Pratima Pokharel
Charlotte,NC
Summary
Seasoned Business Analyst offering over sevenyears of healthcare and insurance industry experience and success. Expert on business and systems requirements, user acceptance testing and end-user training. Accomplished at leveraging past lessons to inform future decision-making. Experienced as a Business Analyst/Product Owner in directing and driving cross-functional teams of technical experts to analyze systems & processes and implement infrastructure improvements. Operated and successfully implemented projects in various software development life cycle (SDLC) methods including Agile and Waterfall. Well versed with HIPAA, claim processing from point of entry to finalizing, claim review, pre-authorization, identifying claims processing problems, their source and providing corresponding solutions. Experienced creating Business Requirements Documents (BRDs), Functional Requirement Documents (FRDs), and Technical Requirement Documents (TRDs) for various systems and business stakeholders. Extensive experience in developing User stories, creating Screen Mockups, creating Wireframe, conducting Gap Analysis and Impact Analysis, Cost Benefit Analysis, Risk Analysis. Highly motivated team player with excellent Interpersonal and Customer Relational Skills, Proven Communication, Organizational, Analytical, Presentation Skills, and Leadership Qualities.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Sr. Business Analyst
Carelon Medical Benefits Management, Inc.
10.2019 - Current
- Responsible for serving as the liaison between the business and IT in translating complex business letter needs into application software
- Responsible for analyzing and identifying problems and opportunities, and recommending solutions that help improve the communication area of the client.
- Acted as key liaison communicating with various stakeholders, including managers, developers, and end-users; conveys complex information in an easy-to-understand manner
- Managed multiple letters projects at once, including setting goals, establishing timelines, tracking and reporting progress
- Worked with programming staff to ensure requirements will be incorporated into system design and testing
- Responsible for overseeing business change requests as well as defect resolutions
- Conducted, led and participated in various refinement/grooming session with the business stakeholders to facilitate the requirement gathering process.
- Reviewed and accepts/rejects results both during a Sprint and in the Sprint review
- Attended various sprint ceremonies and be available to team during the sprint for clarifications and acceptance of user stories
- Mentored junior analysts on best practices for business analysis techniques, fostering professional growth within the team.
- Collaborated with the third party vendors like Napersoft/Azuba to streamline the project delivery process on timely manner.
- Collaborated closely with stakeholders and manager to identify opportunities for process improvements and drive continuous innovation in the letters area.
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Involved in preparation of UAT plan along with the testing and documenting the results.
Business Analyst/UAT
CNA Insurance
11.2018 - 10.2019
- Gather, analyze, document business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders, thereby drafting the Requirements Document, Business Requirement Document (BRD) and Screen mock-ups using Microsoft Visio
- Conduct Gap-Analysis and make As-Is and To-Be diagrams to understand new business requirements and challenges in implementing new modules of ClaimCenter over the existing claim management system
- Configure screen layouts, business logic, business rules, and operation parameters such as roles, permissions, user attributes, and regions as well as create new screens in Guidewire Studio as needed
- Involve in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation for SIT and UAT to assure that all aspects of a Project are in Compliance with the Business Requirements
- Responsible for preparing Business Requirement Document (BRD), Functional Requirement Document (FRD) and then translating into functional specifications and test plans
- Working with testing team to finalize confirmation criteria to make sure all scenarios are covered
- Working closely with the project manager, business lead and technical lead to identify, research and escalate issues and risks to the appropriate work stream for resolution
- Involves in planning and implementing both high-level and detailed system and integration test plans
- Perform overall Requirements Management and build the Requirements Traceability Matrix
- Working on production and pre-production defects analysis and fixation with testing and development teams
- Working with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
Business Analyst/UAT
CNA Insurance
03.2017 - 03.2018
- Worked with business area and technology representatives to formulate and define systems scope and objectives using different Guidewire Modules
- Conducted requirements definition for Claims solutions
- Collaborated closely with business stakeholders to understand their business requirements, informational needs and data sources
- Translated business needs into clearly defined and document detailed business requirements/ functional requirements inclusive of process flows, data flows, traceability matrices as well as screen mock-ups
- Configured screen layouts, business logic, business rules, and operation parameters such as roles, permissions, user attributes, and regions as well as created new screens in Guidewire Studio as needed
- Collaborated with development and testing teams to provide subject matter expertise, ensured that out of the box functionality is leveraged and assisted in troubleshooting and resolving issues
- Participated in the development and planning of the User Acceptance Testing activities, including test plans and scripts, based on requirements
- Facilitated UAT execution phase and worked with the business owner to obtain user acceptance test signoff
- Identified and reported testing results to ensure functionality, quality, and quantity standards are met
- Collaborated with the development team and manager to determine appropriate solutions and retests corrections to ensure problems are resolved
- Conducted/participated in requirements gathering sessions, meetings, and presentations
- Conducted review sessions for completed business/functional requirements with key business users focused on gaining consensus and final business approval
- Managed testing and related processes for ClaimCenter development projects and ongoing enhancements
- Coordinated with the end user to get the post-production issues resolved using the ServiceNow tool
- Identified, analyzed and documented defects, errors, and inconsistencies in the application
- Participated in the PI (Product Incremental) planning with the extended stakeholders of the overall project
- Worked closely with Scrum master and Tech lead to manage the stories in backlog based on sprint priority
- Facilitated scrum standup with stakeholders to get the status of the current sprint.
