Professional Summary

• 13 years of experience in IT industry with 8 years at Client site in Confidential
• Successfully implemented various complex projects as per schedule and within budget
• Very good in Functional knowledge in healthcare insurance, claim processing and Financial systems at Confidential and is responsible to resolve issues received by client by managing the team.
• Consistently demonstrated capabilities to manage and successfully deliver complex projects.
• Shows strong project management skills with SDLC methodology.
• Has good knowledge of Agile process and Lean Management Techniques.
• Good at Planning Leading Teams to meet the targets as per schedule, thereby build the strong motivated focused team
• Has good experience in leading managing the teams of size from 5 to 20 members
• Proficient in Drafting Work plans, Deriving WBS, Resource Plans, WBS Estimates Project Schedules, Risk Assessments.
• Experience includes preparing the project plan using MS Project.
• Has very good command on AS/400 programming language RPGLE CLLE, CBLLE, SQL 2000 and DB2 database. Also expert in Mainframe programming, JAVA, Crystal Reports XI and RDBMS concepts
• Currently Project Lead and working on Claims Processing System in USA.
• Has a very excellent analytical capability and communication skills.
• Proficient knowledge in management of full project life cycle concept through implementation and always ready to take ownership of projects.
• Preparing project management methodologies and techniques
• Develop project plans, share information such as project objectives, technologies, systems, information specifications, schedules, funding, and staffing
• Manage project execution to ensure adherence to budget, schedule, quality and scope and identify risks.
• Manage multiple projects and possess out of box thinking capabilities.
• Communicate effectively across cross-functional teams
• Provided designs and architect solutions.
• Provide designs and architect solutions.
• Effectively made presentations to senior management
• Responsible for overall delivery of the project
• Majorly involved in the communication with all the Stakeholders within the project and Co-ordinate
• Schedule and facilitate meetings.
• Excellent knowledge of healthcare industry, specializing claims processing

Technical skills

Projects Profile

Client Name : Confidential

Role : Project Lead and Release Lead

Environment

• Software: Languages: COBOL/ILE, RPGLE, ILE CL, SQL/400, Jwalk
• Database: DB2/400
• Tools: ACMS, MQ series, Hawkeye, Crystal Report XI, ROBOT, Connect Direct, PVCS, MS Project
• O/s: OS/400 V7R1 , AS/400-iseries, JAVA, JAVA beans, Application Server

Project Description

• Responsible for successfully implementing various project. Working on various projects for Confidential application and claims Financial. Excellent knowledge of claim's life cycle. Participated in various projects and handled various responsibilities
• Major projects accomplished are
• Confidential: Responsible for providing design solutions and successful implementation of this project. For Clinical code editing, a adapter established to make asynchronous call during claim Adjudication to Confidential application in XML format. The response and appropriate savings should apply on the claim. Online user are not expected to be hit by performance.
• Confidential: As a compliance project, organization wide initiative was to restructure the architecture. This program was multi phase projects involving large number of trading partners. It consists of 837-inbound, 837-outbound, 276/277 and 835 transactions. Also upgrade application for ICD-10.
• Confidential: Project objective was to allow Coordination of Benefits COB correctly in adjudication when member has other insurance.
• Confidential: Confidential has agreed to meet Sarbanes-Oxley compliance in 2007. With this compliance all payments and invoices should balance. Changes were to add strict balancing criteria in every module and tighten the grip on money inflow-outflow within different departments interfacing with General Ledger system.
• Confidential: Confidential had large amount of data in Confidential and maintaining the data in the AS400 system was costly. The cost effective solution is to migrate old data the low cost application under System Health.
• Confidential: Worked as team lead. The existing adjudication process was using Third party software for the 'Claim Check' version 5.0 processing. CONFIDENTIAL had decided to use the upgraded 8.5 software version than existing 8.5. This has demanded Adjudication to make necessary changes and provide setup for new configurations.
• Cost Containment : Cost Containment is the customer initiative to achieve more savings on claim processing and external partners. This project also initiated steps modularize adjudication programs. As part of this project, I developed new technique called Logical Mapping Process LMP , this has shown tremendous positive results.
• Refund Adjustment : Refund Application is the special processing application developed by third party. Front end of this application is built on JAVA and main process in done in AS/400. This application processes refund and adjustment requests received from business or different vendors.

