Ajay Chandra
Blaine,MN
Summary
Accomplished Technical Lead and Technical PM with over 30 years of experience in steering software development projects and enhancing business processes. Specializing in the healthcare sector for more than 18 years, adept at managing multiple projects while ensuring collaboration between technical and non-technical stakeholders. Demonstrated expertise in full software development life cycle (SDLC) management, including business analysis, requirements gathering, system design, testing, UAT, implementation, and ongoing maintenance. Committed to driving innovation and efficiency within organizations.
Strong technical foundation in software development, including DevOps, Mainframe, PL/SQL, Unix shell scripting, COBOL II, Natural, and various other tools. Skilled in Agile methodologies and Rational Unified Process (RUP), with expertise in risk management, data modeling, and mapping. In-depth knowledge of the healthcare industry, particularly Medicare and Medicaid, with a focus on benefits, eligibility, claims, enrollment, and fulfillment processes.
Experienced in Pharmacy Benefit Management (PBM), integrating contact center systems to create a complete member view across enrollment, eligibility, claims, and fulfillment. Hands-on experience with adjudication engines such as AMISYS, COSMOS, NICE, RxExpress, and RxCLAIMS.
Overview
32
32
years of professional experience
Work History
Project Lead/Technical Lead
Ucare
Minneapolis, MN
06.2013 - Current
- Managed and led clinical process upgrade projects from initiation to successful completion.
- Collaborated with cross-functional teams, including clinical, IT, legal, and finance, to ensure alignment of project scope and objectives.
- Engineered and maintained Amisys surround code along with user exit functionalities employing COBOL, PL/SQL, and Oracle within Unix platforms.
- Experienced in managing payer data workflows and processing claims with efficiency, overseeing institutional and professional provider claims.
- Proficient in creating and managing EDI files such as 837 claim status files for institutional and professional claims, 834 Enrollment files, and 835 Remittance advice files.
- Managed project schedules and finances to deliver high-quality outcomes on time.
- Proficient in managing various encounters, including CMS RAPS and MDH.
- Collaborated with Express Scripts to manage the communication of enrollment and eligibility files, accumulators, and pharmacy claims.
- Led a team of 4-8 professionals, providing mentorship, support, and performance feedback.
- Ensured project compliance with healthcare regulations, including HIPAA, FDA, and other industry standards.
- Analyzed data from multiple sources to identify trends and inform decision-making processes.
- Drove continuous improvement in project delivery by providing strong leadership and guidance.
Lead Systems Analyst
Prime Therapeutics
Minneapolis, MN
06.2011 - 11.2013
- As a Lead systems Analyst, gathered, analyzed, designed, and documented requirements for Language translation project, multiple quarterly release, Member Level Benefits and Mail Uplift project
- Managed projects involving Medicare PARTD and commercial members.
- Created comprehensive web service requirements supporting the integration of ePostRx and contact center software.
- Used SOAPUI to test Web services
- Developed B2B documentation.
- Skilled in utilizing Rational Unified Process (RUP) methodologies.
- Led the implementation of key projects at Prime Therapeutics, including contact center application enhancements, Prime Reporter improvements, language translation initiatives, and the PrimeMail Uplift—RxExpress migration to ePostRx. Managed projects related to procure-to-pay applications, reporting and analytics, and inventory and finance integration with ePostRx. Additionally, spearheaded the 2014 Call Letter enhancement for RxClaims and individual market (IVL) enhancements for the grace period.
Business Systems Consultant
Ovations
Minneapolis, MN
04.2007 - 06.2011
- Gathered, designed, and documented requirements for multiple web projects as a Business Systems Consultant.
- Developed AARP partnered, united brand, and secure horizon branded sites.
- Integrated the web portal with the contact center application (GPS), implemented a drug cost estimator, and facilitated formulary database integration. Managed the integration of the pharmacy finder, view plan pricing tool, and several other initiatives, including call-to-activate and click-to-call applications.
- Developed web projects encompassing PARTD benefits, claims, broker commissions, fulfillment, billing and enrollment applications.
- Utilized RUP methodology alongside Rational Tools Suite for planning, developing, and deploying iterative releases.
- Experienced in optimizing processes through thorough software application lifecycle management.
Technical Lead
Ameriprise Financial
Minneapolis, MN
01.2006 - 04.2007
- Led effort to gather, design, and estimate requirements.
- Developed process flow and data flow diagrams.
- Created BSAR, BSDR, and BSTR documentation.
- Coordinated with Wells Fargo, Mellon, JPM Chase, Bank of America East, American Express, and Cenveo to transition NDM file transfers to an MFT solution.
- Installed and configured ConnectDirect with SecurePlus for MS Windows applications.
