Rajesh Ramachandran

IT Senior Project Manager-Lead Consultant with immense expertise in Healthcare payor Line Of Business across Group enrollments, Medicare, Medicaid & Individual plans of CVSHealth-Aetna. Experienced in HCB business process for Quoting and Rating domains, Plan sponsors/benefit configurations, Eligibility domains, Billing applications, Fulfillment products and various reporting domains. Currently performing role of scrum intake lead and lead consultant for GROUP ELIGIBILITY business area with team size of 35+ members span across US, Offshore-India and Canada locations. Proficient in implementing Large programs, various non conventional tool solutions-process at Aetna to resolve various business/IT needs. Production implemented critical initiatives includes system changes for New business, compliance requirements, business acquisitions and mergers, application modernization initiatives, Strategic digital initiatives and so on.

• Experienced in both waterfall & safe agile project lifecycles.
• Certified Scaled SAFe 4 Agilist professional.
• IBM Mainframe trainings and certifications at Cognizant Technology Solutions, India

I485/AOS In-progress(EB3)

GreenCard EAD Approved

CVS Health/Aetna: ADA Engagement In Group Business Domain [04/2008-Till date]

Roles and Responsibilities

· Performing role of scrum intake lead, vendor lead consultant and subject matter expert in the Group business domain

· Leading vendor teams of size 29+ offshore associates, 4+ US associates and 2 canada associates

· Performing project intake activities, planning and execution of various IT projects. Includes E2E test planning & schedule production releases with no code overlaps

· Production release support and design test automation initiatives in the engaged domain

· Contracting & proposal activities with customer/Aetna for the OSV model(T&M and FB contracts)

· Experienced in both Agile & waterfall SDLC methodologies

Environment: COBOL, CICS, DB2, IDMS, JCL, Midrange UNIX systems, Java web applications, Secured PCI boxes etc.

Tools: RFT, RQM, RRC, RTC, Jenkins, QTP, Quality center, ClearQuest, ClearCase, Non conventional tool solutions etc.

Client Description: CVS Health-Aetna is one of the nation's leaders in health care business, dental, pharmacy, group life, disability, long-term care insurance and employee benefit provider. Aetna provides health benefits to US populations through employers/individual business/Medicare/Medicaid across 50 states, with products and services uniquely designed for its small group, middle market, and National account employers. Aetna serves more than fortune 1000+ companies than any of its competitors. The company also serves individual, Medicare & Medicaid beneficiaries in certain markets. Aetna is a diversified health and well-being company that provides broad spectrum of products and services.

Project Description: Enhancements and Maintenance activities for Group business Member Enrollment Applications in Mainframe architectural ecosystem - Massive computing platform

MEA is the main business engine that supports the Member Book of Record and the Operational Data Store (ODS). The application supports the enrollment, maintenance, and termination of traditional members as well as relationships between Member and Plan data. MEA supports membership across National Accounts, Middle Market, Small Group and Individual.An individual who is enrolled in one of Payor products and/or services is referred as Member. The Member Book of Record is the enrollment database, the single source of enrollment information. Member Enrollment Application (MEA) deals with the member enrollment into Payor systems, subscribed to traditional products. Enrollments are performed in two modes, Batch and Real time/online enrollments. Both batch and online processes share the functional services to perform the enrollments. During this enrollment process, the functional service interact with other domains like plan, provider/network.

The Primary functionality of the MEA enrollment system is the Member Management. This system feeds the membership data to all downstream in need, like fulfillment and letter processing, capitation, claims, billing and sales & marketing, vendor applications, RXSY,affiliates, datawarehouse/EDW apps etc.

Professional reference will be shared upon request!!