Case Management Health Care
Resume:
Vamsi Lohith Inuganti
Email:*****.****@*****.***
WhatsApp: +1-732-***-****
LinkedIn : vamsilohithinuganti
ABOUT ME
Covering 9+ years of professional experience in the IT Industry, I have involved in roadmaps, leadership, requirements gathering focusing on Pega PRPC and Customer Decision Hub (CDH). I navigate the entire Pega development lifecycle with industry best practices. Across Health Care, Insurance, Telecom, Finance, and Banking domains, I bring a robust foundation in Agile Scrum methodology.
DIGITAL SKILLS
Pega PRPC / PEGA Cloud/Customer Decision Hub (CDH) / Pega constellation/ Pega cosmos/BPM (Business Process Management) / CRM (Customer Relationship Management)/ System Architecture / Rule-based Decisioning / Case Management / UI/UX Design / PEGA Smart BPM/Application Development / JavaScript /XML/Servlets/ SQL developer / Postgres / PEGA Agile Studio/AWS /WebSphere/Oracle/DB2/MS/SQL/Kibana/cloud-based Pega implementations/Grafana
WORKEXPERIENCE
Pega Senior System Architect (CSSA) in Verizon, TX, USA [06/2024 – Till Date]
(Environment, 8.7&8.8)
Case management and BPM processes to enable an Omni customer experience (Post upgrade tracking, journey management, upgrade eligibility, PTP, Change MDN, 5G tracking)
Provides end to end experience, integrating with backend systems to guide the transaction processing in the channel, with pause/resume and tracking to completion. eg: Change MDN - which provides a consistent experience for MDN change across all channels
Provides a guided experience in the channel to complete a transaction process. eg: Promise to Pay, provides agents a guided experience for the collections process
Identify the issues using logs from Kibana and Grafana tools.
Collaborated closely with business stakeholders to comprehend their requirements, crafting decisioning solutions that aligned with the organization's goals and objectives and following SCRUM Development methodology.
Successfully integrated Pega applications with AWS cloud services to leverage scalability, reliability, and security features.
Implemented AWS services such as Amazon S3 for storage, Amazon RDS for database management, and AWS Lambda for serverless computing within Pega applications.
Utilized AWS CloudWatch and Pega Predictive Diagnostic Cloud (PDC) for real-time monitoring, logging, and analysis of application performance metrics.
Designed and implemented scalable and cost-effective cloud solutions on AWS for enterprise applications.
Defined decision strategies and rules for making real-time decisions based on customer data, business policies, and analytical insights. This involved adeptly leveraging Pega's Decision Management capabilities to optimize customer interactions.
Worked hands-on with core decisioning rules such as Actions (Offers), treatments, eligibility/applicability/suitability proposition management, Decision data, contact policies, strategies, campaigns, and simulation.
Pega Senior System Architect (CSSA) in Cigna, TX, USA [07/2022 – 02/2024]
(Environment, 8.6&8.7)
Cigna employs a customer care support application developed using Pega, demonstrating our commitment to enhancing service efficiency. Beyond being a health insurance provider, Cigna positions itself as a dedicated partner in overall health and well-being, available 24/7 to address both physical and mental health needs. I will make health care more affordable by partnering with providers who provide quality, cost-effective care. Our goal is to provide you with comprehensive health care coverage with “no surprises.”
Collaborated closely with business stakeholders to comprehend their requirements, crafting decisioning solutions that aligned with the organization's goals and objectives and following SCRUM Development methodology.
Successfully integrated Pega applications with AWS cloud services to leverage scalability, reliability, and security features.
Utilized AWS CloudWatch and Pega Predictive Diagnostic Cloud (PDC) for real-time monitoring, logging, and analysis of application performance metrics.
Designed and implemented scalable and cost-effective cloud solutions on AWS for enterprise applications.
Defined decision strategies and rules for making real-time decisions based on customer data, business policies, and analytical insights. This involved adeptly leveraging Pega's Decision Management capabilities to optimize customer interactions.
Worked hands-on with core decisioning rules such as Actions (Offers), treatments, eligibility/applicability/suitability proposition management, Decision data, contact policies, strategies, campaigns, and simulation.
Created the decision architecture (Decision/Strategy Logic) that seamlessly integrated with our intricate technical stacks, providing technical leadership on decision architecture and advocating best practices on our Pega platform.
Designed and configured rules, flows, propositions, and decision logic, actively contributing to the effective implementation of decisioning solutions within the organization.
Pega Senior System Architect (CSSA) in Anthem Health Care, TX, USA [07/2020 – 06/2022]
(Environment 7.6&8.4)
Anthem's Compass application, built on Pega, is crucial for National Customer Care in handling GBD calls.
It offers configurable features, suggesting articles related to service cases. Used by the Anthem Service Experience team, Compass is a web-accessible tool for addressing GBD call needs. It enables tasks ranging from address updates to claims research. In case of a failure, the impact is severe: the inability to service GBD calls, potentially leading to financial penalties. Such a failure significantly impacts contractual service levels for all GBD lines of business.
