PROFESSIONAL SUMMARY

TECHNICAL SKILLS

EDUCATION

Bachelor of Engineering in Electronics and Communication.

CERTIFICATIONS

• Cleared LOMA-002(Health Concepts) Health Insurance domain test conducted by Life Office Management Association (LOMA).
• Cleared the IBM DB2 UDB V8.1 family fundamentals certification.

ACHIEVEMENTS

• Selected as best performer in consecutive appraisal cycles.
• Appreciation for excellent work in mentoring new resources.

PROFESSIONAL EXPERIENCE

1. Project : Confidential,

Duration : From October 2010-August 2011

Description:

Currently WGS claims IT team run Mainframes jobs that simulates the Blue Exchange Get-27xBenefit accum SBI and reports user defined errors encountered during the process.

These reports are then shared with respective Benefit coding teams for review and correction. The simulation jobs are currently executed on demand basis.

As of today these reports are dependant upon I support and not generated frequently, hence with the automation of BX batch simulation, reports will be generated and will be available to business for review on weekly basis.

Also the current simulation process does not capture any re-occurring errors. The proposed change would capture the re-occurring errors and that would help the business to evaluate the impact and prioritize the error resolution.

Responsibilities:

§ Preparation of detailed technical design documents based on analysis of functional business requirement which includes developing block diagrams and logic flowcharts.
§ Worked on coding and unit testing of enhancements in COBOL and integrating them with existing system.
§ Resolution of system bugs uncovered during all phases of testing.
§ Worked on support by executing and monitoring the daily job cycle on mainframe.
§ Analyzing and resolving various issues in COBOL programs like abends and illegal data issues faced while executing cycle jobs.
§ Reporting Daily and Weekly status.
§ Preparing and documenting various deliveries(phase wise and in between).
§ Mentoring new resources about the processes followed in project.
§ Co-ordinate the activities with team members and reporting.

Environment : Mainframes, JCL, COBOL, IMS DB,DB2 and VSAM.

2. Project : Confidential,

Duration : From July 2010-October 2010
Description:

Affordable Care Act puts into place comprehensive health insurance reforms that will hold insurance companies more accountable and will lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.
The Act will not be implemented all at once. Portions of the law have already taken effect. Other changes will be implemented through 2014 and beyond.

The scope of this claims project is the reforms that are already in effect. These will be implemented in Claims systems before 23-Sep-2010.

Patient Protection and Affordable Care Act included several provisions that became effective on September 23,2010

The department of Health and Human Services will be issuing regulations that server to further define the provisions provided for in the Patient Protection and
Affordable care Act.

Responsibilities:

§ Analyzing the requirements, and providing solutions to meet the requirements ontime.
§ Providing support in executing and monitoring the daily job cycle on mainframe.
§ Providing solutions to issues raised in System Testing (SIT) and User acceptance Testing(UAT).
§ Working on Enhancements of the existing codes by adding new functionality to it.
§ Analyzing change request in existing business functionalities, designing and coding in COBOL for their solutions
§ Involved in code review and formatting of COBOL programs.
§ Creation of test data & test plan for various objects and scenarios.
§ Maintain documentation for all work done.

Environment : Mainframes, JCL, COBOL, IMS DB,DB2

3. Project : Confidential,

Duration : From May 2009-June 2010

Description:

The ETS Claims Integration (ECI) project will provide the capability for WGS to process & pay claims for members enrolled on STAR system. The members specifically targeted for this project are Individual “Under 65” population within Consumer Business Organization. There are 3 steams of work to this project as below.

1. Foundational Stream that builds the basic functionalities in WGS to enable the processing of claims for new Individual products in the Consumer Business Segment. This includes all of necessary interfaces to other internal & external systems and applications that are needed to provide complete operational and financial support, including but not limited to: reporting, member communications, accumulator processing and synchronization, processing screens, claim editing, claim processing rules, file feeds and interfaces with customer facing applications.
2. Mandates Stream – This supports state (CA/CO/NV/GA) & product mandated requirements for the
processing of new product claims.
3. Product Stream – This defines the new individual product setting in WGS and interface systems and brings the business alive for processing of STAR claims for new products.

