AJAY RAO

No.*.Sukesh, V.P.Cross Road, Mulund (West), Mumbai - 400080 Cell: +91-982******* adlmpp@r.postjobfree.com

Summary

Solutions-oriented IT professional with 20+ years of experience at managing and leading projects, collaborating with project teams, interfacing with clients, and deploying functional and technical services to build successful solutions for clients

16+ years of experience in Insurance domain with 11 years’ of experience in US Healthcare Payer landscape and around 5 years’ experience in P&C Insurance (UK and US market)

Certified Scrum Master

America’s Health Insurance Plans (AHIP) certified. Have attained HIA, PAHM, MHP, and HCSA certifications

Experience in handling client/server, web-based, product configuration and custom development projects

Completed Business Architect course at Pega Academy

Experience in CMMI level 5 processes and development models like waterfall and agile (scrum)

Performed roles like Onshore Coordinator, Project Manager, Business Analyst, Configuration Analyst, and Pre-Sales lead

Healthcare Domain knowledge : Medicare and Medicaid

Experience in working on Facets and NetworX applications: Benefits, Plan, Product, Provider, Provider - Networks/Relationships, NetworX Pricing, Service Rules, Supplemental Rules, Fee Schedules, Agreements, Qualifiers, Workflow, Benefit/Variable components

Good experience and knowledge of Facets Data Model

Knowledge of EDI HIPAA 5010 X12 Transactions including 834,835, 837, 270, 271, 276, 277

Experience in Business Analysis techniques – Agile Principles, JIRA, Requirement elicitation, documentation, presentation, estimation, requirement change, designing business process map, UML.

Conducting requirement elicitation sessions with business users and coordinate the work with offshore team

Experience in writing of Business Requirement Document (BRD), Functional Specification Documents (FSD), Requirements Traceability Matrix (RTM), Use Cases, AS-IS / TO-BE flow charts, Activity Diagrams

Had H1-B petition from 01st Oct 2015 to 31st Dec 2017 and H1-B visa from 26th Oct 2016 to 31st Dec 2017. H1-B has not been used and is eligible for new H1-B petition in non-cap category

Possesses B1 Visa valid till May 2022

Available for immediate joining

Highlights

Multi-project implementation

Project Management

Budgeting & Forecasting

Client Management

Collaborative Leader

Waterfall & Agile Methodologies

Facilitate Scrum Ceremonies

Requirement Elicitation

Team Building

CMMI & ISO Audits

Process Improvements

Value Innovation

Healthcare RFI & RFP

Facets Configuration & Testing

Proficiencies

Platforms: Windows, Linux (Red Hat, Mandrake)

Languages: Html, JavaScript, PHP, Delphi 5, Delphi 6, ASP.Net 2.0 and 3.5

Framework / Platform: .Net, Microservices, Web API, SharePoint

Databases: MySQL, Paradox, Oracle, Sybase, MS SQL & SSIS 2005, 2008 and 2012

Tools: Visual Source Safe, MK Source Integrity, SVN, MS Visio, TFS, Jira

Insurance Product: Facets (4.51, 4.81, 5.21), Networx Pricer, Subscribe 2000

Experience

Majesco Software & Solutions India Pvt. Ltd. Aug 2019 – Jul 2020

Projects: Majesco Suite Implementation

Client: Ullico Casualty Group, LLC

Duration: Feb 2020 till Jul 2020

Type: Implementation

Role: Project Manager

Ullico Casualty Group, LLC is the risk solutions provider for labor and offers Professional Liability to protect multiemployer and public benefit funds, unions. As part of modernizing and have a flexible solution to address market needs quicker than their existing legacy system, Ullico decided to implement Majesco’ s proprietary suite comprising of Policy, Billing and Claims modules.

