KALPANA EDURU

Ph: +91-955*******

ac6uom@r.postjobfree.com

ac6uom@r.postjobfree.com

SUMMARY:

An acknowledged Software Professional with an around of 7.4 years of IT experience in BPM – PEGA PRPC and Java/J2EE Web Applications development and Testing. Experience includes Healthcare Insurance and Banking and Financial domains.

Experience in the BPM application development using Pega PRPC 6.x, HCIF (for health care), Smart Dispute Frameworks.

Having Experience with Pega Scrum and Agile Methodologies.

Proficient in Pega Methodology Implementation cycle including Business Process Modeling, Analysis, Designing, Development, Integration, Testing, and Deployment of BRE and BPM Applications.

Good knowledge on CPMHC Framework.

As a core team member I have involved in many areas of PRPC which include Flows, Flow actions, Correspondence rules, Activities, Declarative rules and Integration Services.

Experience in working with Agents and Listeners for batch process.

Implemented SOAP Services and Connectors to integrate with the external systems.

Involved in requirement gathering along with business analysts to better understand end user requirements and various scenarios.

Worked on Debugging and Bug fixing Activities using Rules Inspector with Lead and System Architects for Harness, Declare Expressions.

Good knowledge on using debugging and performance tools like Clipboard, Tracer, Pega Log Analyzer(PLA), Performance Analyzer (PAL) and System Management Application (SMA).

Experience in Rules like Product rules, Rule-set management, and associated tools such as export & import tools and Deployment.

Actively involved in code migration and other deployment related activities.

Experience in working with the QA Testing Team creating Test Plans and Test Cases.

Experience in RDBMS technologies like Oracle SQL, PL/SQL and MS-SQL.

Experience in Distributed Application development using JAVA.

Ability to learn quickly in work environment, productive interpersonal skills with ability to understand and co-operate group requirements efficiently.

Certification:

Certified Senior System Architect in PRPCV6.2 from Pega Systems, USA

Certified System Architect in PRPCV6.1 SP2 from Pega Systems, USA

ORACLE Certified Java SE6 Programmer from ORACLE Corp.

Education:

B.Tech (CSE) from JNTUniversity, Anantapur, India.

TECHNICAL SKILLS

Smart BPM Suite : Pega PRPC 5.x/6.x/7.x

RDBMS : Oracle 11g

Application/Web Servers : Tomcat 6.0, Web Sphere 6.0.

Programming Languages : Java (JDK 1.5/1.6), SQL/PLSQL

J2EE Technologies : Servlets, JDBC, Hibernate, Web Services

Markup Scripting Languages : HTML, XML

Frameworks : HCIF, Smart Dispute, CPMHC.

Development Tools : PEGA PRPC, Eclipse IDE, TOAD, SQL Developer

Methodologies : PRPC, AGILE, SDLC.

Business Verticals : Healthcare, Insurance, Banking,

Operating System : Windows, UNIX &LINUX

Work EXPERIENCE

Worked as Senior Software Engineer for UnitedHealth Group Information Services(Optum Services) from Oct 2013 to Nov2016.

Worked as Senior Engineer for Virtusa Consulting Services from March 2013 to Sep 2013.

Worked as Software Engineer for UnitedHealth Group Information Services from Feb 2011 to March 2013

Worked as Project Engineer for WIPRO Technologies from July 2009 to Jan 2011.

ACHIEVEMENTS

oWorked in Newjersy, USA for 6 months on L1-B Visa from UHG/Optum for EAS project from Feb2016 to Aug2016.

oReceived 2 Bravo! Diamond recognition awards for EAS project in 2016.

oReceived Star Performer Award for MAS-Unite Project from UnitedHealth Group in 2014

oTravelled to Florida, USA for Global Case Management Project from Virtusa on Business Visa(B1) in 2013.

oReceived Team Excellence Award for EAS Project from UnitedHealth Group in 2012.

oReceived Sustaining Edge Award for EAS Project from UnitedHealth Group in 2012.

oReceived SPOT Award for EAS Project from UnitedHealth Group in 2011.

oReceived FIMC (Feather In My Cap) Award for QCBDS Customization Project from Wipro Technologies in 2010.

PROFESSIONAL SUMMARY:

UnitedHealth Group Information Services(UHGIS),Hyderabad/NewJersy Jan ’16 – Nov’16

Pega Senior System Architect/SME(Subject Matter Expert).

1.Enterprise Adjudication Service (EAS)

EAS is the Claims Processing Engine developed in Pega by UHG for Auto-adjudicating the claims which were sent to manual processing by the legacy systems. This solution will pull the claim from an external COMET queue. Once the claim has been identified, EAS will pull additional data via external foundation calls to TOPS (Legacy system for adjudicating Commercial Claims). Once EAS receives the claim the system will perform some initial edit checks to ensure the claim has the necessary data to continue processing through EAS. If the claim does not meet the required edit checks, it will be returned to the original platform for manual processing.

