Manager Engineer

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RAMAKRISHNAN VAIDYANATHAN Phone: +1-949-***-****

Email: ******@*****.***

Profile

IT Experience

Total Years : 22 years

Cognizant : 16 years

Designation Senior Manager – Projects at Cognizant Technology Solutions Core Capabilities

Healthcare PBM Client Benefits Administration

• Client Engagement services and Solution implementations

• Business and Process consulting

• IT Project Management

• Quality Engineering & Assurance Management

• IBM iSeries AS/400 technology

• AS/400 & DB2 Technical consultant

• TCoE – Client Implementation Benefits Testing

• SoapUI API Test automation

• HP Unified Functional Testing Automation

Product expertise

• RxClaimTM Plan Benefits configuration management

• Providing Account Management services in the PBM industry

• RxClaimTM Product Advisor

• RxClaimTM Benefits SME

• Formulary Management

• Commercial and MedD Claims Adjudication – Retail/Mail/LTC/HIF/ALF/Paper/Specialty

• Mail Order PPS/SANITAS Dispensing Application SME

• Mail Order LINKS and Specialty Order HBS/SPARCS app

• Specialty Distribution Warehouse management system with Turning Point application.

• SPECTERA (UHC) Vision Care

Educational Qualification

• Masters in Computer Application, Bharathidasan University, India - 1999

• Bachelors in Computer Science, Bharathidasan University, India - 1996 Work Experience

• Cognizant Technology Solutions – 2005 ~ Till date ~ Onshore (USA) & Offshore (India) Clients

o CVS Health - Texas, Illinois – 2014 ~ Till date

o Express Scripts - New Jersey, Florida – 2013 ~ 2014 o United Health Care (Spectera, Optum Rx) – Maryland, California – 2005 ~ 2013

• Saud Bahwan Group, Sultanate of Oman – 2001 ~ 2005

• Barry Wehmiller India (P) Ltd., India - 2005

• Jay Instruments Systems Limited, India – 2000 ~ 2001

• Efficient Data Processing (P) Ltd., India – 1999 ~ 2000 2

Skill Classification Description Expérience

Primary Skills

IT Project Implementation and Delivery Manager

QE&A Test Manager

14 years

7 years

Secondary Skills iSeries AS/400, RPG, ILE, CL, SQL, MQ series 15 years Data base DB2, Oracle, Maria DB, MS SQL 20 years

Database tool SEQUEL, DBU, Aqua data, Toad for DB2 20 years Development Environment iSeries AS/400, RPGLE, CLLE, RLU, SEU 15 years Server Platform IBM iSeries, Mainframe 15 years

Tools used

MQ series, SPOOLMAIL, TRAILBLAZER, ROBOT, TWS, Hawkeye, Abstract, Crystal reports, HP ALM, SoapUI, HP UFT, Aldon/CMS, Turnover, Rally

15 years

Certifications

IBM iSeries administrator, Microsoft .Net, ASP.Net, Java, Oracle, Python, Core Java

Digital Awareness Academy

courses

Data Science

Introduction to Data Science

Data Science: Master Machine Learning Without Coding

Introduction to Machine Learning for Data Science

Big Data Fundamentals

Probability and Statistics for Business and Data Science

Storage Solutions of Introduction to Data Science Cloud Computing

Digital Fundamentals (Technical) Integrated

Introduction to Cloud Computing on Amazon AWS for Beginners

Ultimate AWS Certified Solutions Architect Associate 2020

AWS Certified Cloud Practitioner (LEGACY)

Cloud Computing Fundamentals

Azure CI/CD DevOps Demo of Cloud Native Technical Architect - Azure Enablement

Microservice Design Pattern

Artificial Intelligence

Artificial Intelligence A-Z™: Learn How To Build An AI Healthcare Courses

Pharmacy Benefits Management

Healthcare Provider Industry

Health Plans and Healthcare Basics

Provider Network Management in Health Plans

Medical Management in Health Plans

Information Management and Claims in Health Plans

Specialty Services and PBM in Health Plans

Underwriting, Rating and Financing in Health Plans

Government Laws and Regulations in Healthcare

Domain Knowledge Healthcare PBM industry

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PROFESSIONAL EXPERIENCE

Client: CVS Health: Feb 2017 – present COGNIZANT Technology Solutions Mail and Specialty Order Management system – QE & A CVS Health, Buffalo Grove, Illinois

• Provide Testing Services and support in Mail Order processing system - LINKS application, Tristar, HBS/SPARCS application, Regional Order Creation Center (ROCC) and Specialty Dispensing applications.