Responsibilities

Project delivery & management

Participate in requirement elicitation

Followed Agile principles, practices and values through Scrum

Facilitate Daily Stand-up, Sprint Review, Sprint Retrospective, Sprint and Release planning

Using Jira as Agile tool for maintaining and tracking stories and sprint cycle

Create and maintain relevant metrics that help the team review, measure and plan work on daily basis

Track and report team velocity, Sprint capacity and project status to management

Coaching the development team on scrum practices and process

Worked with the team to have best practices, value innovation, and SDLC processes are religiously implemented

Coordinated dependencies and managed inter-team dependency among teams

Protected the team from distractions by removing impediments at all levels of management and business

Facilitate team in process improvement and value innovation

Projects: Billing Implementation

Client: Vault Insurance

Duration: Aug 2019 Jan 2020

Type: Implementation

Role: Project Manager

Vault, one of the leading home insurance providers in US was using their legacy system to bill their end customer for premium. Their legacy system had process gaps, manual intervention at places in the process, non-scalable, and performance issue. Majesco’s proprietary billing suite product helped them have a faster to market and cloud based modernized solution, which consists of loosely coupled sub modules and highly configurable built in entities.

Responsibilities

Project delivery & management

Participate in requirement elicitation

Followed Agile principles, practices and values through Scrum

Facilitate Daily Stand-up, Sprint Review, Sprint Retrospective, Sprint and Release planning

Using Jira as Agile tool for maintaining and tracking stories and sprint cycle

Create and maintain relevant metrics that help the team review, measure and plan work on daily basis

Track and report team velocity, Sprint capacity and project status to management

Coaching the development team on scrum practices and process

Worked with the team to have best practices, value innovation, and SDLC processes implemented

Coordinated dependencies and managed inter-team dependency among teams

Protected the team from distractions by removing impediments at all levels of management and business

Facilitate team in process improvement and value innovation

Capgemini Apr 2003 – Aug 2019

Projects: Medicare Pre-Enrollment (Fazal) & Facets Business Reporting

Client: Universal American (UAM)

Duration: Jan 2016 till Aug 2019

Type: Enhancement & Maintenance

Role: Project Manager

Pre-enrollment process for various Medicare products at UAM is handled through Fazal application. Capgemini has developed this application for UAM to facilitate their pre-enrollment process and has been subsequently involved in enhancement and maintenance of this application. Fazal application handles configuration of new plans, manual & batch enrollment processing for multiple lines of business, and handle interface to multiple external systems.

Medicare plans at UAM are administered using Facets platform. Facets at UAM cater to all complex business process requirements. Facets reporting requirements at UAM primarily focuses on claims, member and provider reporting requirements across all LOB. Capgemini has been facilitating UAM in developing and enhancing various business reports and extract requests using Facets data model.

Responsibilities

Requirement elicitation, gap analysis, design solution

Facilitate and review business complex deliverables

Project delivery & management

Followed Agile principles, practices and values through Scrum

Facilitate Daily Stand-up, Sprint Review, Sprint Retrospective, Sprint and Release planning

Using Jira as Agile tool for maintaining and tracking stories and sprint cycle

Create and maintain relevant metrics that help the team review, measure and plan work on daily basis

Track and report team velocity, Sprint capacity and project status to management

Coaching the development team on scrum practices and process

Worked with the team to have best practices, value innovation, and SDLC processes are implemented

Coordinated dependencies and managed inter-team dependency among teams

Protected the team from distractions by removing impediments at all levels of management and business

Facilitate team in process improvement and value innovation

Impart training on Medicare, Facets and Facets data model

Medicare and Facets SPOC for offshore team

Project: US Healthcare Pre-Sales

Duration: Jan 2014 till December 2015

Role: Pre-Sales Lead

Responsibilities:

RFI/RFP Analysis

RFP solution design

Collaborate with stake holders

Resource & Pricing Estimation

Participate in yearly GTM (Go To Market) strategy meet

Prepare Brochures, Playbook, Capability Deck, Case Studies, Elevator Pitch, Email Flyers, Value Proposition

Complete ownership (Plan, Design, Development, Implementation, Maintenance) of GTM solutions

Conduct domain and initiative trainings at organizational level across business accounts

Proposal preparation & client presentation

Project: Facets Configuration

Client: Universal American

Duration: August 2010 till Dec 2013

Type: Configuration

Role: Configuration Analyst, Project Manager

Facets configuration project involved analysis, configuration and testing of different benefit plans, provider agreements, providers, members and various different business rules set by the business requirements, CMS guidelines and periodic notifications. Claims processing played a vital role in testing all the different scenarios of configuration. The project involved extensive use of Facets Data model and different third party applications such as EncoderPro and Trailblazer.

