Nikhila Suresh
Alpharetta
Summary
Senior Business Consultant and IT professional with over 18 years of extensive experience in the healthcare domain, specializing in enrollment, provider management, and claims processing projects. Expertise in migrating legacy systems to innovative platform solutions and a deep understanding of Enrollment 834 and Claims 837 file formats. Proven track record as a Business Analyst and Agile Scrum Master, with skills in gathering requirements, creating user stories in JIRA, and managing project implementation activities both onsite and offshore. Strong relationship management abilities with clients and stakeholders, complemented by a solid foundation in risk management and project tracking using tools such as Microsoft Project and Smartsheet.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Sr. Business Consultant
UST HealthProof
Alpharetta, GA
05.2024 - Current
- Assisted healthcare customers with platform-based services. Supported enrollment and claims processing across various business lines using health rules payor and health rules answers from HealthEdge. Aided customers in simplifying functional landscapes and enhancing operational and financial metrics while adapting to new care delivery models.
- Guided junior consultants to enhance team capabilities and foster professional growth.
- Cultivated strong client relationships by employing effective communication strategies to understand needs and deliver customized solutions.
- Improved client satisfaction by analyzing business processes and implementing customized solutions.
- Evaluated customer needs and feedback to drive product and service improvements.
Offshore QA Manager
UST Global
Trivandrum
02.2021 - 04.2024
- Led QA team in developing and implementing testing strategies to enhance product quality.
- Established and maintained QA processes, ensuring compliance with industry standards.
- Conducted root cause analysis on defects, driving continuous improvement initiatives.
- Mentored junior QA staff, fostering skills development and knowledge sharing.
- Managed defect tracking systems, streamlining reporting and resolution processes.
Onsite Lead/ Scrum Master
UST GLOBAL
01.2018 - 02.2021
- Coordinate with product, business, technical, and other client partners to prioritize, plan, and execute development schedules in-line with product development initiatives and regulatory needs.
- Identify and track team velocity, financials, and other critical metrics in relation to the project/program and its plan.
- Provide transparency into gaps, issues, risks and opportunities across scrum teams, tackle impediments.
- Manage project risks, scope changes and other non-standard events throughout the life of the project.
- Contribute as Onsite QA lead coordinating the System Integration testing.
- Conduct the test result walkthrough with clients and get their approval.
- Guide and execute the UAT done by client partners.
- Defect management by logging defects assigning correct severity and priority in JIRA.
- Consolidating and sending the Overall test status to client and other stakeholders.
- After production implementation, work to formulate the process and procedures to follow during warranty support.
- Create the monthly dashboard to track the SLA’s and sharing with Client.
- Health Partners Plan’s (HPP) mission is to manage our business to exceed expectations, to operate with respect and dignity in all relationships and to continually improve the health outcomes of our members. Founded nearly 30 years ago, Health Partners Plans is one of the few hospital-owned health maintenance organizations in the US.
QA lead
UST GLOBAL
06.2017 - 12.2017
- Review Requirements and create an Estimate (LOE).
- Design analysis and preparing project schedules.
- Develop Test plan and Test ideas for benefit plans/provider/contracts/claims/enrollment.
- Design Test cases and prepare test data for Benefit plans and Contract testing.
- Logging defects assigning correct severity and priority in JIRA.
- Execution of test cases in test management tool, establishing requirement traceability, and generating reports.
- Find out risks and escalate necessary issues to configuration team.
- Consolidating and sending the Overall test status to client and other stakeholders.
- Maine Community Health Options (MCHO) Health's mission is to partner locally with Members, businesses and health professionals to provide affordable, high-quality benefits that promote health and wellbeing.
Offshore Business/Technical Analyst
UST Global
01.2011 - 05.2017
- Handling a team of 6 members.
- Coordinating all the tasks assigned from Onsite.
- Guiding the team in Analysis/coding/testing/implementation activities.
- Working directly with Anthem business people in the defects assigned to LO team.
- Providing all support and guidance to the team.
- Independently handling priority defects assigned on time so that there is no SLA miss.
- Ensuring quality deliverables from the team on time.
- Reviewing all the changes implemented from the team as part of system enhancements and defect fixes.
- Anthem, Inc., is a provider of health insurance in the United States. It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. Provides Health Plans for Medicare, Medicaid, Dental, Vision & Employers.
Mainframe Developer
UST GLOBAL
04.2010 - 12.2010
- Production Support activities – job monitoring and fixing the abends.
- Release activities - Package freeze, RFC creation, Implementation plan creation etc.
- Analysis of the new requirements.
- Preparation of Analysis documents.
- Coding as per the requirements.
- Test case and test data preparation.
- Unit Testing the components.
- Mentoring the new members joining the team by taking business as well as technical sessions.
- Frequent interactions with onsite in clarifying the requirements and day to day tasks.