Once the system believes the claim is valid, EAS will determine the rule set to apply (slotting table) to the claim lines. EAS will determine if the claim requires additional data, if so, the claim line is tagged and the necessary source system is queried. Assuming the system has all the required data, EAS will decision the claim into one of the following; pay, deny manual decision, or MCR review. The system will take the Manual decisions and MCR review and will return the claim to the original platform. The system will take the pay and deny decisions and continue processing through the calculation service to determine responsibilities.

Responsibilities:

Understanding the Use case walkthrough of EAS application and translating use cases to technical design document.

Designing the class structure, business flows and identifying the Work and Data Model.

Interacting with the business stakeholders for issues/enhancements.

Application Monitoring and performing health checks for UNET,COSMOS and SAM applications

Performing Deployment Support

Incidents, Problem tickets and change tickets managements.

Understanding of business requirements on the given module.

Attending SSD (Solution Summary document) walkthrough and involve in grooming and sizing the sprint as per the design of module.

Created Agents that run activities that support integration connectors to interact with Legacy systems.

Worked with Services for accessing Web Services using WSDL.

Implying the Pega rules like Activity, Sections, Flows, Harness, Flow Action, Declarative rules.

Actively involved in supporting all testing phases on Project (QA, PROD support) on implemented user stories.

Healthcare Claims validation and reporting to business team about the validated claims after the code migration to production environment.

Proactively involved in the Production Deployment end to end process actives like from uploading the ADR documents to sending sample claims to business approval for other teammate deliverables.

Involved in EAS Pega 7 upgrading work and fixed assigned issues.

Supporting the team members to resolve any technical issues.

Creating technical guideline documents to ensure uniform quality on all the deliverables of EAS application.

Providing technical leadership to development team for problem resolution.

Involved in Organizational BPM initiatives by developing Claim Adjudication Model that defines UHG health care industry standard.

UnitedHealth Group Information Services(UHGIS),Hyderabad Sep’15 – Dec’15

Pega Senior System Architect

Project Name : Magenta, OptumRx

Magenta application reads the data from CSV files using File Listeners. Application performs all the validation checks from the file and adds if any record is violating the validation rules and adds the same validation error message to the same record and stores the completed file in the specified output location for business review.

Responsibilities:

Understanding of business requirements in assigned use cases.

Technical design document (TDD) Preparation.

Involved in creating activity rules and designing of User interface.

Taken ownership of assigned Use case. Involved in Coding, Unit Testing, System Integration Testing, Functional Testing and End-To-End Testing of the assigned use cases.

Implemented decision rules like Decision tables, Decision Tree, When rules.

Implemented and worked on Data Tables.

Developed PRPC Rules for database connection, data access from external database.

Implemented Listeners to read and write a file data from the specified location path.

Worked on Rule set creation, patch creation. Application deployment in test environments like QA, IST and UAT environments.

Involved in review of code, Technical Design Document, estimation and scheduling.

Works with team to analyze, fix, and unit testing defects.

Environment: Pega PRPC 7.1.4, Oracle 11g, IBM Web Sphere, TOAD.

UnitedHealth Group Information Services (UHGIS), Hyderabad Apr ’14 – Aug’15

Senior Software Engineer/ SME(Subject Matter Expert).

Project Name : Enterprise Adjudication Service (EAS)

EAS is the Claims Processing Engine developed in Pega by UHG for Auto-adjudicating the claims which were sent to manual processing by the legacy systems. This solution will pull the claim from an external COMET queue. Once the claim has been identified, EAS will pull additional data via external foundation calls to TOPS (Legacy system for adjudicating Commercial Claims). Once EAS receives the claim the system will perform some initial edit checks to ensure the claim has the necessary data to continue processing through EAS. If the claim does not meet the required edit checks, it will be returned to the original platform for manual processing.

Once the system believes the claim is valid, EAS will determine the rule set to apply (slotting table) to the claim lines. EAS will determine if the claim requires additional data, if so, the claim line is tagged and the necessary source system is queried. Assuming the system has all the required data, EAS will decision the claim into one of the following; pay, deny manual decision, or MCR review. The system will take the Manual decisions and MCR review and will return the claim to the original platform. The system will take the pay and deny decisions and continue processing through the calculation service to determine responsibilities.

Responsibilities:

Designing the class structure, business flows and identifying Work and Data Model.

Implemented the complete Integrations module that involved interaction with external systems using integration connectors.

Implemented Data Management Service Layer, Pre-Processing and Post Adjudication modules as per the requirement.

Worked with the Business Leads, and Business Analysts to define business requirements for designing, testing, and analyzed those requirements.