Responsibilities:

Requirement elicitation, Gap Analysis, Design solution and Estimation

Configuration and testing of benefit plans (HMO, PPO & PFFS) & Networx Agreement

Configuration and testing of various different modules like Application Support, Claims, Provider, Member, Fee Schedule and Workflow modules

Generate backend reports using Sybase / SQL Server

Project delivery and management

Impart process improvement and value innovation

Impart training on Medicare, Facets modules and Facets Data Model

Project: Member Health Applications

Client: Member Health

Duration: June 2009 till July 2010

Type: Development & Enhancement

Role: Web Development Manager

Member Health provides prescription benefits for Medicare, including one of the most popular Medicare Part D Plans, Community CCRxSM in US. This engagement involved execution of various projects from offshore which were implemented at onshore by Member Health IT team. The projects included web development, SQL package implementation and QA. It involved setting up of different teams at offshore for various projects.

Responsibilities:

Project planning

Resource planning and Project Scheduling

Requirement elicitation, gap analysis, design solution

Estimation

Onshore-Offshore coordination

Project Delivery

Functional SME

Project: UAM ADM Services

Client: Universal American

Type: Development & Enhancement

Duration: Feb 2009 till May 2009

Role: Web Development Manager

This project encompassed various projects implemented at onshore by UAM IT development team. They included .Net web development, SSIS SQL package implementation and business reporting services. It involved setting up of different teams at offshore for various projects.

Responsibilities:

Project planning

Resource planning and Project Scheduling

Requirement elicitation, gap analysis, design solution

Onshore-Offshore coordination

Project Delivery

Functional SME

Project: PnL Expense Portal

Client: Universal American

Duration: June 2008 to Jan 2009

Type: Development

Role: Web Development Manager

PLIC agents, unlike other Insurance Companies within UAM use the Net Taxation model for P&L determination. UAM staff used EAS to enter expenses and used a paper trail mechanism to keep track of receipts. Their existing process involves lot of efforts and manual work, ownership was more on UAM rather than Offices. This project addresses the re-engineering aspects of the existing business process and provides for streamlining mechanisms with adequate checks and balances.

Responsibilities:

Requirement elicitation, gap analysis, design solution

Prepare business requirement documents

Build functional specifications from BRD

Building process flow & use case diagrams

UAT test cases

Application Design

Project planning

Resource planning and Project Scheduling

Project Delivery

End User Training

Technical and Functional support to the team

Project: InstaInsure

Client: ICICI Prudential Life Insurance Company

Duration: Jan 2008 to June 2008

Type: Development

Role: Business Analyst

ICICI Prudential Life Insurance Company is a joint venture between ICICI Bank - one of India's foremost financial services companies-and prudential plc - a leading international financial services group headquartered in the United Kingdom. They have been the leading private life insurer in India offering Life, Retirement and Health Insurance plans. InstaInsure was one of their pioneer project through which ICICI Prudential, implemented the concept of instant buying of health insurance online.

Responsibilities:

Requirement elicitation, gap analysis, design solution

Prepare business requirement documents

Build functional specifications from BRD

Building process flow and use case diagrams

UAT test cases

End User training

Functional support to the team

Project: Lotus Apps Conversion

Client: Universal American

Duration: Jan 2007 to Dec 2007

Type: Development

Role: Project Lead & Business Analyst

The project involved migration of existing Lotus Notes applications to MOSS 2007 and .Net 2.0. The applications were re-designed to ensure all the functionality present in Lotus Apps is captured. The new applications were designed as web based intranet applications and were made accessible cross-domain along with single sign-on feature was implemented. User security module was designed and integrated with applications, which provided features to assign adequate rights to the business users.

