* ****** ***

Flanders,NJ-*****

Email id : adg6j8@r.postjobfree.com

Cell: 862-***-****

Rajesh Sulekha

Summary

Outstanding Leader with 15 years of extensive international experience across multiple industries in managing Large Portfolios and programs with cross-functional, geographically dispersed teams working in fast paced environment. Excellent skilled at Strategic Planning, Portfolio Management, Project Delivery and ability to organize, synthesize, and clearly present relevant information to executives and senior leadership.

Experienced leader with explicit skills in Mergers & Acquisitions and leading the overall PBM integration of the target organization from people, process and technology perspective

Currently, as a Lead of the prior authorization portfolio at Express Scripts, I lead and direct strategy for our One PA platform, which centralizes prior authorization work streams in a best-in-breed platform and has captured upwards of $85M in savings for our clients.

Currently leading the 3M CIGNA clinical/Coverage work to ONE PA platform

Led the transformation of Clinical Review Portfolio at Express Scripts establish CRD Cloud operating model establishing service management processes in multi cloud environment. Also, led agile enablement of the teams aligned to Scaled Agile Portfolio framework. Led the program to define CI/CD pipeline, including tools such as JIRA, GitHub, Jenkins and Service Now

Led and Manage Evicore / ESI SSO Integration and has captured upwards of $3.2M in savings for our clients

Extremely strong technology leader and innovator with outstanding problem-solving skills. Possess strong negotiation/facilitation skills committed to forging strong relationships with clients. Possess excellent client interfacing/communication skills, highly appreciated by the clients.

Actively involved in Knowledge Management, Imparting Trainings, advisory/Technical Committees

Excellent knowledge of Health care, PBM, CRM and Telecom Domains leading large programs

from intake till implementation

Had the privilege to learn and work Software Engineering technologies like Pega PRPC 7.x, 6.x, 5.x, Java, Documentum, FileNet - Java, JSP, Servlet, JDBC, JTA,JMS,EJB - XML, HTML, JavaScript - AJAX, Struts, MVC DB2, MSSQL, MYSQL - WebSphere, JBoss Application Server, Tomcat - Windows, Unix, Linux, Spring Boot, React, Pivotal Cloud Foundry (PCF), Mainframe, PEGA Robotics, POSTGRESSQL,Java and Oracle 6 & 7, AWS, Cobol,Rexx, CICS,DB2 and VSAM

Also knowledge in AWS service such as AWS EC2, AWS S3, AWS RDS, AWS CloudWatch and AWS Cloud Certified Practitioner.

Actively involved in Knowledge Management, Imparting Trainings, advisory/Technical Committee

Education:

B.E (Bachelor of Engineering) in Electronics &Communication Engineering from Anna University in Distinction with an aggregate of 78% in the year 2006.

Plus-Two from Kerala Higher Secondary Board of Education in First Class with Distinction with an aggregate 0f 79% in the year 2002.

SSLC from Kerala Board of Public Examination in First Class with Distinction with an aggregate 0f 84.33% in the year 2000

Professional Experience

CIGNA/Express Scripts (ESI) April 2017 – Present

Senior Manager - Software Development Engineer

Coverage 360 (C360) is a Pega based application that helps in processing coverage reviews and appeals that is fully integrated with Express Scripts’ eligibility and claims adjudication system.A coverage determination request could be initiated through various means like rejected claims, fax requests, manual phone calls, IVR, physician website, Home Delivery and Express Path (prescriber desktop). The intake process typically captures all the required details to initiate a coverage review. Some of the details captured include membership/patient information, drug details, coverage product details, prescriber details, claim rejection details, caller/requester details, etc. C360 connects to various external sources like Eligibility, CBM, PRB, IDF, FCRS, ATK, DUR, Polar, Mainframe, etc. to aid in capturing all these information. For information received via fax, there are dedicated fax numbers to differentiate initial coverage determination requests from Appeals. Also, Auto fax provides ICR/OCR capabilities to route Medicare related requests to separate work queues. Multiple work queues are setup in C360 to help sort the fax related requests (Appeals, Medicare, Urgent, DoD, etc.). This helps in assigning work to users based upon their skills. If information on these fax forms is insufficient, users have the capability to fax back requesting for further details.

Lead product delivery globally as lead of 120-person engineering organization in US, Brazil, India, and Philippines noted for delivering high-quality solutions within challenging restrictions. Drive business agility as execution lead for Express Scripts coverage review platform comprising multiple PEGA/BPM-driven products.

In my current role, presently managing a software engineering team of 120 + Software Engineers including Dev, QA & Application Support. My team is responsible to manage applications like Coverage and Clinical review system, Print and Fax system, Medical Prior Auth, Pharmacy Prior Auth etc.

Talent & Performance Management - Hire, mentor and drive high performing software engineering teams.

Customer Focus - Work closely with sales, business, banks & 3rd party payment platforms on user journeys, friction points, transaction-conversion and optimizations. Convert them to tech backlogs and deliver iteratively.

Tech Enabler - Tech Solution, Design, Full life cycle software development, DevOps & Test Automation

Project Management / Delivery.

Metrics / Dashboards - Proficient in defining and driving Engineering, Process & Business metrics & dashboards to help team take decisions & improve with measurable goals.

