SUMMARY:

• Successful IT Professional with 10 years of Overall IT experience
• Working expertise in Major Health care IT Systems (Fortune 500 Company - Anthem Inc)
• Strong Client relationship skills with Excellent Project Management/Co-ordination skills.
• Worked with Multi-National Customers/Project Stake holders Integration (US, China, LATAM, INDIA)
• Ability and willingness to acquire knowledge and assimilate to new technologies.
• Ability and willingness to handle Multiple Projects.
• Good Analytical, Problem Solving and Interpersonal skills.
• Proactively works with stakeholders to identify future System opportunities and enhancements.
• Provides the link between the technical and business views of the system by ensuring that the technical solutions being developed will satisfy the needs of the business.
• Working Experience with Confidential
• 7 years of Working experience in Confidential
• SME in Claim Processing Systems
• Worked in Major health care Mandate Projects (HIPP 5010, ICD 10)
• Expertise in Confidential Claims Processing
• Worked in Membership & Enrollment Service delivery team.
• Working as a Senior System Analyst for System Claim Auto-Adjudication Claim Project.
• Reserve Amount Predictive Analysis (MS Azure) - AI Tool
• Worked in Pre-Authorization/Case Management, Utilization Management & Referral Tagging
• Worked in Confidential Quoting & Underwriting System
• Worked in Prediction Analysis - International Claim Reserve Amount ( MS Azure )
• Working Experience with in Health care Products
• Good Knowledge on the Claim Interface Systems.
• Good Knowledge on FCS/Check-write Systems
• Good Knowledge in Overall Confidential Claims/Membership System.
• Working Experience with Major Insurance Portals
• Group Administration Portal ( Confidential Insurance) Pre-Authorization/Case Management Portal ( Confidential Insurance) Consumer/Member Portal ( Anthem/ Confidential Insurance) EDI Portal (Blue Exchange - 270/271 Eligibility) Broker Portal
• Good programming skills on COBOL, JCL, CICS, REXX, JAVA, PL-SQL.
• UNIT testing Experience with TERADATA & SQL.
• System Impact Analysis Experience with TERADATA & SQL
• Strong in documentation - UTCs, UTRs, LOE, TDD and Defect Tracker
• Good working knowledge on mainframe tools like FILEMANAGER, SPUFI, IOF, IBM Debugger, Fault analyzer, CHANGEMAN etc.
• Good working knowledge on mainframe version control tool like CHANGEMAN.
• Exposure to Full life Cycle of Software Development including Requirement Analysis, Designing, Unit Testing, Maintenance and Documentation
• Ability and willingness to acquire knowledge about the new technologies, good analytical, problem solving and interpersonal skills
• Working experience in Services/Portal front end and backend side
• Strong Client relationship skills.
• Good programming skills on COBOL, JCL, CICS, REXX, JAVA, PL-SQL
• Good knowledge in IMS and Assembler.
• Strong in documentation - BRD, Project Scope document, UTCs, UTRs, LOE, TDD and Defect Tracker.
• Good working knowledge on mainframe tools like FILEMANAGER, SPUFI, IOF, IBM Debugger, Fault analyzer, CHANGEMAN etc.
• Exposure to Full life Cycle of Software Development including Requirement Analysis, Designing, Unit Testing, Maintenance and Documentation.
• Working experience in Services/Portal front end and backend side.
• Strong Knowledge base in MS SQL
• Working for Confidential Data Governance Project using Microsoft SQL Sever Working for Confidential Data Analytics Project using Microsoft SQL Server/MS Azure Working for Data Warehousing Project (Migrating from MS Excel to MS SQL Server)
• Good UNIT testing Experience with TERADATA & SQL Reporting
• System Impact Analysis Experience with TERADATA.