• Project execution in PPS and SANITAS Dispensing Application, Testing Services and Governance.

• Handled mid size and large programs with CVS, Anthem inhouse clients and Aetna, Wellcare, Humana White label clients.

• Mail services includes New and Refill Order claim adjudication received via Mail, eRx, IVR, Fax and CVS Health Portal.

• Fulfilment support and solutions includes Exception, Induction, Picking/Filling, Checking/PV, Packing, Loading and Manifesting using PPS, SANITAS and SCANDATA dispensing application.

• Test methodology uses Agile and Waterfall.

• Dispensing automation solutions using HP UFT (Unified Functional Testing) Tool.

• Maintain application life cycle management and software testing using HP ALM Quality Center Tool and Rally.

• Part of CVS Anthem implementation embracing 3 implementation waves in Summer 2019. It was a team effort and personal sacrifice in bringing over 8M members in total onto the IngenioRx platform. The last wave of 5.7M member migration was the largest PBM migration ever (not just CVS). Client: CVS Health: July 2014 to Feb 2017 COGNIZANT Technology Solutions RxClaimTM Benefits EGWP Test Lead and Pharmacy Benefit Relation Manager CVS Health, Irving, Texas

• Employer Group Waiver Program (EGWP) - MED D - Benefits SME. Point of Contact for the Test and QA functionalities.

• First tier point of contact for information gathering in audits relating to pharmacy claims processing, including audits by state and federal agencies.

• Handled 98 top tier clients of CVS Health EGWP that includes AT&T, SHELL, State of New York, State of OK, etc.

• SSI-PDP benefits setup testing is a major accomplishment every year during Welcome season.

• Delivering 100% defect free benefit configuration bearing the Med D members interest as they are above 65+ years.

• It was an added advantage to come from RxClaimTM IT background into CVS Health RxClaimTM EGWP Benefits testing, as it helped to notch even negligible issues.

• TCoE Process Reengineering. Develop Integrated and automated Benefits Testing Platform.

• Responsible for making updates in the PBM system as part of Medicare Part D PDE reconciliation.

• Achieved high laurels for the consecutive 3 Welcome Season delivering Above and Beyond quality.

• RxClaimTM Benefits configuration product specialist that comprises of Member Enrollment, CAG setup, BPG setup, Claim Adjudication, Point of Sale (POS) configuration, Network and Pricing (NIFs), Provider enrollment, UM and Formulary management, Copay, Coinsurance, OOP, and DUR modules, Follow-Me-Logic (FML), Clinical Program Management (CPM) implementation, Specialty drug and Standalone Module (SAM).

• Worked on both traditional Plan benefit setup and XRef benefit setup.

• Reviews and tracks all aspects of pharmacy claims processing for completeness and coding accuracy.

• Handled testing and validation tools like TBGT, EzTEST, Plan Drill, Patient Pay Drill, Rx EzQuery, Attachmate macros.

• Benefits and Integration testing across below lines of business – EGWP SSI, Employer Commercial, Formulary and UM testing. Provides claims research, analysis, and support during audits.

• Researches, troubleshoots and resolves claims issues with internal and external partners.

• Tracks requests coming into the department and evaluates trends; involving others as necessary.

• Supports leadership and the department on a wide array of PBM related initiatives, tasks and projects related to all aspects of the plans’ pharmacy benefit for all lines of business.

• Follows all state and federal regulations and contractual requirements, including record retention requirements. 4

Client: Express Scripts: Feb 2013 to June 2014 COGNIZANT Technology Solutions Quality Assurance Manager - WMS

Curascript Specialty Distribution - Express Scripts, Lake Mary, Florida Managed the QA team of both Onsite and offshore and provided technical QA support in Curascript SD Turning Point System application.

