Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Gopan Pillai

Charlotte,USA

Summary

Dynamic Data Analytics Manager with a proven track record at AmeriHealth Caritas, specializing in SQL Server and Azure Databricks. Expert in driving HEDIS modernization and data governance initiatives, while fostering stakeholder engagement. Passionate about optimizing processes and delivering impactful data insights that enhance health plan quality for millions.

Overview

21
21
years of professional experience
1
1
Certification

Work History

Data Analytics Manager

AmeriHealth Caritas
Charlotte, USA
03.2021 - Current
  • Led the planning and delivery of HEDIS analytics projects and strategic initiatives within the Health Plan Quality department for 30 lines of business, catering to 10 million lives across Medicaid, Medicare, and Exchange product lines.
  • Directed strategic HEDIS modernization for migrating data from on-prem Oracle and MS SQL HEDIS platforms to an Azure cloud-based solution from the HEDIS business team.
  • Established and directed data governance framework for HEDIS data ingestion into internal repository and transfer to external vendor systems, generating cost savings for Pay for Performance measures.
  • Collaborated with Quality leadership and Market Presidents across LOBs to design analytics dashboards utilizing Tableau / Power BI, generating data insights including REL Dashboard, Impact from supplemental sources and ROI, Telehealth Dashboard, Rate Report for organization-wide data initiatives.
  • Advocated for HEDIS Business team regarding data challenges and discussions with Market leaders to uncover new opportunities for data enhancement
  • Detected deficiencies in data processes and documentation, executing measures to bridge those gaps and record steps for future utilization.
  • Experience managing diverse data for Medicaid, Medicare, DSNP, MMPs, and Exchange Lines of Business
  • Cultivate, guide, and oversee continuous growth of team of Sr Analysts and Programmers for design, development, and execution of data analytics projects.
  • Facilitate ETL pipeline development for seamless ingestion of large data sets into SQL repository
  • Orchestrated integration of clinical data from EHR systems employing CCDs and FHIR resources into HEDIS repository
  • Formulated and instituted data-driven solutions optimizing operational efficiencies and curtailing costs.
  • Served as liaison for HEDIS team in various external audits each year for NCQA and State Regulatory reporting on Data Ingestion, transformation, and Integration to HEDIS Repository.
  • Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.

TriZetto Program Manager

Cognizant
Charlotte, USA
09.2016 - 03.2021
  • Directed team of Product Managers, HEDIS SMEs, and Data Analysts collaborating with Quality Management team to achieve HEDIS and STARS objectives for reporting year
  • Conceptualized and formulated strategies for HEDIS health care product development while customizing solutions for diverse markets and clients in collaboration with internal partners.
  • Utilized expertise in Stars Analytics for crafting performance improvement plan aimed at boosting HEDIS and Non-HEDIS Stars Measures
  • Developed and executed strategic initiatives to enhance business development efforts.
    Coordinated industry events and conferences to bolster brand presence and networking opportunities.
  • Provided marketing support to optimize lead generation and sales outreach.
    Facilitated pre-sales processes to streamline client engagement and conversion rates.
  • Executed over 50 RFPs and demonstrations for diverse clients.
  • Strong understanding of comprehensive Prospective and Retrospective Workflows from Data Intake, Measure Generation, Rate Reconciliation for Admin and Hybrid Measures through Medical Records Project, CAHPS & QHP Sample Frames
  • Oversee relationship with Medical Record Retrieval vendor while monitoring program contracts to ensure compliance with service level agreements.

Delivery Manager

Cognizant
Charlotte, USA
08.2015 - 08.2016
  • Oversaw delivery management for cross-functional Agile team comprising 15 resources across multiple Scrum Teams and technologies
  • Direct project delivery incorporating various technologies like MuleSoft and Talend, in addition to managing technology migration projects for SeeBeyond and IBM Integration Bus.
  • Cultivated relationships with key business stakeholders while managing customer escalations.
  • Manage multiple RFPs and execute contracts for product business development with new customers utilizing system and domain expertise
  • Facilitated team development while ensuring accountability for commitments and removing work roadblocks.
    Leveraged organizational resources to enhance project capacity.
    Mentored and developed team members to improve skills and performance.

IT Project Manager

Cognizant
Charlotte, USA
02.2012 - 08.2015
  • Offshore Development Manager, responsible for end-to-end delivery of customer projects
  • Scope, schedule, budget management, status reporting to various stakeholders
  • Requirement & change control management

Senior Application Developer

Cognizant
Charlotte, USA
08.2004 - 02.2012
  • Offshore Dev Lead, responsible for end-to-end project delivery
  • Coach and mentor new resources in the application and health care domain
  • Involved in Migration project which involved migration from Unisys mainframe to IBM Mainframe

Education

Bachelor of Technology - Electrical and Electronics

University of Calicut
India

Skills

  • SQL Server and Azure Databricks
  • Data visualization: Tableau and Power BI
  • ETL processes and data integration
  • Snowflake and Hadoop
  • Data governance and compliance
  • Data analytics and visualization
  • Project management
  • HEDIS and health plan quality
  • Cloud migration strategies
  • Data analysis techniques
  • Stakeholder engagement
  • Process optimization

Certification

  • Project Management (PMP)
  • Professional Scrum Master (PSM I)
  • Advanced Project Management Certificate on Mastering Integrated Programs by Stanford
  • ITIL Foundation

Timeline

Data Analytics Manager

AmeriHealth Caritas
03.2021 - Current

TriZetto Program Manager

Cognizant
09.2016 - 03.2021

Delivery Manager

Cognizant
08.2015 - 08.2016

IT Project Manager

Cognizant
02.2012 - 08.2015

Senior Application Developer

Cognizant
08.2004 - 02.2012

Bachelor of Technology - Electrical and Electronics

University of Calicut

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Gopan Pillai