  • Conducted System testing and Regression testing on enrollment application.
  • Utilized Clear Quest for Defect Management and reported defects to development team.
  • Participated in Defect Triage meetings.
  • Published Status Reports to clients.


Education

Master of Science - Information Technology

COLLEGE OF ENGINEERING, GUINDY

Skills

    Quality Assurance

    Database Testing

    SQL

    Healthcare claims and Benefits

    Agile Methodology

    Defect Tracking and Monitoring

Certification

  • CERTIFIED SAFe 6 PRODUCT OWNER/MANAGER
  • BUSINESS ANALYSIS COURSE

Timeline

Claims Representative

Cigna-Evernorth Services Inc.
05.2023 - Current

PARAPROFESSIONAL EDUCATOR

VERNON PUBLIC SCHOOLS
10.2022 - 12.2022

ASSOCIATE - PROJECTS

COGNIZANT TECHNOLOGY SOLUTIONS
11.2009 - 01.2014
  • CERTIFIED SAFe 6 PRODUCT OWNER/MANAGER
  • BUSINESS ANALYSIS COURSE

Master of Science - Information Technology

COLLEGE OF ENGINEERING, GUINDY
Poornima Mani