- As QC of the project, preparing and uploading the metrics on time and discussing the variance in team meetings by preparing the Causal Analysis Report.
- The Pharmacy Capability Sourcing ProServ team provides production support and queue work amounting to less than 100 hrs. The project assumes maintenance, lights on and select business support activities of less than 100 hrs for the ProServ.
Mainframe Developer
UST GLOBAL
06.2009 - 12.2009
- Worked in adjudication part - Rate Load track of the project.
- Analysis and Coding.
- Updating the RTM.
- Test data preparation.
- Unit Testing, System Integration testing, UAT.
- Lead a team of 3 members during October 2009 – December 2009.
- Proper review of code, test results and implementation activities.
- Handling the implementation activities.
- WellPoint NextRx Pharmacy Benefits Management (PBM) systems have been acquired by Express Scripts Inc (ESI).
Mainframe Developer
UST GLOBAL
10.2007 - 12.2008
- Handling the PDE section in the project.
- Requirement analysis.
- Preparing the Approach Document.
- Coding and testing the programs as per the requirement.
- Preparing One-Time jobs for the run-in production.
- Creating scheduling RFC and running jobs in production.
- Updating job run details in the trackers.
- Maintenance document preparation.
- Issue resolution.
- Worked as DPC for the project.
- Taken measures to reduce defects in the team.
- The project deals with design and implementation of Medicare part D drug program.
Education
B. Tech - Electrical & Electronics
Adi Shankara Institute of Engineering And Technology
Kalady06-2006
Entry Level Training - Mainframes
UST Global
ThiruvananthapuramSkills
- Agile Frameworks – Scrum
- Atlassian JIRA tool
- Excellent written and Verbal Communication skills
- Good Facilitation and people management skills
- Business analysis
- Planning and execution
- Training and mentoring
- Task prioritization
- Teamwork and collaboration
- Time management
- Mainframe language: COBOL/JCL/IMS DB/DB2/SORT
- Analytical skills
Certification
IBM certification Rational – 640
000-730 DB2 certification
AHM-250 Healthcare certification
Business Analysis Fundamentals
Insights from a Business Analyst course
Timeline
Sr. Business Consultant
UST HealthProof
05.2024 - Current
Offshore QA Manager
UST Global
02.2021 - 04.2024
Onsite Lead/ Scrum Master
UST GLOBAL
01.2018 - 02.2021
QA lead
UST GLOBAL
06.2017 - 12.2017
Offshore Business/Technical Analyst
UST Global
01.2011 - 05.2017
Mainframe Developer
UST GLOBAL
04.2010 - 12.2010
Mainframe Developer
UST GLOBAL
06.2009 - 12.2009
Mainframe Developer
UST GLOBAL
10.2007 - 12.2008
B. Tech - Electrical & Electronics
Adi Shankara Institute of Engineering And Technology
Entry Level Training - Mainframes
UST Global
Skills Summary
Scrum, Atlassian JIRA, MS Excel, PowerPoint, Project, Visio, TestRail, COBOL, JCL, IMS DB, DB2, VSAM, IDCAMS, SORT, FM IMS, CHANGE MAN, File-AID, File manager, Excellent written and verbal communication skills, Good facilitation and people management skills
Education Training Certifications
- B. Tech in Electrical & Electronics, Adi Shankara Institute of Engineering and Technology, M.G. University, YYYY-MM-DD
- Entry Level Training in Mainframes, UST from Capital Mark, Thiruvananthapuram, 3 months
- Communication and personal development program Level 4, attended
- IBM Rational - 640, taken
- 000-730 DB2, taken
- AHM-250 Healthcare, taken
- BSAC, completed
- Business Analysis Fundamentals, completed
- Insights from a Business Analyst, completed
Experience Highlights
UST GLOBAL, Kerala, India, 2007-09-01, present, Sr. Business Consultant, Health Care Platform Solutions, Integrated Health Care Services (IHCS), 2021-02-01 to present, Providing platform-based services to healthcare customers., Health Partners Plans (HPP), 2018-01-01 to 2021-02-01, Managing business to exceed expectations and improve health outcomes., CHO (Community Health Options), 2017-06-01 to 2017-12-01, Providing affordable, high-quality benefits., WGS-STAR Lights-on Support - Managed Services, 2011-01-01 to 2017-05-01, Providing solutions for improving clients’ business., Capability Sourcing ProServ, 2010-04-01 to 2010-12-01, Providing production support and queue maintenance., ESIDAY1Q – Proserv, 2010-01-01 to 2010-03-01, Providing support to changes implemented., Medinah – Proserv, 2009-06-01 to 2009-12-01, Updating PBM systems to reflect ESI pharmacy rates., RHI PBM collaboration, 2009-01-01 to 2009-03-01, Implementing activities to improve profitability., MEDICARE PART D, 2007-10-01 to 2008-12-01, Design and implementation of Medicare part D drug program.