Summary

** + years of experience in analysis, design, development, production support and

maintenance of various Mainframe applications.

6+ years of experience in production support, maintenance, analysis design, development of various, ETL, J2EE and .Net web and desktop applications.

8 years of experience in handling offshore and onsite teams and working in global delivery model. Experienced in managing and working with multiple geographically distributed teams.

Worked on multiple projects in both waterfall and agile methodologies.

Experienced in identification and implementation of Business value Additions and Business manual process automation with robotic automation

Vast experience (13+ years) in Healthcare insurance domain.

Vast experience in development of complex ETL programs, Customer Information Control System screens and batch processes involving critical business rules and regulations.

Extensive experience in production support and maintenance of critical Healthcare IT applications.

Experienced in quality management activities and processes. Well versed in CMMI Models.

Well versed in handling critical time-constrained issues and driving Immediate Response teams(IRTs)

Well versed in handling estimations for large projects, doing cost vs business analysis.

Well versed in handling issues spanning across teams and collaborating to handle the issue and take them to conclusion.

Key Healthcare Domain Knowledge

Medical Management

Broker Compensation

International Classification of Diseases – Tenth revision (ICD-10)

Healthcare Provider Domain

Healthcare Contracts and Pricing

HMO and Pharmacy Claims

Key Technical Knowledge

Programming Languages : ETL, PL\SQL, COBOL, CICS C#, C, C++, JCL, REXX,EZTREV, MICROFOCUS COBOL, Java

Script, PERL Scripting, Shell Script, VB, VB.Net

Databases : DB2, Oracle, Sybase, MS SQL Server

Development Tools : Visual Studio for .Net, Expeditor, OPEN TEXT EXCEED, IBM Data Studio, SDF2 for CICS,

Microsoft FxCop, Strobe, Rational Developer for

z Systems (RDz)

Reporting tools : SAP Business Objects Crystal Reports

Designing tools : Microsoft Visio, ETL( Informatica and IBM Datastage)

Version Control Tools : Microsoft VSS, Clear Case, Clear Quest, Endevor (MF Code versioning)

Vikram Sunil Bhagwat – Technology Lead

Contact No: +1-267-***-****

Current Location: North Wales, PA

Email id: adgbrb@r.postjobfree.com

Project Management Tools : PlanView, Integrated Project Mgmt Tool, Remedy for Change Tracking

Ticketing Tools : HP Service Center, SNOW(Internal tool)

Software Development Life Cycle : Water fall and Agile(SCRUM and KANBAN) Academic Qualification

• Bachelor of Engineering in Electronics and Telecommunication in 2007 from Pune University, Pune, Maharashtra, India.

Certifications / Professional Awards:

AHIP-Fundamentals of Health insurance, Part A (Basics of Health Insurance)

AHIP-Fundamentals of Health insurance, Part B (Basics of Company Operations)

AHIP-Healthcare Management AHM 250 (Healthcare Management: An Introduction)

Certified in Open Systems

Certified in Mainframe technologies

3 time Star Performer Award in 2009, 2010 and 2012. Languages known:

English, Hindi, Marathi

Total Work Experience:

Company: Infosys Limited Period: July 2007 to Till Date Projects

Project Title: Aetna Managed Services

Client: Aetna Inc.

Duration: From Sept, 2014 to Till date

Role: Production Support Lead - US

Description: Aetna Managed Services project involves handling Application maintenance for multiple complex Aetna IT applications. The project involves complete support of Client applications with a focus on -

1. Day to day Live Production Environment Monitoring and Maintenance, 2. 2. Business Queries and Issues Resolution

3. Delivering Critical Fixes to production systems to keep environment business available.

4. Software Infrastructure Support and enhancement 5. Business Value Addition to critical business process to increase business productivity

6. Critical Incident Monitoring and coordination.

7. Automation of manual business processes to reduce errors in live production environment.

8. Tracking and training teams both onsite and offshore and 9. Providing extensive technical support to business partners Role and Responsibilities

Production support and maintenance of business critical IT applications like Aetna Total Clinical View, Strategic Reporting Database, Operation and Reporting Databases, NISS and Broker Account Entry System.

System Design, system development and installation of issues hindering business functionality for ATV, BAES, SRDB ODS, RDS and NISS.

Identifying opportunities for member outreach based on patient health information.

Handle extremely high volume data loads in ATV to meet the business needs via batch monitoring and fixes.

Keeping the ATV application available 24*7 time so that there are no gaps in member/patient heathcare and support.

Handling precertification - preauthorization transactions for providers so that members don’t have service gaps.

Handling Utilization Management (UM) feeds to Third party Administrators for specific plan sponsors.

Feeding crucial precertification data into Claims adjudication systems so that claims are settled on time and within the required SLA (service level agreements).