SKILLS SUMMARY:

Operating System: IBM mainframe Z/OS, Windows

Tools: FILEMANAGER, SPUFI, IOF, IBM Debugger, Fault analyzer, CHGMAN

IBM Rational tools: defect management and tools like JIRA, IBM JAZZ, Service NOW, MS SharePoint

Languages: COBOL, JCL, CICS, REXX, Java, SQL, MS SQL Server

Databases: TERADATA, DB2, IMS DB/DC

Tools: SOAP Tester, HIPPA BX Tester

RPC Tester: Enterprise Benefit Testing Tool (EBA Tester)

EXPERIENCE HIGHLIGHTS:

Business System Analyst/Project Manager

Confidential

Responsibilities:

• Work exposure in Agile driven Projects.
• Worked with Multi-National Customers/Project Stake holders
• Managed System Migration / Claim Modernization Projects.
• Work exposure in Health care domain such Quoting & Underwriting, Claims, Pre-Authorization business domain & Projects.
• Business Analysis, System Analysis & Technical Project Management responsibilities.
• Healthcare System Migration project from Quoting & Underwriting to Claims Module.
• Successfully delivered multiple challenging projects.

Confidential

Sr. Business System Analyst/Technical Project Manager

Responsibilities:

• Working experience in below mentioned Health Care Claims Business areas.
• Confidential Mapper/Edit/Load Process
• Accumulators (Legacy/ODS)
• Adjudication
• FCS/Check-write
• Blue Exchange (270/271 Eligibility)
• Edits (Edit Analysis, Edit resolution)
• Medicare/Medicaid/COB
• Consumer Portal/Google Portal
• Medicare Sequestration
• Claim Services/RPC
• TPA
• CDHP-LITES Issues.
• IQT Issues.
• Broker Portal/Applications
• FACETS
• Benefit Application
• Professional/Institutional Pricing
• Business System Analyst/Technical programmer in Overall Healthcare Claims Business
• Business System Analyst/Technical programmer in a Critical Area (BX/Portal) for Claims Business Area (Blue Exchange (BX) is critical System which has direct Impact on System Performance Score)
• Unit testing experience using TERADATA Reporting
• System Integration Testing using TERADATA/SQL Queries
• Responsible for working directly with Client Business Analysts & IT Managers.
• Responsible to Analyze & give solution to System Issues.
• Responsible to work on System Enhancements & Permanent Issue resolution Enhancements
• Preparation and review of technical specifications
• Gather business/technical requirements from Client, Create technical design document,
• Prepare estimation plan document
• Provided assistance to software developers and testers to resolve defects during the testing process.
• Performed data analysis for production issues to find out the root causes.
• Participate in daily requirement gathering sessions with Business user team, held to gather information and complete requirement understanding.
• Prepare High level business design document.
• Coordinate different systems affected with changes.
• Coordinating development activities.
• Extend support in SIT and UAT phase.
• Coordinating project release activities
• Assists in resolving production issues
• Involved in user reported Issues - Root cause analysis & its fix.
• Reviews and attend client meetings

Confidential

Responsibilities:

• Responsible for design, Coding, Testing
• Quality Controller of the project
• Preparation and review of technical specifications.
• Responsible for the execution of the project by providing on call Batch Support in Shifts.
• Develop new report programs
• Responsible for fixing ERROR occurring in Production run, Analysis/ Fixing program problems,
• Test data and Test cases preparation, Preparation of Technical Documentation.
• Interaction with clients and proposing solution for their requirements.

Software Used: COBOL, JCL, TSO/ISPF, Change Man, Control-M, File Aid, SAR, ABEND-AID

Confidential

Responsibilities:

• Setting up targets/Goals for the process - Setting and maintaining critical to quality and critical to process targets for the process.
• Monitoring the overall processes of the application, identifying improvement areas and implementing adequate measures to maximize customer satisfaction level.
• Experience in using various Quality control tools to checking coding standards.
• Governance model and client focus.
• Effectively coordinating Transition management project roles.
• Employee management - Performance goals, review and constructive feedback, career planning and mentoring of Software Developers etc.
• Determining training needs of employees and conducting need based training programs to enhance their Operational efficiency leading to increased productivity across the process.
• Representing the commercial delivery for new employee orientation

Confidential

Software Engineer

Responsibilities:

• For application development using Java JSP, Servlet, Filter, JDBC, Security, SQL
• Preparation of Technical Specification Documents
• Involved in Coding, unit testing and Unit test results preparations as per the specifications.