Worked on Database mapping, acquiring remote database connection, and other database related operations.

Created Decision Rules, Map Value, Decision Table, Decision Tree and Declarative Expressions as per the requirements.

Responsible for the migration of Rule-Sets and Databases.

Created Agents that run activities that support integration connectors to interact with Legacy systems.

Worked with Services for accessing Web Services using WSDL.

Involved in Organizational BPM initiations by developing Claim Adjudication Model that defines UHG industry standards health care.

Testing and debugging using tracer and Rules Inspector.

Environment: Pega PRPC 6.1 SP2, HCIF, Oracle 11g, IBM Web Sphere, Java, SOAPUI, TOAD.

UnitedHealth Group Information Services (UHGIS), Hyderabad Oct ’13 – Mar ’14

Senior Software Engineer/Lead Developer.

2.myEasyBook Adjudication Service (MAS-Unite)

MyEasyBook Adjudication Service (MAS) is a solution proposed to support the business needs of Member Eligibility and Member Liability for Unite-myEasyBook Portal, which is a provision for HDHP (High Deductible Health Plan) customers to book online appointments. MAS publish two Web Services to cater these business needs and myEasyBook/Unite consumes these web services via data power. These services provide Eligibility and Liability details of a member. One Web Service (getMemberEligibility) interacts with different external legacy systems to fetch the eligibility details of the member and sends the appropriate date to the consuming application. Second Web Service (getMemberLiability) receives the pseudo claim from as a Request. The Claim is slotted based on the defined set of business rules to a particular category. Based on the category service interacts with external systems to fetch the additional information like copay, coinsurance and accumulator information related to that member based on Policy and Service Category. Based on the accumulator information that is received Service calculates the member and payer Liability upon applying set of business scenarios by checking all the exceptional conditions like MemberOutOfPocketReadched, Benefit Visit Maximum etc. Once the pseudo claim is successfully adjudicated, service returns how much amount the member and payer is liable to pay for that claim.

Responsibilities:

Involved in end-to-end development of the application.

Designing the class structure, business flows and identifying Work and Data Model.

Created SOAP Services and exposed them to the myEasyBook end users as per the requirements.

Implemented Data Management Service Layer and Liability calculation modules as per the requirement.

Worked with the Business Leads, and Business Analysts to define business requirements for designing, testing, and analyzed those requirements.

Worked on Database mapping, acquiring remote database connection, and other database related operations.

Identify the requirement gaps early in project lifecycle and working with System Analyst to resolve the gaps.

Worked with CONNECT-SOAP Services for accessing Web Services using WSDL.

Deployment of MAS application in various environments likes Development, QA, UAT, Stage.

Support production deployment of MAS application as well.

Supporting the team members to resolve any technical issues.

Creating technical guideline documents to ensure uniform quality on all the deliverables of MAS application.

Environment: Pega PRPC 6.1 SP2, HCIF, Oracle 11g, IBM Web Sphere, Java, SOAPUI, TOAD.

Virtusa Consulting Services Pvt. Ltd., Hyderabad, India Mar’13 – Sep’13

Senior Engineer

1.Global Case Management, AMEX Florida, USA.

Global Case Management is a portal for Customer care professionals to raise disputes for American Express credit card customers. Project is built on Pega Smart dispute framework.

Based on different channel communication from the customers, CCPs raise disputes by presenting a set of questions to the customers and resolves the disputes based on the different type of responses provided by the card holders and merchants. Application interacts with different legacy systems to get the customer account and transaction details and also communicates with the acquirer to get the information required to resolve the dispute.

Responsibilities:

Discussions with Business users, Feasibility study, identifying and analyzing the modules.

Interacting with Product Managers, Business Analysts, SMEs to understand the Business Process and Business Rules.

Designing the class structure, business flows and identifying Work and Data Model.

Implementing work flows part of day to day business operations, the workflows is crucial to success of the system, especially considering the PEGA guardrails.

Developed Rules for Validation and Integration rules pertained to Rule-Connect- and Rule-Service- .

Integrated PEGA with external systems using SOAP Connectors.

Worked on DB mapping, remote DB connection, and other DB related operations.

Converting complex business rules in to PRPC decision tables, decision trees and Map Value pairs. Reviewing of the existing decision rules and identifying key defects and fixed the issues.

Involved in Design and development of Integrations with other system using Connector/Service rules.

Code reviews and code optimization, defining and developing coding guidelines through preflight tool.

Environment: Pega Rules Process Commander PRPC 6.1 SP2, XML, SOAP, Java, IBM Web Sphere6.0, ORACLE 11g, Windows XP

UnitedHealth Group Information Services (UHGIS), Hyderabad Feb ’11 – Mar ’13

Software Engineer/Pega System Architect.

