MAHARAJA KVM

Mobile US - +1-562-***-****

Email ID: aczxcy@r.postjobfree.com Total Work Experience – 9 YRS

Experience Summary

7.6 years of experience in IT industry and immense knowledge about US healthcare domain and 5 years of experience in closely working with Business by Managing Various Client Projects.

7 months of experience in USA, California in CRM lead management using Salesforce.

Project Manager expertise includes, Planning and Defining Scope in Documentation of client requirements and translate them into design specifications, clearly defining the scope of the project for the team, setting measurable goals for each team member that should define the overall project’s objective.

Preparing Time and work estimate for the project in Identifying and specifying the critical activities of the project and then equally delegating the roles to each member of the team, Planning the project meticulously and communicating the number of working hours for the project per the resources and the technology available, Resource planning, Following Agile methodology

Budget Allocation and Cost Estimates for various activities and make any cost considerations that there might be.

Monitoring Potential Risks & planning to fix the gap brought about by the delay if any happens. Check whether everything is functioning well without any bugs, and ensure the work will be done as per the estimated time.

Has Managed Various Trizetto Products namely QNXT, FACETS, CLAIMFACTS and QicLink in Healthcare industry for United Health group and Molina Healthcare Clients.

Has worked as a Business Analyst in Market Place (Obama Clare Project), Medicare, Medicaid, Dual Eligibility Plans in Molina Healthcare from Long Beach, California client Location for 6 months. Has driven various initiatives and supported Broker and commission gateway by providing various critical reports to business.

Expertise includes assignments in Requirement Analysis, Testing, Preparation of Business Requirement Documents, Development Support

Functional skill set includes Requirement gathering, Test Bed Walkthrough, creating test strategies, mentoring offshore on testing, Functional Specifications evaluations.

Automated the Duplicate Commission Validation, which has resulted in the reduction of the manual charge back and voucher creation for Finance Team using SSIS, SSRS in SQL DB.

Has worked in PLM Upgrade projects in UNIX, LINUX, WAS (IBM WebSphere) environments and schedulers namely Autosys, TWS.

Quick adaptability to emerging technologies and eager to pursue challenges.

Lead and tracked the progress of the Salesforce CRM application to various business areas for the customer.

He has in depth knowledge about various healthcare functionalities namely eligibility, provider setup, claim adjudication, billing, broker and commissions, Utilization Review, Underwriting, COBRA, Review health plan performance, 1099 Tax processing and customer Inquiry.

Education

Title of the Degree with Branch

College/University

Year of Passing

MBA

BE (ECE)

Anna university

Anna university

2011

2008

Technical Skills

Operating Systems

Windows/UNIX/Linux

Technology

Mainframe, AS400, SQL, Dot net,

Programming Languages

Tools SSIS, SSRS

COBOL, TriZetto COBOL

Databases

SQL, MS-Access

Certifications

Completed TriZetto Facets L0 and L-1 training program in Membership/Enrollment, Claims adjudication, Customer inquiry, salesforce, Lead management, Basic and Advanced Batch Processing, Provider, Utilization Review, Facets Work flow and configuration.

Completed Healthcare AHM250 certification

Completed internal certifications in ITIL (Information Technology Infrastructure Library) for AVM SBU.

Certified in COMMEX (communication excellence) Praxis

Certified Innovator’s Accelerator (IA) (External certification)

Certified proDIGI (Digital 101 certified professional)

Visa Details

L1A – Individual Valid till Jan 2019, Green Card Processing Is in Progress.

Contact Details

Mobile No : +1-562-***-****

Project Experience

Cognizant Corporation USA

Sept 2016 to Current

Senior Product Specialist –Technical

Project Name – Molina Healthcare Eligibility and Claims

Location – Long Beach, California

Maharaja was managing Molina Broker Gateway and VUE Front End Broker and Commission Portal applications to support Obama Care plans for Molina Healthcare. His responsibilities include managing the application and ensure the Insured, Policy, Agent Policy, and Premium information are processed. He was working closely with Various IT and business team by ensuring the commissions for Agents, Agency, and Bonus for Broker channel manager are paid on time. He was instrumental in gathering the Requirements from business and preparing BRD which was used to cascade to the IT development and Testing teams. Maharaja has an expert understanding of Software Development Life Cycle (SDLC) methodologies and he understands technology and its applications in the prevailing business and technical environment. He was involved in Project Execution & Tracking activities to coordinate the new initiative of extending the salesforce CRM application to Provider inquiry and Broker calls, which resulted in the secure transmission of the Sensible Healthcare data within the expected time. He has Facilitated Business Case preparation for the Provider credentialing and claim adjudication modules to prepare Test teams to develop Functional testing, UAT and SIT testing. Has hosted Q&A sessions to discuss and resolve open questions with business and affinity partners. Regression, Business, and UAT testing. He has Created and updated

oFunctional Specs

oSupplemental Specs

oAPI Documents

oMapping Documents

oProcess Flow Diagrams

He was primarily working on the Molina Healthcare QNXT application where enrollment of members to various plans and products, under various providers, claims adjudication were handled. He was taking care of the Molina broker gateway where agents commission and Bonus were managed. He was instrumental in supporting the 835-remittance advice to providers and explanation of Benefits (EOB) to members. He has been working on Customer service and inquiry department by supporting the Lead management (salesforce) Application where welcome call, onboarding of brokers, Appointment and License updates were maintained. He has analyzed critical production issues and fixed them within a short span of time. Later Impact analysis was done with various reporting till the date was cleaned up in production systems. Worked on Autosys Scheduler to automate the Jobs to support various Business Request using SSIS and SSRS Tools.