Handling extremely complex bulk premium loads into BAES for various different sources.

Close Monitoring of check runs for BAES and AP Trade so that brokers are paid on time via CITIBANK within the specified SLA.

Handling extremely crucial bulk data updates to National Information for Sales Support application which assists sales teams in RFPs.

Performance tuning to application so that they as little CPU as possible and during off-hours so that there is significant cost reduction.

Customer Management via periodic status reporting

Knowledge Management using SharePoint.

Configuration Management using IBM ClearCase, IBM ClearQuest and Microsoft VSS.

Identifying and implementing process automations and Business Value Addition Ideas using RPA(Robotic Process Automation)

Work Product inspection and Work Product Reviews using IBM Clear Quest

Risk Identification and Mitigation planning.

Critical Issue troubleshooting and resolution with Immediate response Teams (IRT)

Trend Analysis of present and past business issues using Service Now(SNOW)

Infrastructure change management and checkouts

Production Jobs scheduling and detailed monitoring of critical processes using ZEKE.

Disaster recovery of systems and application in live production environment.

Training for disaster recovery and setting up disaster recovery environment.

Quality Management and CMMI compliance auditing and reporting. Project Title: Aetna HMO Claims and Pharmacy RxSY Suite Client: Aetna Inc.

Duration: From Oct 2013 – Aug 2014

Role(s): Technology Analyst – US and Technology Lead - US Description The Aetna HMO Claims Suite of application involved development, maintenance and support of HMO Claims and related applications. The project also included day to day system support and business analysis of Claim adjudication systems (both batch and online), Claims Xten (CXT). The Aetna Pharmacy RxSY Suite of application involved development and maintenance of Pharmacy Suite of applications. The Important activities include developing and maintaining legacy applications including RxSY (Aetna Legacy Pharmacy Claims System), Rx-HMO, Aetna Integrator (AI), PDED and commercial and medicare EOBs. The project also included day to day system support and business analysis. Role and Responsibilities

Leading Onsite and offshore teams in Pharmacy and HMO Claims domain

Requirement Elicitation and Gathering via requirement sessions and SCRUM meetings.

JAD (Joint Application Development) sessions

Communication with Project Manager of Aetna regarding project schedule, progress and open issues.

Providing clarifications of the Business requirements to the development and testing teams.

Providing guidance to development teams to decide on design approach.

Reviewing the Application design specification, component design specification and Unit and Integration test plans.

Reviewing the System, UAT test plans, test scripts and test result summary.

Compliance regulation auditing and reporting.

Incident and Problem Management

Problem trend and root cause analysis

Production Batch Support

Knowledge Management and Mentoring of offshore teams. Project Title: Aetna Provider, Contracts and Rating Suite Client: Aetna Inc.

Duration: From Dec 2007 – Aug 2013

Role(s): Software Engineer, Senior Systems Engineer, Technology Analyst, Technology Analyst – US

Description: The Aetna Provider, Contracts and rating Suite of application involved development, maintenance and production support of Provider domain and related applications. Application Supported includes application like Strategic Contract Manager

(SCM), Service Codes and Service rate (SCSR), Data Archive and Delivery (DAD) and Capitation Applications. The significant work involved was ICD9 –ICD10 Crosswalk, ICD10 Remediation, ICD10 End to End Claim Testing, Member Payment Estimator, Reference Based Pricing, SCM complete application rewrite and 3rd

party medicare software installs.

Role and Responsibilities

Handling High visibility and large volume data loads for HIAA (Health Insurance Association), RMS (Rate Management System), Medicare Rate Load, ICD10 procedure and diagnosis codes from CMS (Center from Medicare and Medicaid).

Handling and executing Rate and Service Area affiliation loads.

Extensive knowledge and specialization in install and usage of Medicare pricing softwares like OPTUM and Burgess.

Developing and maintaining pricing rules for HMO and ACAS claims adjudication systems.

Creating services for that would feed Claims Adjudication systems with ICD9 – 1CD10 and ICD10 – ICD9 crosswalk information.

Yearly purge of data from Data Archival and Delivery systems.

Creation of tools to automate the testing of OPTUM and BURGESS rates to reduce install TAT.

Analysis of business specifications and converting them into technical solutions

Service architecture and conceptual designs of applications SCSR, SCM and DAD.

Handling of Re-pricing applications for Aetna which enables external Aetna partners to price claims.

Design reviews, Code reviews, work product inspection and reviews.

QA testing oversight and support

Resolving and troubleshooting issues, day-to-day support, report generation and auditing.

Mentoring of offshore and onsite teams.

Personal Information

GENDER : Male

PASSPORT NO.(VALID UPTO) : G1387406 (16 Jan 2017)

: N9005528 (18 Feb 2026)

NATIONALITY : Indian

MARITAL STATUS : Married

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