Rashmi Jaiswal

About Rashmi Jaiswal

Extensive IT experience as a Business Analyst in Healthcare and Insurance Domains with solid understanding of Business Process Modeling, Business Requirements Gathering, Business Process Flow, Systems Analysis and Testing Conducting Business Processes Evaluation and facilitated the changes in SDLC, while constantly collaborating with cross functional teams Design, documentation and review of business documents like BRD, FRD and SRS Experience in Agile methodology and Scrum framework projects for authoring Technical, Business, Functional and Non-Functional requirements starting with Epics, Features and User Stories Experience in facilitating Joint Application Development (JAD) sessions with IT Groups, SMEs and other project stakeholders Experience in maintaining EHR, EMR systems with regards to HIPAA compliance Experience in various Insurance plans such as HMO, PPO, PFFS, Medicaid and Medicare Working on different modules like Claims, Claims Life cycle, Membership, Provider and Billing Experienced in project management with HIPAA, HL7, X12 transactions 270/271, 276/277, 820, 835, 837, queries and testing Excellent experience working on Agile tools like JIRA and Rally Software for user Story creation, defect management and story prioritization Competent in creating Unified Modeling Language (UML) diagrams for Business Process Modeling like Use Case Diagrams (UCD), AD, Sequence Diagrams (SD), DFD, FC and Wireframe Prototypes Extensive experience with MS Visio for drawing flow charts and screen mockups and MS Project for status reporting and planning Assisted QA team in generating test plans, test scenarios, test cases, and managed complete defect tracking life cycle using various defect tracking tools Conducted detailed gap analysis for enterprise projects, identifying system inefficiencies and proposing solutions for central fill,340B, and Free drug program workstreams Acquired in-depth knowledge of free drug programs, insurance plans, and E referral, including PAP, bridge, temporary, and replacement plans Experienced in 340B Pay report and procurement process involving NDC- dispensed tracking, claim management and profitability checks. Additionally in-depth knowledge of replenishment process via TPA portals, managing inventory credits, and ensuring accounting in the 3010 Script Med system report Experienced in Central fill operations, addressed system gaps, including delivery address validation, duplicate order prevention, inbound and outbound file transaction errors between central fill and CVS US Citizen

Experience

1. Senior Business System Analyst (Enterprise Architecture)

   Blue Cross Blue Shield Association

   Jul 2025 — Present · Austin, TX, US

   Senior Business Systems Analyst and Enterprise Architect with expertise in transforming business needs into scalable enterprise solutions, improving workflow efficiency, and ensuring alignment with organizational goals.

Education

• Disha Institute of Management of Technology, Raipur

  Master of Business Administration - MBA, Business Administration and Management, General

• Chhattisgarh Swami Vivekanand Technical University (CSVTU)

  Certification of supply chain Management