Pusa Venkateswararao
Hyderabad,TS
Summary
With over 10 years of specialized experience in the U.S. healthcare industry as a Business Systems Analyst, I have developed a strong background in payment integrity and fraud prevention , focusing on the identification and management of fraudulent claims in Postpay. Additionally, I have expertise in Claim Anomaly Detection (CAD) to ensure that claims are paid appropriately
Overview
1
1
Certification
11
11
years of professional experience
Work History
Senior Business & QA Analyst
Carelon Global Solutions
Hyderabad, TS
10.2020 - Current
- Supported healthcare business requirement analysis for Carelon Global Solutions teams, improving clarity on project needs.
- Facilitated requirement sessions with product, operations, and technology partners to align stakeholder expectations and support project outcomes.
- Translated business needs into functional specifications for Carelon Global Solutions systems.
- Reviewed claims and provider data workflows, identified process gaps, and added controls to reduce risk.
- Assessed existing systems and processes, identified gaps, and recommended improvements.
- Performed gap analysis between current-state processes and future-state processes.
- Partnered with IT teams on application development based on business requirements.
- Drafted user stories and process flows for cross-functional stakeholder review.
- Developed and implemented data analyses, data collection systems, and other strategies that improved statistical efficiency and quality.
- Collaborated with Payment Integrity, Analytics, and external client teams to design, validate, and implement overpayment detection concepts through the Enterprise Concept Management (ECM) platform, enabling identification and recovery of healthcare claim overpayments.
- Supported and validated CAD platform functionalities including analytics management and scheduling, claim validation workflows, dispute management, and automated overpayment/disregard letter orchestration, improving operational efficiency and recovery tracking.
- Led end-to-end analytics validation activities, including UAT (QA Validation) and Production analytics, ensuring accurate claim identification, business rule compliance, and successful deployment of recovery opportunities across multiple clients and tenants.
Associate Consultant
Robert Bosch
coimbatore, TN
02.2020 - 08.2020
- Built CI/CD pipelines for enterprise deployment workflows
- Managed containers and orchestration across production systems
- Coordinated incident response with development and operations teams
- Automated provisioning using Infrastructure as Code tools
- Monitored system health through logs and alerts
Data Analyst
IBM india Pvt ltd
Hyderabad, TS
10.2015 - 01.2020
- Developed Cognos reports and dashboards for enterprise reporting needs.
- Developed Cognos BI Reports using Report Studio and Query Studio.
- Created SQL queries to validate source data and report logic.
- Optimized existing Cognos packages for improved performance and scalability.
- Tested report layouts, filters, and calculations for accuracy.
- Collaborated with business analysts and data teams on reporting changes.
- Coordinated testing and validation procedures through software development lifecycle.
Education
Bachelor of Technology -
Andhra University
Skills
- Requirements analysis
- Business analysis
- US Health Care
- Gap analysis
- User stories
- Process mapping
- Stakeholder management
- SQL
- BI tools
- Data reporting
- Cloud Solutions
- API Integration
- Agile/Scrum framework
Certification
- AHM 250 -Professional, Academy for Healthcare Management (PAHM)
Timeline
Senior Business & QA Analyst
Carelon Global Solutions
10.2020 - Current
Associate Consultant
Robert Bosch
02.2020 - 08.2020
Data Analyst
IBM india Pvt ltd
10.2015 - 01.2020
Bachelor of Technology -
Andhra University