SUMMARY:

• More than 6 years and 8 months of experience in Mainframe technology and Healthcare domain.
• Presently working as a Systems Analyst with UST Global Inc.
• Have been employed here from and working with prestigious Healthcare client Confidential . From, working at the client place located in Woodland Hills, California.
• Have good exposure to development, testing and maintenance projects.
• Have 5 months of experience as Business Systems Analyst.
• Have sound knowledge on Software Engineering methodologies and Mainframe.
• Have experience in all aspects of MVS, OS/390 and z/OS.
• Expertise in Healthcare system. Good design and analytical skills.
• Capable of handling risks and issues in projects.
• Good leadership quality with excellent communication skills and client handling capability.
• Have a sense of commitment and responsibility towards the work.
• Understand Business requirements by attending meeting with Business Partners and Business Analyst
• Preparing Project requirement from the business requirement.
• Providing Estimation for Design through Rollout
• Follow up for the approval / sign - off from Core Team, BP, BA and Architect during each project phase
• Preparing Functional Design (FD) documents from the requirements
• Preparing Technical Specification and Technical Design documents.
• Providing Technical solutions to the other development resources.
• Coding / UTP preparation
• Developing / Leading / coordinating through successful unit testing.
• Supporting through System and Integration and UAT tests.
• Planning and Executing Dry run
• Implementing Mainframe Batch applications and other interfaces.
• Support Implementation and post production support.
• Co-Ordination of meetings with the client and team members.
• Preparation of MOM (Minutes of Meeting)
• Leading the off-shore team and co-ordinate with the client
• Creating Weekly Status Report, Metrics, Resource Utilization
• Support to the Existing Applications

PROFESSIONAL EXPERIENCE:

Confidential

Mainframe Technical lead / Systems Analyst

Responsibilities:

• Health Exchanges are the new market place where qualified individuals and small businesses can purchase qualified health plans (QHPs). The states can either choose to setup their own exchanges or they can opt - in for Federal Exchanges which operated by HHS.
• Exchanges must be operational by January 2, 2014 and self sustaining by January 1, 2015. An Exchange is an organized marketplace to help consumers and small business to buy health insurance in a way that permits easy comparison of available plan options based on price, benefits and services, and quality. In order to provide these HCR complaint products, other systems (FACETS, CHIPS, ACES, CS90) need to be migrated to STAR system.

Confidential

Mainframe Technical lead / Systems Analyst

Responsibilities:

• WAW is an application that will support data access and update functions for Confidential Advocates (call center agents) across the enterprise to perform their duties. The WAW will interface with core backend systems (e.g. WGS, FACETS, STAR and ACES) through difference services to provide advocacy information, as well as additional data stores to provide ancillary data needed by the advocates and specialty data stores.
• Orchestration Module - COBOL program which interacts with the common connector and adapter modules to route the data request back to IAS.
• Service Business Interface (SBI) - COBOL program which contains the logic to get the requested data and call I-O sub-routines to populate the response message
• RPC I-O Modules - COBOL sub-routines called by the SBI and which perform the database accesses.
• Database access modules - COBOL sub-routines called by the RPC I-O modules and actually interface with the databases
• We used SOAP UI for testing the WAW services.

Confidential

Mainframe Technical lead / Systems Analyst

Responsibilities:

• All business supported by GA state business migrated to STAR system. This project will replicate the current eligibility that GA business has with Confidential to STAR system. Once the business is migrated to STAR, Confidential will decommission legacy applications which are no longer required in the GA system and its scope. I handled following tracks in this project.

Confidential

Mainframe Technical lead / Systems Analyst

Responsibilities:

• Through the 2012 Medicare Readiness Program Confidential should enable, support, and continuously improve Senior s ability to sell, enroll, service, and pay claims for our existing and future products and members in a compliant manner. Following existing functions were modified in order to support and administer the 2012 annual benefits. Enrollment & Set Up, Case/Group Set Up, Billing, Letters, ID Cards Changes, Benefit Coding, Finance & Capitation, EPost, Medical Management, WMDS, Front End Enrollment, PBM, Network Set Up.

Confidential

Mainframe Technical lead / Systems Analyst

Responsibilities:

• A CO (Colorado State) mandate applicable to the Small Group market was passed effective 01/01/2011 that will change the current STAR system s tobacco rating methodology. Addition of tobacco indicator reflects tobacco usage in the calculation of rates in STAR small group system. If a carrier reflects tobacco usage, then a rate adjustment need to be taken in his/her premium amount calculation and the ID card also should reflect that whether he/she is a tobacco user. All the areas (e.g.: Customer Care Service) which uses the STAR system should make the changes to indicate if he/she is a tobacco user with an updated premium amount.

Confidential

Mainframe Technical lead / Senior Software Engineer

Responsibilities:

• The Project is an ongoing maintenance project and involves the resolution of issues and other Enhancements required for the Claims System. The issues/enhancements are reported as CQs (Clear Quest) and have very low turnaround time. In addition to this, Production support is also provided to the client.

Confidential

Mainframe Technical lead / Senior Software Engineer

Responsibilities:

• During migration, all the transactions will be evaluated based on BIN and DOS to determine if they are bound for Confidential or ESI. All the details to rout the claims to Confidential or ESI have to be loaded into the ESI exception table. This data look up will enable ESI to route claims to Proserv / ProPBM appropriately through the ESI router. As part of the BIN routing process, a daily feed from ProServ and ProPBM for members with dual/duplicate coverage needs to be generated and shared with ESI on a daily basis. These records would be loaded to the ESI exception table. After migration, claims coming from ESI would be compared against the exception table to determine the system in which the claim needs to be adjudicated.

Confidential

Mainframe Technical lead / Senior Software Engineer

Responsibilities:

• With the sale of the Confidential PBM to ESI (Express Scripts, Inc) and the migration of Confidential s pharmacy members to ESI s anchor system, there is a need to ensure the back end reporting still function as currently designed. Current Process 1 system will be decommissioned as of the sale date. Hence, the feed will be sent from ESI instead of the current Process 1 system. ESI will send a standard claim layout and changes have to be made in interfaces so that it can accept this standard layout and create the reports.

Confidential

Mainframe Developer / Senior Software Engineer

Responsibilities:

• Pharmacy Benefits Management (PBM) system of a leading healthcare have been acquired by another PBM. As a part of the deal close out, PBM systems should use pharmacy rates defined by new PBM to process claims and reporting purposes. The changes as part of this project include.
• ‘Medicare Part D’ is a new outpatient prescription drug benefit added to the Medicare program according to the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). The project deals with design and implementation of Medicare part D drug program. It involves creation of new programs and adding functionality to existing programs so as to support the IT requirements as and when it comes.