SUMMARY:

• Highly - accomplished, solutions-driven, execution focused and visionary technology development strategist with wide-ranging expertise in healthcare, pharmacy and finance operations.
• More than 15 years of demonstrated achievements of positively impacting bottom-line and delivering profitable growth through effective technology.
• Managing and leading teams in areas of BPM Architecture and development, IT application development / integration and infrastructure development.

TECHNICAL SKILLS:

Pega Framework: Pega PRPC, Pega HC, Pega CPM, Pega GSPM and SA, Pega PCS, Pega Claims, Pega Care Management, Pega Claims Workstation Pega Smart Dispute and Fraud Management.

Platforms: J2EE, Pega, IBM BPM and WebSphere Process server, .IBM ESB, Net, C#, Microsoft SRS and ILOG

Methodology: RUP, Agile, TOGAF, Zachman.

Databases: Oracle, DB2, UDB, MS SQL Server.

Middleware: WebSphere MQ, WebSphere Message Broker (MB), TIBCO.

Productivity Tools: Microsoft Office, including Visio, PowerPoint, Excel, Project and Share Point.

Specialized Applications: Diamond Perot, TriZetto Facets / QNXT, McKesson ClaimCheck / ClaimsXten, Medecision Alineo, Ingenix / 3M/Burgess pricing, FICO™ Insurance Fraud Manager and IBM FAMS

PROFESSIONAL EXPERIENCE:

Confidential

Strategy & Enterprise Architecture

Responsibilities:

• Provided strategy leadership and operationalized technology solutions in response to changing marketplace. Build out roadmaps for large capability like Claims, Provider & care Management, Servicing to save 20% on the technology spend with the right implementation technologies.
• Provide the leadership and build the cloud strategy of migration and building new applications in cloud Azure and AWS saving the cost by 45% and reducing the deliver time by 20%
• Demonstrated organizational leadership ability by evaluating and implementing third party dental, vision, life and disability service on Salesforce Platform adding $120million annually to the bottom-line.
• Lead a team through product evaluation and implementation of Product Platform on the AWS cloud saving business 40million$ over 3 years.
• Built a strong team of 40+ members from ground up on Pega BPM to delivery initiative in the 5million annually, automating backoffice workflow like Claims Exception, Care Case management and Credit card case management; build a team of certified LSA’s, SSA’s and LBA’s.
• Responsible for increasing the customer acquisition by 50% by implementing a Know Your Customer(KYC) leveraging Pega PRPC across all segments from wealth management to retail.
• Build a Big data solution roapmap by dismantling traditional warehousing solution, build the data quality leveraging Informatica IDQ
• Responsible for building a team of Data Scientist to leverage R and Scala to identify Gap and Opportunities in large programs like Care Optimization and Provider Utilization & Billing.

Chief Enterprise Architect, IT solutions

Responsibilities:

• Recruited and built a team of 50+ team consultants with specialized technology skills with domain experience grossing 18+ million annually
• Demonstrated leadership by delivering industry-first integrated insurance platform on SOA-enabled, real-time, providing annual saving of $20M by migrating claims, enrollment, billing and utilization management processing from legacy platforms and leverage Pega Claims framework for exception management.
• Facilitated launch of Care platform leveraging Pega PRPC HC framework and clinical / medical decision support platform supporting HL7 along with EHR / EMR integration contributing to a $20M savings.
• Managed organizational co-ordination by implementing pharmacy products on Prime therapeutics with Pega as the core exception-processing platform, Pharmacy Benefit Manager (PBM) reducing the operating cost by 30%.
• Responsible for increased operational efficiency by implementing Pega - Smart Dispute Framework for Credit and Debit Card Dispute and Chargeback Automation resulting in saving of 30million annually.
• Built strong foundation for greatly reduced fraud, waste and abuse using Pega fraud framework, saving as much as $30M, through creation of an analytical infrastructure.

Design Architect

Responsibilities:

• Demonstrated leadership and strategic communications skills by working closely with legislators and providing oversight of IT teams and infrastructure to increase recovery of Medicaid / Public Assistance overpayments by 400%.
• Directed a team of analysts, developers and testers to build an over-payment recovery application. Mentored and built a successful team via personal development and professional growth.
• Achieved 60% decrease in software development with implementation of strategic outsourcing program, as well as implementation of RUP and Agile development methodologies.

Manager & Senior Consultant

Responsibilities:

• Provided leadership role by managing and guiding technologists / business consultants in development of business case, proof-of-concept and to secure VC funding of $40+M.
• Provided the technology leadership in developing NASDAQ’s first trading system on Java and Oracle platform introducing fastest trading in the market place, saving Fleet Bank $8M dollars in transaction fee.