ALEKHYA POTTURI

Project Description:

Enterprise pricing service is a claim processing application built on top of PEGA Smart Claim Engine (SCE). Various internal applications (PEDRO, PYSL, MRC, EPS) work in tandem to acquire necessary information, validate and process the received claims. A processed claim is then either reimbursed with eligible amount or rejected to the health care provider

Project Description:

Enterprise pricing service is a claim processing application built on top of PEGA Smart Claim Engine (SCE). Various internal applications (PEDRO, PYSL, MRC, EPS) work in tandem to acquire necessary information, validate and process the received claims. A processed claim is then either reimbursed with eligible amount or rejected to the health care provider

Project Description : Apollo - Intervention & Prevention

Apollo is an integrated platform for Intervention (Call Center app) and Prevention (Participant Portal) programs aimed at helping millions of participants improve their health; and as a result, bringing down costs for health care companies, employers and state departments that purchase this solution.

Project Description: Prior Authorization & Appeal, UHC

An appeal is a special kind of complaint an insured can make if the plan declines to cover prescribed drugs or refuses to pay for drugs you've already received or if the plan decides to stop covering drugs you're currently receiving. The appeal process is a specific process that must be followed to ensure the complaint is reviewed appropriately and accurately.

Project Description: Customer Inquiry Application, Bank of New York Mellon

Customer Inquiry Application (CIA) investigates issues/exceptions in Funds Transfer, Multi Currency, and Trade transactions. The platform runs on Pegaworks, legacy C++ Client Server technology and it is to be replaced with Pega RULES Process Commander and its Smart Investigate framework.