Responsibilities:

§ Analysis, Coding and Testing of RPC modules
§ Preparation of Test plan, Test cases and Status report.
§ Execution of test cases.
§ Performed system testing, user Acceptance testing through RPC tester.
§ Review test results to ensure the functionality is as per the client requirements.
§ Mentoring new resources about testing processes followed in the project.
§ Co-ordinating the activities with other team members and reporting to the Onsite POC.

Environment : Mainframes, JCL, COBOL, IMS DB,DB2

4. Project : Confidential,

Duration : From April 2008-May 2009

Description:

Part D plan sponsors (PDP sponsors and MA organizations) are required by CMS to determine, at the time of enrollment, whether a beneficiary was previously enrolled in Part D or had other creditable coverage prior to applying to enroll in their plan, and whether there were any lapses in coverage of 63 days or more. Part D plan sponsors shall inform CMS of these lapses in creditable coverage so that CMS can compute the Part D plan member’s Late Enrollment Penalty (LEP). The member is then billed the LEP (as part of the premium payment), or the LEP is included when his/her premium is paid through Social Security (SSA deductions).

Responsibilities:

§ Analyzing the requirements, coordinating the activities with other team members and reporting to the Onsite POC.
§ Involved in requirements analysis, design preparation of various requirements.
§ Analysis, Coding and Testing of batch and online codes
§ Involved in the resolution of production issues regarding Medicare Part D
§ Also, worked as the Defect Prevention controller for the project.

Environment : Mainframes, JCL, COBOL, IMS DB/DC

5.Project : Confidential,

Duration : October 2007-March 2008

Description:

Client constantly comes out with innovative ideas to maintain its leadership position. It has a revolutionary vision of putting individuals in control of their Health Care through the creation of quality, affordable and flexible health plans. It offers a broad range of medical and specialty products
The CDHP, Consumer Driver Health Plan, Enterprise Integration project is Client’s commitment to develop and implement a consistent suite of market-leading CDHP products for the Blue plans by Jan. 1, 2007.Client currently has several CDHP products that they offer to consumers and clients based upon their geographic location. When this project is complete, Client will offer one suite of CDHP products in all regions where they can conduct business under the Blue brand.

Roles & Responsibilities:

· Claims processing system study
· Requirements gathering, Impact Analysis, Designing, Coding, unit testing.
· Generating one-time JCL, coding small programs for generating reports and claim extract jobs as per the requirement by the client during UAT.
· Monitoring the jobs in integration and UAT. Supporting the Production moves.
· Preparing Unit Test Plans/ Unit Test Results as part of regular requests or during UAT of other requests whenever requested by client.
· Preparing the documents and checklists for quality audit.

Environment : Mainframes, JCL, COBOL, IMS DB

6. Project : Confidential,

Duration : November 2006- October 2007

Description:

Client constantly comes out with innovative ideas to maintain its leadership position. It has a revolutionary vision of putting individuals in control of their Health Care through the creation of quality, affordable and flexible health plans. It offers a broad range of medical and specialty products

Claims Tight Integration Project is an enhancement project aimed to better align UM decisions with the claim systems to ensure accurate and efficient claim results. The expected outcome from implementing these requirements is improved auto adjudication, improved claim processing accuracy, and more accurate/consistent application of UM rules

Roles & Responsibilities:
· Requirements gathering, Impact Analysis, Designing, Coding, Unit testing.
· Generating one-time JCL, coding small programs for generating reports.
· Preparing Unit Test Plans/ Unit Test Results as part of regular requests or during UAT of other requests whenever requested by client.
· Preparing the documents and checklists for quality audit.
· Quality Controller of the Project.
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Environment : Mainframes, JCL, COBOL, IMS DB
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