3.Enterprise Adjudication Service (EAS)

EAS is the Claims Processing Engine developed in Pega by UHG for Auto-adjudicating the claims which were sent to manual processing by the legacy systems. This solution will pull the claim from an external COMET queue. Once the claim has been identified, EAS will pull additional data via external foundation calls to TOPS (Legacy system for adjudicating Commercial Claims). Once EAS receives the claim the system will perform some initial edit checks to ensure the claim has the necessary data to continue processing through EAS. If the claim does not meet the required edit checks, it will be returned to the original platform for manual processing.

Once the system believes the claim is valid, EAS will determine the rule set to apply (slotting table) to the claim lines. EAS will determine if the claim requires additional data, if so, the claim line is tagged and the necessary source system is queried. Assuming the system has all the required data, EAS will decision the claim into one of the following; pay, deny manual decision, or MCR review. The system will take the Manual decisions and MCR review and will return the claim to the original platform. The system will take the pay and deny decisions and continue processing through the calculation service to determine responsibilities.

Responsibilities:

Designing the class structure, business flows and identifying Work and Data Model.

Implemented the complete Integrations module that involved interaction with external systems using integration connectors.

Implemented Data Management Service Layer, Pre-Processing and Post Adjudication modules as per the requirement.

Worked with the Business Leads, and Business Analysts to define business requirements for designing, testing, and analyzed those requirements.

Worked on Database mapping, acquiring remote database connection, and other database related operations.

Created Decision Rules, Map Value, Decision Table, Decision Tree and Declarative Expressions as per the requirements.

Responsible for the migration of Rule-Sets and Databases.

Created Agents that run activities that support integration connectors to interact with Legacy systems.

Worked with Services for accessing Web Services using WSDL.

Testing and debugging using tracer and Rules Inspector.

Environment: Pega PRPC 6.1 SP2, HCIF, Oracle 11g, IBM Web Sphere, Java, SOAPUI, TOAD.

WIPRO Technologies, Hyderabad July ‘09 – Jan ‘11

Project Engineer/Java Developer

1.Cricket, Qualcomm, USA Aug ’10- Jan ‘11

Cricket wants to launch the Application Download Server (ADS) 4.x solution with their new Prepay integration using Cricket’s Common Services Platform (CSP).Cricket wants their prepay users to access BREW content through following Shims.

DeviceConfig Interceptor

SID Info shim

SID Group Shim

CheckPPAuth shim

msgDownloadAck shim

RecommendationPlugin shims

Whenever user downloads an application, all the billing transactions gets executed using SurePay server

Responsibilities:

Involved in the requirement analysis.

Involved in development of CheckPPAuth shim, msgDownloadAck shim using Web Services.

Performed the unit testing for all the developed modules.

Environment: Web services, Axis1.4, IBM Web Sphere, Java, Eclipse, JUnit, Maven, Sonar

2.Qualcomm BDS Customization - Verizon CBF and Plaza Retail,

Qualcomm, USA. Jan ’10 – July ’10

In Content Based Filtering project, client requires all the content vended through BREW Distribution System (BDS) to be suitably tagged with an appropriate content rating. The developer will submit a suitable rating for their content. Client will review the rating and provide its own mapping for an internal rating system. The Application Download Server will make use of an API exposed by client to determine a subscriber’s rating. Only the content that matches with the subscriber’s rating will be allowed to be displayed to the user on the device, all other content is not available to the user. Plaza Retail is porting of existing functionality to higher version of Application Download Server and Storefront servers

Responsibilities:

Involved in development of Item-Rating-Email module which is responsible for sending mail to Admin with the help of Java Mail APIs containing active item lists with suitable Meta-data fetched from Oracle database.

Involved in coding and unit testing of the module.

Involved in automation of different shims involved in the project.

Involved in Functional and Acceptance Testing of CarrierCatalogXml and UpdateContentRatingJob module.

Environment: Java, Eclipse, JUnit, Maven, IBM Web sphere, Oracle SQL Developer, SQL, PL/SQL

3.Bug Reporter Server

Nokia, USA Sep ’09 – Dec ’09

Bug Reporter is a Web Application on Tomcat that receives the requests from the client over HTTP as a Zip file which will have bug information and bug video embedded. Bug Reporter extracts the Zip and parses the bug information from xml file and stores the bug information on server file system and converts the bug videos into .swf format and passes this information to Bugzilla Server via XML-RPC and updates the Bugzilla server with the bug information.

Responsibilities:

Involved in development of File Upload and Video Conversion modules.

Involved in coding and unit testing of the modules.

Environment: Java, JSP, Servlets, JDBC, HTML, Eclipse, JUnit, Others

Personal Profile

Name : Kalpana Eduru

Date of Birth : 01/06/1987

Nationality : Indian

Marital Status : Married

Passport Visa Status : B1 on old passport.

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