SreeGowri Madineni

• Client: Anthem, Inc:

Anthem is a leading U.S. health insurance provider, operating under various Blue Cross and Blue Shield names. They offer diverse health plans to individuals and employers, focusing on providing access to healthcare services.

Project : Paper Claims

The project involved validating CMS, UB and Member submit forms to ensure accurate claims data is transmitted in 837 files. The objective was to verify correct mapping of provider, patient, diagnosis, procedure and billing information in compliance with HIPAA standards and payer specific requirements.

• Analyzed requirements and participated in project walkthroughs with onsite teams.
• Created and executed functional and regression test cases.
• Validated CMS-1500, UB, and member forms for accurate 837 EDI data mapping.
• Verified key EDI segments and ensured compliance with HIPAA and payer guidelines.
• Used SQL to validate 837 outputs against database records.
• Performed API testing using Postman and CIW to verify data integration.
• Collaborated with developers and analysts to resolve mapping issues and enhance claim accuracy.
• Anthem, Inc. is a leading U.S. health insurance provider, operating under various Blue Cross and Blue Shield names. They offer diverse health plans to individuals and employers, focusing on providing access to healthcare services.

Project: RFAI – Mainframe Modernization & API Testing

Worked on a digital transformation project aimed at optimizing provider communications and automating claims processes. The project involved transitioning finalized claims to digital RFAI notifications, reducing manual intervention and improving system efficiency. Contributed to mainframe modernization efforts and conducted API testing using Postman and CIW application to ensure smooth integration and accuracy of automated workflows.

Responsibilities:

• Analyzed requirements and contributed to test planning and documentation.
• Participated in mainframe modernization testing for automated claim workflows.
• Performed API testing using Postman and CIW to verify data exchange and system functionality.
• Logged and tracked defects in Jira and coordinated with cross-functional teams for resolution.
• Attended regular status and defect review meetings with project stakeholders.

• Understanding & Analyzing the Business requirements.
• Preparing Test cases as per requirements.
• Participated in daily status calls and weekly meetings to discuss the progress and bugs identified in testing.
• Analyze the work and reporting any issues to the Manager/Project lead.
• Prepared TESD doc.
• Involved in executed in test scripts.

• Attending business calls and understanding of requirements.
• Validating the data as part of testing.
• Participated in daily status calls and weekly meetings to discuss the progress and bugs identified in testing.
• Involved in executed in test scripts.