Responsibilities:

• Scope Planning and Impact Analysis
• Client Interactions for business issues and maintenance activities
• Defining the responsibilities for onsite and offshore team and ensuring SLA is met
• Reviewing the project status and taking corrective measures
• Requirement Gathering Preparing Business Requirement Documents
• Coordinate with Enterprise Release Management
• Participate and provide direction in Release Management meetings
• Manage project plan, schedule, scope and quality
• Perform risk analysis and mitigation
• Project tracking and providing direction to team member as needed
• Identify improvement opportunities. As a part of it, developed 'Logical Mapping Process' LMP which has shown tremendous improved results
• Identify dependencies, prepare development plan
• Reviewing the status of the project and taking corrective measures
• Prepare integration testing plan, execute with team and validate results
• Onsite-offshore coordination
• Participate in UAT
• Successfully managed medium teams of 5-10 members

Domain:

• Health Insurance
• Claims Processing
• Capitation

Client Name : Confidential

Roles : Associate Consultant

Environment

• Software: Languages : COBOL
• Database : DB2, VSAM
• Tools : Changeman, Easytrieve, VisionPlus
• O/s : Mainframe

Project description:

• Requirement was to enhance of the existing Credit Card Management system to accommodate to meet business demand. Review and test the functionality and Confidential activities. Household, Member of Confidential which is consumer lending, credit card services, finance and maintains insurance maintained on Vision Plus and IBM 3090. In existing Credit Card Maintenance System CMS , block code indicates the accounts which are actively receiving benefits. The block set on the account can be overridden with high priority block codes. This leads to account erroneously remove from the benefit receiving claim status. The Confidential module modifications required to include right Confidential to drive the insurance benefits. A New process has to develop to activate and deactivate the claim status based on the data received from Insurance Services.

Responsibilities:

• Communicate with Onsite and Offshore team leads
• Requirement Gathering and Analysis
• Prepared specification document, code, review and unit test
• Responsible for Integration testing

Client Name : Confidential

Roles : Programmer Analyst

Environment

• Software: Languages : RPG/400, COBOL ILE
• Database : DB2/400
• Tools : SDA, RLU
• O/s : OS/400

Project description :

• Confidential, Maintains Insurance for the Claims for the Liability, Workers compensations, Auto Insurance and it is also has part of Life and Health Insurance maintained on AS/400 and IBM 3090. In existing system, claims are handled in AS/400 system and other policy information is stored in mainframe. Enhancements include modifications in security codes and additional features to accommodate new information. Data is transferred across AS/400 and mainframe depending on the requirement. Farm claims are present in the mainframe. AS/400 system has to enhance for accommodation of Farm claims. Batch programs in mainframe and screens in AS/400 were undergone modifications. The communication between mainframe and AS/400 is handled through Confidential files which transfers data from AS/400 to mainframe and mainframe to AS/400

Responsibilities:

• Requirement Analysis
• Prepared specification document, code, review and unit test

Client Name : Confidential

Roles : Programmer Analyst

Environment

• Software: Languages : COBOL
• Database : DB2
• Tools : Changeman
• O/s : Mainframe

Project description:

• Confidential. is one of Confidential largest department stores, drug store, catalog and e-commerce retailers and operates approximately 1,100 Confidential department stores. The project is to build a Freight Confidential application that automates the processing of freight invoices received from carriers. The FAP application processes an invoice in a series of sequential steps referred to as the invoice workflow . Each step in the workflow is actually a batch program that runs on a fixed schedule. The successful completion of each step in the workflow or an override for that step is necessary before the invoice is allowed to proceed to the next step in the workflow. The Confidential system will also contain web-based maintenance screens for adding, changing or deleting data in Confidential support tables. Support tables are those tables that contain the rules for automatically processing an invoice for example, the payment matrix table, the rate tables, the user privileges table, etc.

Responsibilities:

• Perform Impact Analysis
• Preparation of Program Specifications
• Coding, Review and Unit Testing