Engineered a sophisticated class structure within PRPC, encompassing class groups and work classes aligned with the organizational hierarchy and following SCRUM Development methodology.
Defined decision strategies and rules for making real-time decisions based on customer data, business policies, and analytical insights. This involved adeptly leveraging Pega's Decision Management capabilities to optimize customer interactions.
Worked hands-on with core decisioning rules such as Actions (Offers), treatments, eligibility/applicability/suitability proposition management, Decision data, contact policies, strategies, campaigns, and simulation.
Created the decision architecture (Decision/Strategy Logic) that seamlessly integrated with our intricate technical stacks, providing technical leadership on decision architecture and advocating best practices on our Pega platform.
Designed and configured rules, flows, propositions, and decision logic, actively contributing to the effective implementation of decisioning solutions within the organization.
Pega Senior System Architect (CSSA) in E-Pragati, (UNDP), Hyderabad, India [12/2018 – 08/2019]
(Environment 7.4)
Pega Knowledge is an enterprise knowledge management application that is part of Pega’s Customer Relationship Management suite of products. It consists of a knowledge portal that provides the tools and capabilities to manage the full life cycle of rich, multimedia knowledge content and the creation and deployment of knowledge self-service and community sites. Pega Knowledge is pre-integrated with Pega Customer Service and related industry solutions, providing simple configuration capabilities to proactively suggest contextual articles with service cases. Pega Knowledge supports organizations that require a knowledge management tool for creating, maintaining, and publishing articles and support for self-service knowledge and community sites.
Created high level Architecture document depicting the interaction with other external systems.
Defined decision strategies and rules for making real-time decisions based on customer data, business policies, and analytical insights. This involved adeptly leveraging Pega's Decision Management capabilities to optimize customer interactions and following SCRUM Development methodology.
Worked hands-on with core decisioning rules such as Actions (Offers), treatments, eligibility/applicability/suitability proposition management, Decision data, contact policies, strategies, campaigns, and simulation.
Created the decision architecture (Decision/Strategy Logic) that seamlessly integrated with our intricate technical stacks, providing technical leadership on decision architecture and advocating best practices on our Pega platform.
Designed and configured rules, flows, propositions, and decision logic, actively contributing to the effective implementation of decisioning solutions within the organization.
Pega System Architect (CSA) in The AA, London, UK [ 05/2017 – 09/2018]
(Environment 7.4)
AA has under invested in IT systems over the last 7 years. Management buy in last year has determined to invest in updating and expanding the business. Several parallel programmers to update all aspects of the AA business lines have been incepted. RIO is effectively what Pega is doing, plus a few changes to surrounding systems. The scope is to replace the existing systems that processes that orchestrate the sales & fulfillment of the Breakdown, Motor Insurance and Home Service products. i.e. the majority of what the AA does. CPM of Insurance is used as the Interaction layer and Claims and IIF layer act as the backbone for the service intent processing for Sales and Mid-term Adjustments.
Created high level Architecture document depicting the interaction with other external systems.
Developed new portal layouts which served new roles in the organization, in addition to the pre-packaged layouts.
Worked hands-on with core decisioning rules such as Actions (Offers), treatments, eligibility/applicability/suitability proposition management, Decision data, contact policies, strategies, campaigns, and simulation.
Created the decision architecture (Decision/Strategy Logic) that seamlessly integrated with our intricate technical stacks, providing technical leadership on decision architecture and advocating best practices on our Pega platform.
Designed and configured rules, flows, propositions, and decision logic, actively contributing to the effective implementation of decisioning solutions within the organization.
Pega System Architect (CSA) in Sedgwick, NJ, USA [ 06/2016 – 04/2017]
(Environment 7.4)
Sedgwick is a project build to address complexity of disability claims, which has been steadily increasing over past couple of years. The changing nature of the disability claims has made these claims much more difficult to adjudicate and manage, such presenting a significant challenge to insurers on how to contain the rising expenses associated with longer claim durations and larger claim pay-outs.
Created the decision architecture (Decision/Strategy Logic) that seamlessly integrated with our intricate technical stacks, providing technical leadership on decision architecture and advocating best practices on our Pega platform.
Defined decision strategies and rules for making real-time decisions based on customer data, business policies, and analytical insights. This involved adeptly leveraging Pega's Decision Management capabilities to optimize customer interactions.
Worked hands-on with core decisioning rules such as Actions (Offers), treatments, eligibility/applicability/suitability proposition management, Decision data, contact policies, strategies, campaigns, and simulation.
Designed and configured rules, flows, propositions, and decision logic, actively contributing to the effective implementation of decisioning solutions within the organization.
Pega Internship - Enhancing Business Process Automation in Hyderabad, India [ 09/ 2015 – 05/ 2016]
In this internship project, participants will delve into the dynamic world of Pega, a leading business process management (BPM) and customer relationship management (CRM) platform. The project aims to provide hands-on experience in designing, developing, and implementing robust business process automation solutions using Pega's suite of tools.
EDUCATION AND Certification
Bachelor in Information Technology
PEGA Certified Decisioning Consultant (CPDC)
PEGA Certified Senior System Architect (CSSA)
PEGA Certified System Architect (CSA)
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