Vendor Management - Experienced managing both in-house & outsourced projects.

Budgeting - Work with tech & business leadership, strategists & finance to prepare software engineering budget in terms of resourcing, tools and cloud cost. Monitor the utilization costs across projects in regular intervals

IBM India Pvt. Ltd. April 2010 – Dec2017

Technical Team Lead/ Manager

ESI is a pharmacy benefit manager (PBM), Offers services to other companies who provide prescription benefits to their employees. POS is on-line pharmacy claim adjudication system. When a member of a Paid Card or Mail plan has a prescription filled at participating pharmacy, the pharmacy transmits the claim information to the Tele paid POS system in a standard NCPDP format. POS accepts claims, verifies member / dependent eligibility, group and drug plan, determines pharmacy participation in pharmacy network –PPO, checks claims for duplicates, performs drug utilization review –DUR, prices prescription, calculates deductible/ cap/ oop, saves claims on POS, Customer service data base and IW, transmits claim response back to the pharmacy.

I was Leading and managing the workforce of POS team of 60+ people and performing budget allocation and analysis along with SME role in ESI. I had successfully Lead/manage the IBM onshore and offshore team during the ESI/Medco integration.

Maximized efficiency through assisting project manager with strategic and timely organization of projects, resources, and schedules

Performed weekly reviews of project charges, task budgets, and overall progress, shortening projects lifecycle time by an average of 15%

Ensured successful implementation of IT infrastructure, Middleware, and Database applications by coordinating business teams, developers, and subcontractors.

CSC. Bangalore, India. Oct 2007 – April 2010

Software Engineer

TDC: Tele Denmark Communication

Columbus is the main ordering application for TDC. Columbus (CU) has a Web-and XML-based interface to Columbine to accept orders. Columbus has its own native CICS environment for order entry/enquiry by the business users. Provides on-line ordering on a number of predefined services for Service Providers reselling TDC product to retail-users.

To analyze the Initial requirements document.

To prepare system design Document detailing the requirements in an order based on the initial requirement.

To prepare program specification documents detailing the Low Level Requirements.

To write the new programs / modify existing programs based on the program specifications.

To prepare the Unit Test Plans (UTP) and System Test Plans (STP) covering the entire possible scenarios.

To perform Unit testing and System testing for the programs as per the UTP and STP.

To fix existing problems in the code – as part of maintenance.

TSS Trivandrum, India. June 2006 – Oct 2007

Analyst Programmer

MACSS means Missouri Automated Child Support System. This is the computer system that links all offices handling child support issues. The Child Support Enforcement Office in Union, Missouri is a division of the Jackson County Prosecuting Attorney’s Office.

Accountable for designing, coding, development, testing, documentation and debugging of applications to fulfill the requirements of one or more user areas.

Support, enhancement or maintenance existing applications.

Coordinated with the operations areas and lines of business to spot out and specify complex business requirements and processes.

Make recommendations, researches and find out alternative solutions

Professional Skill Set

Programming Languages

: VS COBOL II, MF COBOL, JCL,XML

:XSL and XSD,Java, Spring Boot and PCF Cloud

Databases

: DB2, VSAM & SQL.

DB2 Utilities

: SPUFI, Platinum,DB2I

File Management Systems

: VSAM.

OLTP

: CICS1.3,CICS 3.1.

Others

: ISPF, TSO,MQ series

Operating Systems

: MVS.

Tools

:FileAid,AbendAid,TMONCE,TMONDB2,Ditto

:Expeditor, A- Librarian, Cyklus, SDF2, :Unicenter, CA Inter test, Endeavor, File :Master,Jmeter,SDF2,MAPR.

Other Software Skills:

Operating Systems

: DOS, Windows 98 & NT,

: Windows 2000 & Windows : XP, Z\OS/OS/390.

Office Suites

: MS OFFICE 97, 2010

BPM Skill Sets

Pega PRPC 7.x, 6.x, 5.x, Java, Documentum, FileNet - Java, JSP, Servlet, JDBC, JTA,JMS,EJB - XML, HTML, JavaScript - AJAX, Struts, MVC DB2, MSSQL, MYSQL - WebSphere, JBoss Application Server, Tomcat - Windows, Unix, Linux, Spring Boot, React, Cloud (PCF), Mainframe, PEGA Robotics, Java and Oracle 6 & 7.

Certification:

AWS Certified Cloud Practitioner

Certified Pega 8.1 System Architect (CPSA).

AHM250

Certified Scrum Master (CSM)

Project Management Professional (PMP)

Sun Certified Enterprise Architect for Java 2EE (SCEA)

TM Forum's Business Process Framework (e TOM) LEVEL 2 Certified

HIPAA certification has been completed for Health care domain. Lean Sigma certification has been completed in 2011

Training:

Java training in ESI and certified Java professional

Undergone three months training in Mule Training in IBM

Undergone three months training in IBM MAINFRAMES from TSS India Pvt. Ltd

Trivandrum that included JCL, COBOL, CICS, VSAM and DB2.

Undergone training in MQ in CSC Chennai.

Undergone Telecomm training in CSC Chennai.

Undergone XML training in CSC Chennai.

References: Available upon request

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