Having an in-depth and comprehensive understanding of the critical business success factors. Demonstrates an in-depth knowledge of key Services’ operational policies, processes, and methodologies applicable to project management with an extensive understanding of critical project management techniques. Applies expert subject matter knowledge to manage staff activities in solving most complex business/technical issues within established policies. Manages individual contributors and people managers. Has accountability for a large multi-department area(s) or location(s) with significant impact on business unit results and organizational strategy. He Posses Strong interpersonal, verbal, and written communication skills; Understanding of effective communication concepts. tools and techniques; ability to effectively transmit, receive, and accurately interpret ideas, information and needs through the application of appropriate communication behaviors. Main focus on Use Cases, Business Rules, User Interface specifications, write user stories, participate in daily scrums and Work with the technical lead and developers to translate requirements to system design.

BUSINESS UNIT

CLIENT NAME

Health Care Product Group (HPG)

Molina Healthcare

Cognizant Technology Solutions India Pvt. Limited, Chennai, India

Feb 2016 to August 2016

Senior Product Specialist –Technical

Project Name - UHG IT - PLM upgrades COE

Maharaja was handling the PLM Upgrade offshore team, his responsibilities include managing the project by allocating the resources and Project hours, onboarding new resources and ensuring the necessary infrastructure resources are provided. Contributed to Recruitment (measured through participation in the screening and interviewing candidates), Identifying challenges and formulate strategies for process standardization, Constantly mentor and have succession plan for all key roles, Coordinate with onsite and offshore teams as necessary during project delivery, Responsible for billing and invoicing for the portfolio, Participated in Customer review / governance meetings to discuss on Service performance, project issues and improvement opportunities, Ensure that status reports are sent to the customer for the project(s) at the agreed intervals, Anticipate issues and needs of the customer related to the project and address them proactively, Enable periodic skill assessment of associates and subsequent adherence to learning plans . Maharaja Demonstrates an expert understanding of Software Development Life Cycle (SDLC) methodologies; understands technology and its applications in the prevailing business and technical environment. Demonstrates an understanding of the customer domain of activity, and responds to customer’s priority needs for service and support. Demonstrates an understanding of internal quality norms and procedures Accomplishes tasks with a holistic perspective - concern for all areas manages the technical team effectively. Plans and prioritizes activities for the team / Manages resources optimally / Meets deadlines consistently

He was also working on the PLM Upgrade for CDB, BASICS & DCM suite of application where LINUX/WAS/oracle servers to the latest new versions and ensuring the application functionalities namely eligibility, claim, Medicare crossover are working as expected. Project Execution & Tracking activities include coordinate with the Infrastructure team, coordinate with business teams to have the applications tested in UAT. Coordinate the dependent application changes deployment in sync with the Upgrade. Coordinate with TWS, ECG (CFT), DR, Application Monitoring teams on the change and Coordinate Implementation with Infrastructure, SSMO/Application teams

BUSINESS UNIT

CLIENT NAME

Health Care Product Group (HPG)

United Health Group

Cognizant Technology Solutions India Pvt. Limited, Chennai, India

August 2011 to Jan 2016

Senior Product Specialist –Technical

Project Name - UHG IT SSS - UMR - PHS QicLink

As a Key Person in the UMR Qiclink and ValiData SSS offshore Team, his various responsibilities are monitoring the critical jobs and fix if any Production issues as part of on-call activities. To maintain/modify existing production modules in SQL, Stored procedures as part of post deployment activities, new requirement to meet client specifications as required. He is responsible for fixing the Production Issues that arise, Root Cause Analysis (RCA) for incidents, coding the scenarios that would effectively make a functionality change and execute the Unit Test Plan, preparing test scenarios that would effectively verify whether a functionality change is working. He has good understanding of Healthcare concepts. Maharaja has experience with these proprietary tools namely Qview, Qsmart and Etracker and now has an advanced level of knowledge of the application and use of these tools in project management and implementation. As part of rollout type of works, the responsibilities include gathering the requirements from the clients, performing analysis on the business requirements and development of high level and detailed system design, test environment set-up, system testing, implement the system in to the production environment Knowledgeable about the business aspects of applications related to area of work. Readily absorbs new information and keeps up to date in specialist areas; able to draw from and apply this knowledge in a proficient manner.

Maharaja has worked in the various PLM projects like WINDOWS 2K server migration, SATS migration, TWS Job scheduler migration and QAS migration etc.

BUSINESS UNIT

CLIENT NAME

Health Care Product Group (HPG)

United Health Group

Cognizant Technology Solutions India Pvt. Limited, Chennai, India

January 2010 to July 2011

Programmer Analyst

Project Name - UMR-Claimfacts (Cincinnati and Westerville)

Maharaja was a key member in the UMR-CLAIMFACTS (Cincinnati and Westerville) team since the kick off stage of the project. As developer, he has been coordinating the tasks, ensured that the deliverables are quality products by providing a thorough review and delivered on time to clients. He provided speedy resolution and implemented defect free. His job also includes monitoring the critical jobs and fix if any Production issues as part of on-call activities, to maintain/modify existing production modules as part of post deployment activities, new requirement requested by client requirements, development of modules to meet specific requirement and value addition to business and preparing Estimation and Business-Technical Requirement, Technical Design, Test Plan Results and Release Pack documents for enhancement request as result of analysis, coding, testing and implementation. He has automated many processes to keep the UMR CLAIMFACTS Cincinnati system stable and to reduce the incident influx. He was involved in weekly status reporting.

Effective documentation and maintain the documents in the UCAS knowledge repository. He was responsible for maintaining the compliance of HPSM tickets with updated status. He has made several contributions in Knowledge transition for both CINCINATI and WESTERVILLE applications for the newly added resources.

BUSINESS UNIT

CLIENT NAME

Health Care

United Health Group

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