• Responsible for ensuring compliance to Corrective and Preventative Action processes.

• Defined and drove the implementation of QA process and procedures throughout the organization.

• Involved in Project QA time estimation and process-improvement identification and tracking.

• Coordinated Quality audits, and supervised reporting and correction of deficiencies.

• Worked with Quality Engineering to assure the effective implementation of quality control and inspection procedures for Licensing and Compliance project, Suspicious Order Monitoring project, Controlled substance Ordering system, Field expansion project, Accredo TPS template, eCom.

• Supported closure metrics through identification and documentation of case handling errors.

• Expertise in HP QA ALM Tool and used for Requirement gathering, creating Test plan, Test scripts, Defect logging and Test run.

• Writing Quality Procedures using HP QA ALM tool and establishing Quality Curascript Warehouse Management System.

• Cross Functional coordination with other line of business such as Marketing and Purchasing, Distribution Warehouse Receiving and Putaway department, to resolve Customer and Supplier Quality issues. Client: OptumRx: Mar 2012 to Jan 2013 COGNIZANT Technology Solutions Onsite Development Lead

OptumRx - United Health Care, Santa Ana, California Served as a Program manager to manage and coordinate the Fresh Start program- Medco to OptumRx migration. This involves project and people management, recruitment, billing, and client support.

• Responsible for managing resources and acquiring projects from the client and delivery management.

• Key participant in impact analysis, estimation, proposing new solutions and software development in the Fresh Start program, adhering to complete SDLC process.

• Involved in managing various development projects like ePrescribing solutions, Marketing Development System application support, Claims History extraction and reporting to vendors like Ecods, Gopher, Galaxy, New Eligibility enrollment modules, Batch Claim adjudication module, Audit and Finance application, IFMS-Prescription Drug List migration, Data migration and Scalability.

• Portfolios manager role involves on-boarding, resourcing, billing, SOW using the Field glass tools.

• Supports leadership and the IT department on a wide array of PBM related initiatives, tasks and projects related to all aspects of the plans’ pharmacy benefit for all lines of business.

• Follows all state and federal regulations and contractual requirements, including record retention requirements. 5

Client: OptumRx-UHG: Sep 2007 to Feb 2012 COGNIZANT Technology Solutions Onsite Development Lead

OptumRx - United Health Care, Irvine, California

Engagement lead and onsite delivery manager responsible for acquiring projects from the client.

• Had thorough domain knowledge in RxClaimTM application, maintaining the Member benefits, Plan, Eligibility system, DUR, GPI/NDC formulary management, ePrescribing system, Claims management, MAC Pricing forecast application.

• Successfully completed high visibility projects such as RxHD to RxClaimTM Call tracking data update system, Eligibility GPS Duplicate HIC/ Duplicate MBR project, GPI Replication process, EOB Scrubbing, RxClaimTM MODS development, Member Find & replace utility, Partner’s RX & Humana Implementation, PDE Transaction Automation, Batch claim load process, Batch load for PDP_Retro Eligibility process.

• While facing considerable opposition to global sourcing, proved the success of the onsite-offshore model and established resource growth from 1 to 165 in a span of 2 years.

• Worked closely with the CIO and senior leadership and grew the program to over 165 personnel and saved the client over $5 million.

• Worked closely with portfolio management including strategy and planning, business case development, demand management, finance, and CIO weekly portfolio monitoring.

• Define vendor management strategy, directed contract development, and assisted with contract negotiations. Approved over $15 million in annual spend.

• Because of this success, was asked to contribute to the setup of the Fresh Start program that popped up as a migration project from Medco to OptumRx.

Client: Spectera-UHG: Aug 2005 to Sep 2007 COGNIZANT Technology Solutions Sr. Software Engineer - Case Installation

Spectera – United Health Care, Columbia, Maryland

Involved in various business activities to complete their automation projects. Spectera is a division of Specialized Care Services, a wholly-owned subsidiary of UnitedHealth Group, and is dedicated to providing quality service to our clients nationwide.

• Took responsibility for the case installation process between ACIS/Prime systems.

