CURRICULUM VITAE

Sinoj V P

Woodland Hills E-mail: actdec@r.postjobfree.com

California 91367 Mobile: +818-***-****

USA

Objective

Seeking a challenging and rewarding position, in a growth-oriented organization, this offers job responsibility in consulting and software business and to fully utilize my technical abilities.

Experience Summary

Working as System Analyst in UST GLOBAL since 2010 to till date.

6 years of experience in Analysis, Design, Coding, Testing and production support of application software in Mainframe.

Extensive knowledge in COBOL, JCL, DB2,IMS DC,IMS DB SQL, VSAM,TSO/ISPF,CHGMAN, SPUFI,IBM Utilities and FTP.

Strong subject matter expertise in Claims Processing System

Experience in facilitating JAR/JAD sessions for gathering Business and Functional Requirements and documenting them, Translating Requirements into Specifications, developing Use Cases considering all possible scenarios, conducting Gap Analysis and Impact Analysis, Modeling Businesses Processes, Creating User stories, capturing Testing Requirements and preparing Training Manuals and Knowledge Transfer document

Experienced with HIPAA4010-HIPAA5010

Skills Summary

Operating System: Z/OS

Language: COBOL

Databases: DB2, IMS DB

Online System: IMS DC

Tools: CHANGEMAN, FILEMANGER, FAULT ANALYZER, FMDB2, FMIMS, SAR, CTM, SPUFI, IBM PD Tools

Projects

1. Health Insurance Exchange Project.

Client: Anthem

Period: Oct 2012 – Aug 2013 & Oct 2014-Till date

Location: Woodland Hills, CA

Exchange is implemented as part of affordable care act, is markets where individual and small group members are allowed choose best health plan from an exchange and they can compare the plan, pricing etc. The objective of Health Exchange project is to create a new database, which store common information that will be shared between different systems and make it as a single source of truth.

The purpose of this project is to handle accumulator piece to support new HIX products in WGS system. The HIX market represents a new channel for Anthem to expand the services and value we provide to the communities we serve. The exchange strategy team and our state and business unit leaders have engaged in a range of market assessments that have identified the benefits and value of growth in this market and the capabilities we need to operate in this emerging market. My role is to lead a track, which develop database interface modules IO and business layer programs.

As a System Analyst my responsibilities included

Roles& Responsibilities:

•Coordinator, Onsite-Offshore teams

•Lead-Offshore Teams

•Allocate and efficiently manage work

•Resource management

•Analyze and estimate work

•Involved in Analysis of the Programs and Applications.

•Code, Test and Review work products.

•Ensures quality deliverables.

•Implementation Support/Activities.

2. Image Rewrite Project

Client: Anthem

Period: Aug Oct 2013 – Oct 2014

Location: Offshore

Image Processing allows an examiner to calculate benefits for all claims which must be manually processed in addition to resolving data conflicts.

HIX products will be configured in SPIDER system which provides an opportunity to revamp IMAGE processing for SPIDER contracts rather than depending on hardcoded indicative processing. As part of this project existing online claims processing system will be revamped to process the claim based on new set of rules.

3. Blue Exchange Next Iteration

Client: Anthem

Period: Mar 2012 – Oct 2012

Location: Offshore

The Blue Exchange provides a modern network for exchanging information between BCBS Plans to more seamlessly coordinate provider support of automated eligibility and claim status requests across the entire BCBS system. Blue Exchange is the Blue Cross Blue Shield Association’s(BCBSA) inter-Plan system for select HIPAA transaction processing (270, 271, 276 and 277). Blue Exchange provides standard formats, secure and reliable Plan-to-Plan communications, common validation processes, and performance measurements.

The Blue Cross and Blue Shield Association (BCBSA) is a federation of 39 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 100 million Americans.The14-state Anthem is the largest Blue Cross Blue Shield member, and is a publicly traded company. Anthem is an independent licensee of the Blue Cross and Blue Shield Association.

This project is a mandate project which has the objective of enhancing the 270/271 and 276/277 transactions as part of the Blue Exchange Next Iteration (BXNI) Program. January 1, 2013 is the Federal mandate to adhere to the CAQH Operating Rules Phase 2.

4. HIPAA 5010

Client: Anthem

Period: June 2010 – Mar 2012

Location: Offshore

The Health Insurance Portability and Accountability Act (HIPAA) insist the covered entities (health plans, health care clearinghouses, and certain health care providers) to adopt standards on electronically transmitted health care administrative transactions (such as claims, remittance, eligibility, claims status requests and responses etc). The first regulation was issue in December 2000 and was made fully complaint by 2003. The Project is to Remediate WGS 2.0 & STAR Claims system to accept and process HIPAA 5010 transactions from Enterprise EDI (Electronic Claims).

The Federal Government issued a final rule to modify mandated HIPAA transactions by March, 2012. It has been successfully upgraded to 5010 in February, 2012.

5. EPDS

Client: Anthem

Period: Jan 2010 – June 2010

Location: Cochin

Enterprise Provider Database Solution (EPDS) is a consolidation & replacement for several existing applications that maintain the Providers (doctors & hospitals) information for Anthem. EPDS aims to build a foundation to enable the entry of Provider Data once into a central repository, streamlining and standardizing Clients business processes. The EPDS centers on the heart of Anthem’s business model of creating, tracking, marketing, and managing flexible, quality provider networks to support all lines of business, products and services. The intent of the project is to not only support existing business, but to also provide a flexible, configurable solution to enable future business initiatives and growth.

Educational Qualification

B-Tech in Electronics and Communication from Cochin University College of Engineering Kuttanadu.

Certification

IBM Certified Mainframe Professional (3 Months Training In TSO/ISPF, MVS, JCL, VSAM, VS-COBOL, DB2, CICS) conducted by CDAC, Trivandrum (Formerly ER&DCI, Trivandrum).

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