Arvind Balachandar
North Atlanta,GA
Summary
With over 20 years of experience in the IT industry, 17 of which have been focused on healthcare, I am well-equipped to apply my expertise as a Delivery Owner/Solutions Engineer in the healthcare sector. My aim is to contribute towards the development of innovative healthcare solutions that enhance patient outcomes.
Overview
20
20
years of professional experience
Work History
Solutions Engineer Advisor Sr
Elevance Health
07.2018 - Current
- Company Overview: Previously Anthem Inc.
- Worked as the delivery owner for an AI LLM based solution using business knowledge procedures that can effectively try to reduce the manual processing required on the claims.
- Worked as a delivery lead for building a system where the claims can be checked for errors and to send realtime 277CA notifications back to the providers thereby reducing the manual review required on the claims.
- Designed an advanced AI/ML-based enterprise cognitive platform that utilizes key data points to accurately predict the outcome of claims processing.
- Designed a web-based tool that leverages an existing adjudication engine to calculate member liability in real-time, providing a more accurate estimate for healthcare providers.
- Designed a novel process for electronically requesting additional information from providers for claims without denying them, thus enhancing provider satisfaction.
- Created an electronic explanation of benefits (EOB) by leveraging data available across different platforms, streamlining the process.
- Built and managed a new platform specifically designed for consumer-driven health plans (CDHPs).
- Previously Anthem Inc.
Onshore Project Manager
Cognizant Technology Solutions
08.2010 - 06.2018
- Developed a tool that determines member eligibility across all legacy platforms, streamlining the enrollment process.
- Worked on transitioning and renewing member enrollment for those who migrated from legacy platforms.
- Created a solution for the Application Rationalization program that enables claims processing across different platforms.
- Developed and maintained a new benefit configuration engine that added benefits for 10 additional states to the existing claims processing platform.
- Re-engineered the Coordination of Benefits and Medicare claims processing platform as part of the Health Exchanges program.
- Designed a tool to accurately calculate prompt pay for all covered states.
- Created a new tool to assist the special investigations unit in identifying cases of healthcare Fraud, Waste, and Abuse.
Offshore Project Lead
Cognizant Technology Solutions
03.2009 - 08.2010
- Designed functional and technical solutions and developed applications, including conducting unit testing and providing system testing support.
- Collaborated with onsite teams and engaged in software modeling and simulation, quality assurance and performance tuning activities to ensure the successful delivery of projects.
Offshore Project Lead
Computer Sciences Corporation
03.2008 - 03.2009
- Project Application Development and Production Support.
- Partnered with project team members to identify and quickly address problems.
- Maintained open communication by presenting regular updates on project status to customers.
- Reported regularly to managers on project budget, progress, and technical problems.
- Monitored project progress, identified risks and took corrective action as needed.
- Analyzed project performance data to identify areas of improvement.
Offshore Developer
AIG
06.2005 - 03.2008
- Project Application Development and production support.
Education
Scaled Agile Framework -
SAFE
01.2018
Certified Scrum Master -
Scrum Alliance
01.2017
PHIAS -
Professional Health Insurance Advanced Studies
New Jersey01.2013
HCP -
Healthcare Compliance Professional
01.2013
PAHM -
Professional Academy For Healthcare Management
01.2011
Bachelor of Engineering - Computer Science
Anna University
Chennai, India05.2005
Skills
- COBOL
- JCL
- IMS
- DB2
- MVS/OS390
- Windows
- UNIX
- CA7
- Control-M
- VSAM
- Tablebase
- MS Office
- HP Open View
- Clarity Work Bench
- Remedy
- Clear Quest
- Rational Requisite Pro
- Changeman
- Endeavor
- File-aid
- Expediter
- Abend-aid
- SAR
- CADispatch
- JMR
- IS/IM
- File Manager
- Fault Analyzer
- Debug Tool
- Informatica
- Business process improvement
- Application support
- Project management
- Cross-functional coordination
Personal Information
Nationality: Indian (US Permanent Resident)
Timeline
Solutions Engineer Advisor Sr
Elevance Health
07.2018 - Current
Onshore Project Manager
Cognizant Technology Solutions
08.2010 - 06.2018
Offshore Project Lead
Cognizant Technology Solutions
03.2009 - 08.2010
Offshore Project Lead
Computer Sciences Corporation
03.2008 - 03.2009
Offshore Developer
AIG
06.2005 - 03.2008
Scaled Agile Framework -
SAFE
Certified Scrum Master -
Scrum Alliance
PHIAS -
Professional Health Insurance Advanced Studies
HCP -
Healthcare Compliance Professional
PAHM -
Professional Academy For Healthcare Management
Bachelor of Engineering - Computer Science
Anna University
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