• Involved in the decision making for automation of GL Tagging process, Plan Replication process, Plan Activation, Group Activation, Group Management Reports, Commission Assignment & Activation, and the Eligibility process.

• Involved in Testing cycle, Pre & Post Implementation process, Project management, work management, and team management.

• Involved in the estimation and work product delivery of Eligibility system-Auto case installation of entire Spectera domain. Involvement included initiate, analyze, design, code, test, and implement.

• Responsible for offshore management and deliverables, project planning and effort estimation. 6

Saud Bahwan Group: Mar 2001 to Mar 2005

Software Engineer Saud Bahwan Group, Muscat, Oman

Finance & Cashier System, MIS System, Accounting System The project's objective was to provide a total solution on the various issues faced by the Installment Credit department, when handling finance companies.

• Oversaw successful software development and maintenance of on-line account management system in AS/400 technology, an in-house product.

• Involved in the business design of LPO, Payment, Invoicing, Cash Flow Actual, Cash Flow Projected, Documentation, and Incentives. Earlier these activities were done manually with PC based applications.

• Coordinated & integrated application changes across multiple internal groups, multiple vendors, and business operations.

• Worked with all program area leads to manage the five local PMOs. The various programs areas are Parts system, Installation Credit system, Service system, Finance and Accounts system. Saud Bahwan Group: Mar 2001 to Mar 2005

Software Engineer Saud Bahwan Group, Muscat, Oman

Was tasked with automating the business Accounting System project in six months.

• Collation and analysis of requirements, preparation of SRS and conducting feasibility studies.

• Involved in the design, software development, implementation, support, testing and maintenance.

• Defined business requirements with business users, designs functional requirements, works with business users on testing and coordinates the release/deployment of the implemented solution.

• Coordinated team developers, participated in discussion with stakeholders, worked closely with Business support analysts.

• Provided unit test plans to QA and assisted them in thorough preparation of test ware and executing these tests to ensure quality and validate the functionality.

• Engaged in the overall operations of the IBM AS/400 for maintaining the security Implementation and administration of database besides assisting the team in managing various projects.

• Also involved in designing of database objects, workflow and process flow, ERD, DFD, flowcharts and specifications. EDPPL: Dec 1999 to Mar 2001

Software Engineer Efficient data processing (P) Ltd., Mumbai ERP Package

Assigned to provide Barcode solutions to various clients, integrated to the existing software at the client locations.

• A total ERP Package project was undertaken using Visual Basic and Oracle/MS Access database.

• Per the client's barcode specifications, the software solution is provided and will be printed using Barcode Printers and scanners.

• The software comprises of Customer master maintenance, printing software, inventory management, DB Reports and Enquiry screens.

• As a software programmer, responsible for delivering software products using Visual Basic, FoxPro and Oracle application platforms.

• The business focuses widely in the market area of Jewelries, School/College Libraries, Super markets, hyper markets and tags for house hold accessories.

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PROFESSIONAL COMPETENCIES

• Performance driven, versatile leader with over 21 years of IT experience.

• Making decisions with the client's best interest in mind.

• Strong knowledge in the RxClaimTM and Mail Order Dispensing system.

• Craft and disseminate a clear vision by linking projects to the company’s objectives and results.

• Team building and mentoring ability.

• Responsible for the performance management processes for direct reports including mentoring, counseling, providing feedback, career planning, goal setting, and performance assessment.

• Establishes objectives, goals and performance measures specific to resource domain.

• Building excellent rapport with business and client connects and maintain high credibility.

• Maximize productivity with setting clear expectations and proactively communicating project status, issues and risks to internal stakeholders and senior leadership.

• Draft and distribute project objectives and tasks to the solutions team.

• Nurture relationships with project sponsors, business and IT executives.

• Has a complete understanding of the software process life cycle, project planning, control and execution methodologies.

• Well versed in configuration management and Quality Engineering & Assurance activities.

• Key strengths are communication, customer interaction, relationship building, teamwork and problem solving.

• Manages process improvement initiatives, seeking root cause and developing appropriate corrective action. ACCOMPLISHMENTS

• The Model Business Partner Award – 2012

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