Pranay Gelli

• Developing & Executing test suites for regression testing.

• Managing the scope of pre-production Testing within the context of each release/delivery.

• Performing regression suite dry run for functional stories, preparing Test Strategy and Test Plan.

• Verifying change requests and defects, documenting, tracking and communicating test plans, test results and unresolved problems, updating error log / suggestion log and explaining system bugs to Programmers.

• Responsible for preparing Test Plan, Test Case, Test data creation, test execution and test results report and also coordinate s with developers, BA and product owners (PO) on regular basis to track requirements and presenting business demo to stake holds (onshore partners).

• Communicate test progress, Test results and other relevant information to project stakeholders and management, supported and identified continuous improvements within testing processes.

• Worked closely with Project management and development teams to deliver quality through design and implementation, ensured that appropriate quality metrics and goals were defined and tracked throughout project lifecycle.

• Able to lead Test activities across all different phases of testing from test planning to test execution to test reporting

· To perform the Quality Audit of the projects implemented based on the applied logic of Rx claim Pharmacy claim adjudication system. Analyze the benefit requests, review the quality and secure all necessary data to ensure appropriate.

· Responsible for the configuration of Rx-CLAIM in order to support Pharmacy Adjudication by designing Plan Benefits, maintaining Drug Formularies, Member & Client records and pharmacy pricing.

· Worked with client management to Implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system.

· Develop client specific Implementation plans and manage Quality of the processes in accordance with department protocol.

· Maintain acceptable and appropriate Quality levels and production turnaround time.

· Research and respond to all claims processing inquiries from client management, clinical and other internal department.

· Respond to internal inquiries regarding adjudication and/or system capabilities.

· Proficient knowledge of US Health care provider Domain & familiar with facility & physician medicines processing.

· Mentored New team members regarding the process and standards.

Defect analysis and reporting.

· Perform Quality review of new and existing benefit plan set-up in Rx Claim (AS400).

· Responsible for the configuration of benefits and set-up of formularies, client and pharmacy pricing, and pharmacy networks in Rx-CLAIM to support of the adjudication of pharmacy claims.

· Analyzed benefit requests and secured all necessary data to ensure appropriate implementation based on applied logic of Rx-CLAIM pharmacy claim adjudication system

· Perform test claims (as applicable) and document results to ensure requests were completed accurately in the Rx-claim (AS400) system.

· Worked with Client Management to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system.

· Document work performed and audit results based on pre-determined standards and guidelines.