Aarone Raj Sebastin

• Possess 13+ years of extensive experience in the US Healthcare domain with strong domain and business process knowledge.
• Have over 7 years of hands-on experience in Software Testing and Quality Assurance activities.
• Strong understanding of US Healthcare Insurance processes including Claims, Eligibility, Member Enrollment, and Provider workflows.
• Worked closely with business stakeholders to gather requirements and provide requirement clarifications for development and testing teams.
• Experienced in managing and guiding development teams to deliver successful and high-quality products.
• Skilled in preparing Flowcharts, Functional Requirement Documents (FRD), User Manuals, and Use Case Documents.
• Performed feature validation before production deployment and provided internal sign-off approvals.
• Participated actively in defect triage meetings and ensured proper defect prioritization for maximum business impact.
• Coordinated effectively with business users and stakeholders during User Acceptance Testing (UAT).
• Strong experience in writing clear, detailed, and effective user stories to support rapid functionality development by engineering teams.
• Proficient in creating visualizations and dashboards using charts and reporting techniques.
• Experienced in validating and loading Member, Medical, and Pharmacy data received from Third-Party Administrators (TPA).
• Validated payer letters related to Case Management, Utilization Management, and Complaint handling processes.
• Hands-on experience in Test Case Design, Test Execution, Test Result Analysis, and Test Summary Report preparation.
• Performed validation activities across QA, Pre-Production, and Production environments to ensure application quality and stability.
• Good knowledge of SQL queries for data retrieval, validation, and analysis purposes.
• Strong understanding of HL7 messages and healthcare data exchange standards.
• Experienced in working with multiple provider portals for healthcare operations and claims activities.
• Worked on HIPAA EDI transactions, especially 837 claim files, to identify key data elements and support file creation activities.
• Collaborated with US insurance representatives to verify policy eligibility, confirm carrier policies, reprocess claims, and handle appeals through mail, fax, and web portals.
• Strong experience in quality assurance and defect management with the ability to identify, analyze, and resolve complex issues effectively.
• Proven team player with excellent collaboration and communication skills, contributing to the successful delivery of high-quality software products.

Manual Testing (Functional, Regression, Smoke, Sanity, UAT), API, SQL (Basic -validation queries) Data validation, Test Case Design, Execution & Review, Defect Tracking & Defect Life Cycle, STLC & SDLC (Agile, Waterfall), Excel, Word, PowerPoint, Lucid chart, MS Visio, Postman, Salesforce, Qtest, UAT Demo

US Healthcare: Eligibility, Claims, Appeals, Refunds, Denial Management, Payments, EDI Transactions: 837- ANSI X12, CMS 1500 / UB-04, HL7 Messages

Payer portal and Billing Software : Availity, Navinet, Change Healthcare, Trizetto, Noridian, Palmetto, State Medicaid, NextGen, AdvancedMD, lntermedix, eClinicalWorks, Facets, Pega,