Business Analyst
Automobile Club of Southern California AAA
02.2016 - 01.2017
- ACMO AAA Club was using their own legacy system to capture claim process whereas all other clubs already had migrated to Guidewire ClaimCenter module
- Worked as a Business Analyst for the project to gather and document as-is flow and future business flow as well as business requirement in agile methodology to facilitate the migration
- Involved in documenting customization requirements, business rules and data migration requirements for the Implementation of Guidewire ClaimCenter
- Created screen mockups/wireframes using MS Visio and worked with the business owners to get the approval before handing over to the development team
- Conducted all-day marathon meetings to walk through business requirements and get as many requirements signed off as time permitted
- Some of the requirements had more feedback to work on that would be signed off in the subsequent days
- Conducted requirement session and communicated with business to articulate their needs and concerns
- Acted as liaison between stakeholders, developers and quality analyst team
- Interacted with the SMEs (Subject Matter Experts) and stakeholders to get a better understanding of client business processes and gather business requirements
- Conducted Gap Analysis to gather the requirements, by comparing existing Legacy system and Guidewire ClaimCenter
- Documented all data mapping and transformation processes in the Functional Design documents based on the business requirements
- Worked closely with developing teams, discuss their concerns while development and get the solution to their concerns from the business
- Participated actively in the lap planning, demo and retrospective meetings
- Used Clarizen to assign user stories and updated the status for business approval.
Business Analyst
Western Reserve Group
09.2015 - 01.2016
- The project was undertaken to enhance their system (Guidewire) from version .5 to .8
- As a business analyst, conducted the gap analysis and created As-is and To-be diagrams to understand new business requirements and challenges in upgrading to the new version
- Configured screen layouts, business logic, business rules, and operation parameters such as roles, permissions, user attributes, and regions as well as created new screens in Guidewire Studio as needed
- Created and prioritized the backlog in Rally, coordinated planning sessions and maintained user stories and acceptance criteria
- Led requirement-gathering elicitation through open-ended discussions, brainstorming, and prototyping for the enhancement of Guidewire PolicyCenter V8 suite
- Participated actively in the lap planning, demo and retrospective meetings
- Prepared business requirements document and functional specification documents
- Presented business needs to technical teams and identified impacted PolicyCenter User Stories and Other Downstream Systems
- Participated in JAD sessions, presentations, walk-through's and daily/weekly standup meetings within a pure Agile and Scrum development methodology model.
Education
Skills
- User Stories
- Acceptance Criteria
- Product Backlog
- Epics (Feature)
- Sprint Planning
- Project Management
- Powerpoint
- Business Process Improvement
- Requirements Gathering
- Agile Methodology
- User Acceptance Testing
- Needs Assessments
- Business Analysis
- Requirements Analysis
- Process Improvement
- Documentation Management
- Problem Solving
- RALLY
- VersionOne
- JIRA
- Team Foundation Server (TFS)
- HP ALM Quality Center
- Guidewire ClaimCenter V5 and V8
- ServiceNow
- IBM Mainframe
- RapidSQL
- Confluence
Certification
Certified Scrum Product Owner
Certified SAFe 5 Scrum Master
Certified SAFe 5 Agilist
Certified SAFe 5 product Owner/Product Manager
Reference/s
References available upon request
Reference/s
References available upon request.
Timeline
Sr. Business Analyst
Carelon Medical Benefits Management, Inc.
10.2019 - Current
Business Analyst/UAT
CNA Insurance
11.2018 - 10.2019
Business Analyst/UAT
CNA Insurance
03.2017 - 03.2018
Business Analyst
Automobile Club of Southern California AAA
02.2016 - 01.2017
Business Analyst
Western Reserve Group
09.2015 - 01.2016
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