Jun 2022 – Jan 2023 · 7 mos · Hyderabad, Telangana, India

Oct 2018 – Jun 2022 · 3 yrs 8 mos · Greater Hyderabad Area

• The Individual Health Record (IHR), UHG's R&D product platform cognitively transforms multi-sourced heterogeneous data into an understood story of an individual’s health and care. It not only provides patients access to health and health care information in a way that they can understand and use, but also provides clinicians, physicians and patients with a single common environment in support of each individual’s health and care.

Oct 2016 – Jan 2018 · 1 yr 3 mos · Charleston-Huntington Area

• WV DHHR RAPIDS is an integrated eligibility system that delivers public assistance programs, WV WORKS (TANF), Medicaid, Children's Health Insurance Program (CHIP), Supplemental Nutrition Assistance Program (SNAP) formerly food stamps, Emergency Assistance (EA) and seasonal programs; Low Income Energy Assistance Program (LIEAP) and School Clothing Allowance (SCA).
• RAPIDS provide an enterprise environment for the administration and management of a group of related programs to support the need for information at the county state and federal levels. In addition, the system supports extensive and complex interfaces, both on-line and batch, with state and federal systems.
•  Closely interacted with stakeholders, business users and State Track leads for requirement gathering.
•  Help developers understand the business and provide technical guidance to the team to work on various enhancement requirements.
•  Worked as a Product owner for the EBT conversion project from JP Morgan Chase to FIS.
•  Spear-headed the Disaster-SNAP project when the State of West Virginia announced DSNAP benefits to the affected counties.
•  Responsible for sending out High Priority incidents to the State Team.
•  Wrote, assisted and Executed SQL queries to build reports from the DB2 Database.
•  Gathering requirements and providing solutions for program change requests (Incident tickets/datafixes) which were raised in Service Now by state workers and state track leads.
•  Developed an understanding and functional view point of the current state process of the applications for conversion & consolidation under Group Administration.
•  Served as a liaison between the client, the development team and any third-party regarding software functionality throughout the development cycle.
•  Performed analysis and presented results using SQL, MS Access, Excel, and Visual Basic scripts.
•  Developed design specifications for correspondence, reports or interfaces.

Apr 2013 – Aug 2016 · 3 yrs 4 mos · Greater Hyderabad Area

• TOPS-SOS (The Online Processing System – System Operation Support): The application
• employs logic to determine eligibility for coverage, adjudication of claims, patient and provider responsibility from the Revenue Cycle Management. TOPS interacts with various applications for claims, membership, provider and other type of claim related data. TOPS is a mainframe system and involves both online and batch process. TOPS adjudicates more than 250 million medical claims annually.
• Working in this project, Ms Raja gained valuable insights into critical concepts such as Estimation of Benefits, Coordination of Benefits, Claim Life Cycle, Denial/Pend claim, Pre-Auth, Case & Utilization Management, Cost calculation, Eligibility & Coverage among other concepts of the RCM.
• As a System Analyst Ms. Raja is responsible for requirement gathering, analysis, estimation, recommending solution and designing of the requirement. Her role is as follows
•  Work with business stakeholders to build the requirements.
•  Translate business requirements into functional Requirements Document and to Detailed Design Documents
•  Lead analysis sessions and requirements sessions and write specification and functional design documents for enhancements and customization.
•  Analyze product impact.
•  Prepare system solution document and Detail design document for the IT and help them develop the code for the requirements.
•  Verify the Use cases, Test Cases prepared by the QA team.
•  Perform round of Unit testing.
•  Conduct walkthrough sessions for Development and testing team on application/system requirements.
•  Work with QA to create test scripts and scenarios for enhancements and customizations to the core product
•  Communicate activities/progress to project managers, business development, business analysts and clients
•  As QMS coordinator, have been working in making sure that quality related documents and been updated and placed in accurate and timely.
•  Manage the internal audits.

Jun 2011 – Apr 2013 · 1 yr 10 mos · Greater Hyderabad Area

• As a Mainframe Developer, worked on the TOPS SOS Project.
• Key responsibilities in this position included:
•  Responsible for fixing production issues and new enhancements.
•  Interacted with the Clients, SME and system analyst directly to understand the design and get the requirements about the new projects.
•  Created a high level design, estimated the efforts, Completed the design, coding, unit and system testing and involved in implementation activities
•  Involves the usage of expediter to identify the defect and make code changes accordingly.
•  Worked alongside with the onsite counterpart on various business functions such as ENRP, SPI etc to do the initial analysis on the requirement, gather technical information about the enhancement, estimate the efforts for each program, design the changes, Coding and testing and involved in implementation activities.