Responsibilities:

Requirement elicitation, gap analysis, design solution

Prepare BRD and FSD

Build process flow diagrams

Application Design & Development

Development & Testing

Project Delivery

Technical and Functional support to the team

Project: Subscribe 2000

Duration: April 2003 to Dec 2006

Client: Room Solutions

Type: Enhancement & Maintenance

Role: Project Lead & OSC

Subscribe 2000 is a comprehensive insurance underwriting system designed in a generic manner to support multiple insurance markets. Targeted specifically at Lloyd’s and Company’s market supporting full policy life cycle. Subscribe 2000 has been developed as a series of interoperable modules. Each of the core modules like Policy, Reinsurance, EDI Message Control, Signings, Claims, Event Aggregation, Credit Control, Statistics, Business Diary, Management Reporting, and Adhoc Reporting has been designed to address a discrete set of functional requirements.

Responsibilities:

Requirement elicitation, gap analysis, design solution

Building process flow and use case diagrams

Development & Testing

Project Delivery

Technical and Functional support to the team

Schmuc Software Pvt Ltd May 2000 – Apr 2003

Software Engineer

Project: Hospital Management System

Client: Applehealth, Universal ICCU

This software maintains a detailed current status of patients admitted, containing day to day as well as time to time treatment given to the patients, and applicable charges. It also consists of inventory feature, which gives a time to time alert regarding status of medicine present in stock and report generation regarding sales of medicine and a detailed billing feature for the medicines taken by the patient and treatment meted out to the patient. It gives a detailed break up of billing, surgical details, certificates, doctors (consultant and referral doctors) payment along with breakup of their payment, and reporting feature.

Project: Customized Query Builder

Client: DRI

Software: Delphi 5, Oracle 9i

This software helps build customized queries. The clients data are huge in record number, so they are using this interface to build customized views which saves them lot of time and helps them to view the refined data, whose structure (query) are prepared by the user. After a view is built, that particular view can reloaded into the interface, and more filtering can be done on the saved view, after obtaining a satisfied result set, that particular view can be saved. OLAP feature help client builds data cube, after which he can even have a graphical view of the built cube.

Project: Software for Panache Exports

Client: Panache Exports

Panache Exports is a jewelry export company, they are into exporting of diamond and gold jewelry to U.S and U.K. The software development was done for reducing the paper work and making detailed sheets of various types of products, along with the updating report regarding the stages of manufacturing and also maintaining the stock of there raw materials.

Project: www.houseofpanache.com

Client: Panache Exports

This site was developed for the customers of the client, where in the customer can browse through the different set of jewelry offered by the client and can even place order for diamond jewelry online.

Project: www.krisia.com

Client: Krisia Tours and Travels.

It's a site where the travel agents can book for hotel, apartment, package or sightseeing. This site consists of around 50,000 hotels, 200 apartments, 800 packages and 900 sightseeing in different parts of the globe.

Project: www.neuindia.com

Client: Neuindia.

It's a site designed for people in homeopathy. This site provides a list of articles and first aid information about homeopathy and also with the list of products in the homeopathy along with the description of the product and the usage of them. It also provides with a list of homeopathy doctors in India. Also the dealers can place order for homeopathic products online.

Certifications

HIA (Health Insurance Associate)

PAHM (Professional, Academy of Healthcare Management)

MHP (Managed Healthcare Professional)

HCSA (Healthcare Customer Service Associate)

CSM (Certified Scrum Master)

Awards

Certificate of Excellence for implementation of Smart Minds initiative at business account level

VCA (Valuable Contribution Award) for UAM ADM Services project

VCA (Valuable Contribution Award) for Lotus Apps Conversion project

VIC (Value Innovation Certificate) for “Auto Scrum Validation” using Kaizen technique

VIC (Value Innovation Certificate) for “Facets Data Dictionary” using Kaizen technique

VIC (Value Innovation Certificate) for “Facets Benefit Summary Consolidation” using Kaizen technique

VIC (Value Innovation Certificate) for “SPCR Qualifier Groups Review” using Kaizen technique

Education

Bachelor of Engineering: Mumbai University

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