Experienced Mainframe Developer with 10+ years of expertise and a successful track record of delivering complex technology solutions.
Adept in leading functional teams, technical teams, and collaborating with leadership on performing project estimations, project planning, delivery and management reporting in Agile and Waterfall environments.
Proficient in Software Development Life Cycle, Agile development principles, client interfacing skills, conceptual design, technical design, databases and object-oriented programming techniques.
10+ years of experience in Healthcare with detailed knowledge of Claims Adjudication and Disbursement, BlueCrossBlueShield insurance.
Software/Products: COBOL, CICS, JCL, IMS, C++, Python Basic
Development Tools: Endevor, Xpeditor, Debugger, Zeke, Control – M, File Manager, Startool, ISPF, TSO, SPUFI, QMF
Middleware/Databases: DB2, VSAM, IMS, MQSeries
General Tools: ServiceNow, JIRA, Confluence, MS Project planner, Visio, Sharefile, Advance Excel
SENIOR SOLUTION SPECIALIST at Deloitte June 2017– till now
Project: Modernize Migration, Client- Anthem
Extracted complex business rules by analysing COBOL modules from legacy and target system, performed data mapping, gap analysis to understand deltas between Legacy Claim Adjudication Process and Target System. Implemented enhancements to deal with discovered gaps hence making the system compliant to industry standards and HIPAA guidelines
Designed and Enhanced the intake, edit, load and adjudication process of target system to process Institution and Professional claims from multiple legacy systems, thereby saving the maintenance and enhancement cost of running multiple claim processing systems.
Performed impact analysis for sunsetting an application by analysing the impact of deleting component such as Cobol module, Copybook, JCL
Performed root cause analysis of the detected abends and provide impact analysis for proposed improvements to handle/reduce similar future abend
Led multiple sessions with Business and SMEs to align them on the functional requirements, technical requirements and finalize the design approach.
Performed Code review for the components developed by offshore development team to ensure company coding standards are followed.
Created adhoc jobs to extract report for business/Technical checkout post implementation
Handled implementation activities involving – ticket approvals, job scheduling, components staging and review, co-ordinate with overlapping projects, abend review,status updates to leadership
Determined and tracked changes in scope, gathered work estimates and drafted implementation timelines for change requests
Involved in all agile phases, Sprint planning, Daily stand up call, Retrospective and Story Estimation
Coordinated with teams located in multiple geographic locations to expedite the requirement gathering and integration testing processes
Technology Lead at Infosys Limited, USA Feb 2015 – May 2017
Project- Vision 2020, Client- Aetna
Designed and enhanced the process of managing and tracking communications sent out of Aetna for 12 Applications, thereby easing the process of auditing and backtracking.
Designed proposal for automating process of generating schedule of benefit details for Medicare Plans. These automations enhanced efficiency of participating teams due to reduction in effort by 15%
Provided and implemented the solution to revamp the existing suppression process of printed mail communication to members for 17 applications by improving the member hit ratio close to 100% and thus, saving client $100,000 per year.
Developed DB2 stored procedures to use by web services to read data for business reporting of the client communication sent out from Aetna.
Lead and managed the development team with more than 10 developers in USA and India.
Worked with implementation, and other technology teams to resolve critical outstanding defects.
Partnered with the principal architect in designing software architecture of the system to improve the efficiency and performance
Technology Analyst at Infosys Limited, India Oct 2009– Jan 2015
Project- Automatic Claim Adjudication (ACAS), Client- Aetna
Performed data mapping, gap analysis to understand deltas between desired Claim Adjudication Process and existing ones. Implemented enhancements to deal with discovered gaps hence making the system compliant to industry standards and HIPAA guidelines
Fragmented the existing COBOL module in Mainframe into 5 logical sub modules based on functionality to achieve maintainability and performance
Developed Multiple screen using CICS, COBOL, VSAM to add, update delete and browse business rules from front end.
Successfully developed and implemented requirements for 3 critical modules for pricing the claims for Coventry health care. After Coventry was bought by Aetna, the claims filed by providers in contract with Coventry needed to be externally priced.
Designed and delivered the process of calling external rule system for applying recommendation on hospital claims to check for Claim authenticity to avoid incorrect payment and fraud claims processing.
Created high level test plans, case flows, and performed integration testing for the entire application to ensure code efficiency
PR 201, PR 202 internal Mainframe Programming Certification
May 2005 –May 2009 Bachelor of Engineering Electronics Engineering Mumbai University India