Project #1
Project Title: Claims Management System
Client: Conduent Business Services LLC
CMdS Claims provides accurate, prompt, and real-time adjudication of claims and encounters to support state healthcare programs with over 1,300 flexible edits and audits, a powerful COTS-based rules engine, and support for simple and complex pricing methodologies – using configurable program and benefit plan capabilities to accurately and quickly process claims. In CMdS, TPL (Third Party Liability) uses data matching for the recovery of funds to the limit of the legal liability from insurance companies, another person, or any other entity that is liable for health care costs. Includes health insurance benefits, Medicare recoveries, HIPP, casualty/accident claims, product liability claims, medical malpractice, worker’s compensation claims, and estate recovery to ensure Medicaid is the payer of last resort.
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Project Title: CMdS NCCI & Care Management
Client: Conduent Business Services LLC
The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The Centers for Medicare & Medicaid Services (CMS) owns the NCCI program and is responsible for all decisions regarding its contents. The CMS developed its coding policies based on coding conventions defined in the American Medical Association's CPT Manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The NCCI contains two types of edits:
NCCI procedure-to-procedure (PTP) edits that define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported.
Medically Unlikely Edits (MUEs) define for each HCPCS/CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service.
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Project #1
Project Title: EU Serialization
Client: UPS (United Parcel Services)
Project Description:
UPS (United Parcel Services) is based out of USA and it is one of the largest logistics company in US. So, now they started expanding their business in EUROPEAN countries also. They will do international shipping across the world. Especially UPS has started shipping health care related products in Europe, for this they started a project called EU Serialization. In EU Serialization there are three types of flows exists in delivering product to customer, they are Inbound flow, Outbound flow and Return flow. Inbound means Receiving medicines from medicine manufacturing company’s warehouse to UPS warehouse. Outbound means UPS will deliver the medicine product which received from manufacturing company to end customer and finally Return flow means, after product delivered to customer if there are any damage or medicine got expired or some other reasons, then customer can return to UPS so that UPS will return same to the client warehouse. For the above said flows/functionalities I have performed below roles & responsibilities.
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Project #2
Project Title: Lincoln Integration Testing
Client: Lincoln Financial Group
Project Description:
Lincoln Integration Testing means the process of acquiring some of the functionalities from the Liberty Mutual Group and implementing the same functionalities in Lincoln. There is a contract between Liberty and Lincoln for a 6 months period to complete the implementation of what ever the insurance related functionalities available in Liberty to Lincoln. During this process I have worked in testing the Microsoft SSIS pages by running the Autosys jobs and validating the SQL server database. Also worked on IVR testing which is acquiring the Liberty Customer Care IVR call flows to Lincoln customer support. Performed IVR testing on many call flows using the tools like Cisco Jabber, Genesys WDE, Avaya One X Agent and Genesys Ccpulse. All the call flows are represented in the form of Visio Diagrams, based on this visio call flows we performed end-to-end IVR testing for many call flows.
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Project #3
Project Title: Selling IMAGIN
Client: Federal Home Loan Mortgage Corporation (Freddie Mac)
Project Description:
Federal Home Loan Mortgage Corporation (Freddie Mac) is a Federal Sponsored organization and their area of business is mainly in mortgage loans. Capital Markets business promotes the mortgage market’s liquidity and makes funding more available to borrowers by purchasing mortgage-related securities guaranteed by Freddie Mac and other financial institutions as investments and managing their portfolio. Freddie Mac offers different types of loans and one of the loan product I worked is called Integrated Mortgage Insurance (IMAGIN), this type of loans is categorized is IFI 818 in loan terms. IMAGIN is a new way to attract private capital to the low-down payment market. IMAGIN is open to reinsures that meet Freddie Mac’s stringent counterparty standards, which include capital and collateralization requirements.
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Project #4
Project Title: Guidewire Integration
Client: Federated Insurance
Project Description:
Federated Insurance migrating their legacy system (CRM) to Guidewire software, so as part of this process developed web services in such a way to fetch the information from CRM to PolicyCenter, which means if any policy created in PolicyCenter then the same policy should be created in PolicyCenter also automatically. Along with this there are different services created like Policy services, Policy Feed services, Location Services, Transaction Services etc., All these web service functionalities have been tested and verified.
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Project #5
Project Title: FP Portal & PruAnnuities - Migration
Client: Prudential Life Insurance Co of America
Project Description:
Prudential Corporation is an insurance company and they are offering different types of insurance products in NA region. In order to show case these products/details in their websites they are using Vignette as web content management tool currently. Instead of Vignette tool customer replaced with IBM WCM tool as a web content management tool. So, as part of this migration project (Vignette to IBM WCM) we have moved and all the vignette contents to WCM tool and then pushed all the data to respective site area in UI part and validated accordingly. Performed various types of testing like Functional, Integration, Regression and Smoke.
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Project #6
Project Title: SEI Wealth Platform –SWP
Client: SEI Global Services Inc.
Project Description:
The SEI Wealth Platform is a business platform that is the total sum of services SEI provides within the Wealth Management sector. It's a combination of people, process and the technology that make up the platform. The SEI Wealth Platform as designed, allows both our clients and SEI to transform their businesses. This is supported by the key principles of the platform like Offers superior functionality, Comprehensive asset management functionality, the ability to move from account view to a view across the entire client relationship.
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Project #7
Project Title: CapitalOne Retail Banking – Core Deposits
Client: Capital One Financial Corporation
Project Description:
Capital One Retail banking offers a Services which includes savings and transactional accounts, mortgages, personal loans, debit cards, and credit cards and also offers a Commercial banking services for corporates, investment banking etc., For all these banking services Capital One uses Mainframes as a back-end application, so all the above services uses Mainframes. If any account creation happened/ customer details update/deposits/changing customer account type/loan approvals/cheque processing and so on, once these processes done thru manually or thru automation from different channels then finally all the transaction will update in Mainframe screen after nightly batches. This should be validating on a daily basis.
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Project Title: Touch Point Sales & Services (CapitalOne)
Client: Cognizant Technology Solutions
Project Title: MMIS
Client: Xerox Corporation
QA Process & Methodologies
Automation Skills (Exposure)
Test Management Tools