Management Consultant Health Plan

Sandeep Rajan +1-860-***-**** Atlanta, GA

*******-*****@*******.***

Management Consultant Technology Leader Health Plans and Providers

www.linkedin.com/in/sandeeptrajan

Summary

As a Management Consultant and Technology Leader, I focus on Health Plans and Providers Strategy, Technology, and

Operations. With over 18 years working in the US Healthcare industry, I have successfully guided Health Plan payor clients

through intricate business and digital transformations. My consulting expertise encompasses health plan strategy, data and

cloud transformations, advanced analytics, operations optimization, and technology modernization to enhance the core

business value.

Experience

ZS

Business Technology Solutions Manager (Director) Atlanta GA Jan 2023 - Current

• As a leader in the Health Plans & Provider space, I focus on leading digital, data, advanced analytics, and

technology solutions to innovate, drive cross-functional impact and deliver enterprise-wide business value.

• Responsible to execute strategy, account management, program assurance and business value realization.

• Leading data engineering, cloud transformation and business intelligence teams to build enterprise operational

and analytics data hubs for Health Plans enabled through AWS, Databricks, Snowflake, DBT, Tableau.

• Leading health plan data analytics for key business use cases related to Medicare STARS, Risk Adjustment,

Claims payment Integrity, Medicare Advance plan design (NBP, NBA), Cost of Care and quality.

• Engagement lead for a product led discovery for a regional blues to build next generation web portals,

encompassing product owners, UI/UX designers and technology engineering teams on AWS, Acquia DXP.

Cognizant Consulting

Atlanta GA Nov 2021 - Jan 2023

Manager - Consulting (Senior Manager)

• Strategy & operations advisor responsible for healthcare operations proposals of $10M+ revenue/year for

EmblemHealth/ConnectiCare.

• Led the consulting for business and technology operations across domains - sales, marketing, enrollment,

billing, provider, claims, capitation, commission, grievance & appeals, customer service, portals

(member/provider/employer/broker/consumer), provider network, business intelligence and quality.

• Expert advisor to health plan claims processing, payment integrity, and provider business stakeholders to build

new capabilities and operational efficiency.

• Managed key regulatory assessments for Interoperability, Transparency in Pricing, CAA 2021, etc.

Senior Consultant (Manager) New York NY Oct 2017 - Oct 2021

• Led a large-scale business and technology-enabled transformation from legacy to cloud, mobile and analytics-

driven implementation on TriZetto suite (Facets, Clinical Care Advance, NetworX Pricer, EDM, TruProvider),

Salesforce (Service/Sales Cloud, Vlocity), Avaya (IVR), Oracle (Cloud, EDL) for EmblemHealth/ConnectiCare.

• Transformation expertise for business across Commercial (+ASO), Government (Medicare, Medicaid, Duals),

and Exchange markets for medical, dental, vision, Rx, and behavioral services.

• Led vendor assessments including ClaimsXten, Zelis, Cotiviti, PNC-ECHO, HealthPlex, FHN, Multiplan etc

Consultant Newark NJ Jun 2013 - Sept 2017

• Led ICD-10 financial, clinical neutrality strategy and medical policy remediation for Horizon Blue Cross

• Created code governance model, organizational change management process, operational readiness policies,

and vendor readiness assessments for the ICD-10 transition

Infosys Limited

Technology Lead Blue Bell PA Jun 2011 - May 2013

• Technical team manager and mainframe/.net architect for a CT-based National Health Plan, leading software

architecture, design, and development for provider network, reimbursements, and contracts & pricing.

• Key projects: MLR, ACO, capitation, Optum insight (Ingenix), and Burgess reimbursement pricing.

Sandeep Rajan Management Consultant Technology Leader Health Plans & Providers Page 1 of 2

Technology Analyst Blue Bell PA Jul 2009 - May 2011

• Technical team lead and mainframe senior software developer for a CT-based National Health Plan, leading

software design and development for provider reimbursements (capitation, shared reward risk adjustments).

• Key projects: P4P, CMS bonus payments and day-to-day provider capitation enhancements.

Software Engineer Pune India May 2006 - June 2009

• Technical lead and mainframe software developer for a CT National Health Plan, leading projects related to

healthcare claims processing, payment management and medical management (UM)

Competencies

• Strategy and Advisory • Digital & Technology Consulting • Vendor Assessments

• Requirements Management • Business Case and IT Proposals • Regulatory Assessment

• Process Re-design, Roadmaps • Operations Optimization • Organizational Change Management

Education

Master of Business Administration Boston University, Boston MA Jan 2022 - Dec 2023

Questrom School of Business GPA 3.95/4.0

Top 20% of Graduate Student, Beta Gamma Sigma High Honors

Apr 2002 - Apr 2006

Bachelor of Technology Anna University, Tamil Nadu, India

Chemical Engineering Class First GPA 7.94/10

Trainings & Certifications

• Blueprint Certified Solution Designer Blueprint • Prof. Healthcare Management PAHM® AHIP

• Certified Business Analysis Professional CBAP® IIBA • Cloud Certified Digital Leader Google

• Certified Scrum Master CSM® Scrum Alliance • AWS Cloud Practitioner AWS

• Dbt fundamentals dbt Labs • Facets Business Cognizant

• Data Science: R Programming HarvardX • Digital Certified Professional Cognizant

• Databricks Lakehouse Fundamentals Databricks • Accountable Care Organization AHIP

• Business Analytics Specialization Wharton Online • Healthcare Management AHIP

• SAFe Agilist Cognizant Academy • IBM Mainframe Certified Infosys Limited

Skills

• BPM Tools MS Visio, IBM Blue works, PEGA, BluePrint Systems, MIRO

• Business Intelligence Tableau, Power BI, MS Excel

• Database and Data Intelligence: IBM DB2, IDMS, MS Access, Databricks, Snowflake, DBT

• Digital Technology Google Cloud, AWS Cloud, Salesforce Service Cloud, Sales Cloud, Marketing Cloud

• Healthcare Products Cognizant Facets, Clinical Care Advance, NetworX Pricer, TruProvider, Salesforce (Health

Cloud, Service Cloud, Marketing Cloud)

• Programming Languages Mainframe (COBOL, CICS, JCL), SQL, VBA Macros, Python, R

• Project Management MS Project, Plan View, Quick Base, JIRA

• Requirements Requisite Pro, IBM Lotus Notes, HP ALM, Atlassian JIRA

Thought Leadership

• Claims and Payment Integrity - Analytics and Command Center (Offering)

• Transparency in coverage - Revenue Cycle Management (Service Offering)

• Digital claims platform - IT Modernization/Digital Engineering (Service Offering)

• Member 360 engagement - Digital Health/Virtual Care (Service Offering)

• Integrated Healthcare Management (IHM) - Assessment

• Care Management - Capability Maturity Model

• Value based care (VBC) and P4P strategy (Service Offering)

• ICD 10 Implementation Strategy (Service Offering)

Sandeep Rajan Management Consultant Technology Leader Health Plans & Providers Page 2 of 2

Contact this candidate