Tech Lead/Lead Business Systems Analyst
Unified Judicial System
SD
09.2004 - 12.2005
- Served as Technical lead for the Centralized Intake Juvenile Detention and Tracking System, managing the full project lifecycle from inception to completion, including requirements gathering, design, estimation, prototyping, implementation, testing, and quality assurance.
- Created use cases, user experience designs, and programming specification documents.
- Developed a web application using VB.NET.
Project Lead / Systems Analyst / PM
New York City Taxi and Limousine Commission
New York City, NY
01.2003 - 09.2004
- As Project Lead / Systems Analyst, was involved in full system life cycle from ground up, including Requirements Gathering, Design, Estimation, Prototyping, Implementation, Testing, and Quality Assurance
- Created Use Cases, User Experience, and Programming specification document
- Developed ASP.Net Web pages for Image Capture, Inquiry, and Update functions
- Developed project proposal to convert applications to a Client Server based, TCP/IP Intranet/Internet technology
- Proposal included porting of natural screens to ASP.Net Web page Applications
Project Lead / Systems Analyst / PM
New York City Board of Election
New York, NY
06.2001 - 01.2003
- Company Overview: New York City Board of Elections conducted elections for the City of New York
- System-Elect project involved Analysis, Design, and Testing of the System-Elect application
- New York City Board of Elections conducted elections for the City of New York
Data Analyst
PepsiCo
Somers, NY
11.2000 - 01.2002
- National Accounts Customer Master File / Customer Information System project involved Data Mapping between the legacy ADABAS database to Oracle 8 database, extracting data from legacy system, and loading Oracle database one time
Consultant
New York City Board of Elections
New York, NY
04.1999 - 11.2000
- Electronic Paper Tally/Electronic Print Interface project involved automating the process of manual keying of different ballot information into Encore
Consultant
New York City Health and Hospital Corporation
New York, NY
12.1998 - 04.1999
- Computerized Online Budget and Report Analysis project involved converting all OS/VS Cobol programs to VS Cobol II and making Payroll system Y2K compliant
Consultant
Jaguar Cars
Mahwah, NJ
06.1998 - 11.1998
- Interfaced with SMEs to prepare BPR documents for ongoing projects
- Prepared business process models; used Visio to create use case diagrams
Consultant
Fingerhut Companies
MN
08.1997 - 05.1998
- As a Consultant, was involved in Analysis, Coding, and Testing for the Y2K project for Order Entry and order reporting systems
Programmer
Sparelli Daphine, Inc.
London, England
06.1996 - 01.1997
- Inventory Management Information system served as an efficient Inventory Control system
- It included Purchase and Sales systems
Systems Programmer
Artel Systems Pvt. Ltd.
03.1993 - 06.1996
- Accounting Information Management system involved Coding and Testing for a 20th century Finance Corporation, an Investment and Insurance company located in London, and consisted of Members Deposit (MD), Vehicle Loan (VL) and House Loan (HL) systems
Education
Bachelor of Engineering - Computer Science
Mysore University
Skills
- ServiceNow
- Crystal Reports
- Team track
- Use Cases
- Flow Charts
- Visual InterDev
- Dreamweaver MX
- FireWorks MX
- Infragistics Web Controls
- Flash
- MS SourceSafe
- Visio
- TSO/ISPF
- VSAM
- CICS
- Focus
- SuperC
- File Aid
- Xpediter
- CSS
- Test Director
- LoadRunner
- BEA ALBPM 60 Modeling
- PL/SQL
- UNIX shell scripting
- ASPNet
- C#
- VBNet
- VisualStudioNet
- Java
- JavaScript
- VBScript
- MS Visual Basic 60
- HTML
- XML
- VS Cobol II
- Oracle
- DB2
- MS Access
- MS SQL Server
Timeline
Project Lead/Technical Lead
Ucare
06.2013 - Current
Lead Systems Analyst
Prime Therapeutics
06.2011 - 11.2013
Business Systems Consultant
Ovations
04.2007 - 06.2011
Technical Lead
Ameriprise Financial
01.2006 - 04.2007
Tech Lead/Lead Business Systems Analyst
Unified Judicial System
09.2004 - 12.2005
Project Lead / Systems Analyst / PM
New York City Taxi and Limousine Commission
01.2003 - 09.2004
Project Lead / Systems Analyst / PM
New York City Board of Election
06.2001 - 01.2003
Data Analyst
PepsiCo
11.2000 - 01.2002
Consultant
New York City Board of Elections
04.1999 - 11.2000
Consultant
New York City Health and Hospital Corporation
12.1998 - 04.1999
Consultant
Jaguar Cars
06.1998 - 11.1998
Consultant
Fingerhut Companies
08.1997 - 05.1998
Programmer
Sparelli Daphine, Inc.
06.1996 - 01.1997
Systems Programmer
Artel Systems Pvt. Ltd.
03.1993 - 06.1996
Bachelor of Engineering - Computer Science
Mysore University