Sangeetha Karthik

• Functional Analyst for Clinical Compensation
• Business Analyst CAGE team maintaining Backlog, includes creation of stories after collaborating with cross functional teams
• Primary SPOC to maintain and conduct UAT

orked with Business and Vendor Payroll teams to complete critical testing on 3 work items impacting payroll process to ensure pay cycle for Physicians was not impacted

• Worked on all Support UAT items
• Streamline, map and documentation of CAR(Contract Action Request) process
• MAP(Management Approval Plan) for ShiftFees project that included analytics, budget, objectives, focus area, OKR’s Objective & Key Resources, charter and ROI
• CR (Change Request) management.

• Lead & completed 3 projects under 'Stop the Call' program initiative in HPO Business Transformation
• Current state for Provider Calls mapping and worked on solutions which included standardization and enhance IVR capabilities resulting in improved provider experience
• Simplification of Letters Phase 2 communication sent to members
• Re-architect core content, using simple design and plain language to produce lean, clear, and consistent communications
• 80 letters from Enrollment and Communication system were simplified, outcome of the project is to standardize communication sent to members from Highmark and improve NPS
• As a PM worked with cross functional team across the like Copy Writing, legal, Compliance, Governance to ensure all complexities are taken into consideration
• Provided direction and coaching to vendor analyst (copy writer) and other team members during the course of the project to ensure timely and within budget complete of the project
• Executed the project within the approved budget and managed all risks entailed
• Quick Response Code (QR) for ACA markets invoices
• Worked on implementation of QR code on monthly invoices sent to members across Highmark legacy plans for ACA markets, this project is an industry standard requirement and providing self service tools for members to pay their invoices online using functionality
• 2 % of members in ACA currently use QR codes as an option to pay their invoices which is a potential saving of 250 k per annum due to reduction in member calls for paying invoices
• Coordination of Benefits (COB)
• Functional owner for COB migration to new myHighmark app, working closely with Digital Product Owner team to provide requirements and criteria for the addition of the functionality which supports automation of COB info to OPIS (Other Party Insurance)
• Postcard campaign to capture missing COB information from members, outcome was to help reduce the # of rejected claims improving member satisfaction and reduction in call volumes.

• Successfully built and managed backlog for Scrum team and completed phase 1 of CAMUNDA project building Kakfa timers, API’s and endpoints for autofill of prescriptions
• PIPE (Program Initiative Planning Event) participation and preparation
• Worked with the teams through all phases in SDLC
• Responsible for the Release Management lifecycle that involves stages such as scheduling the release, coordinating between teams, and deployment of release as per the schedule and budget
• Liaison between Scrum team and Design teams to build front end /customer facing functions
• Daily Stand Up’s with Scrum team to understand impediments and hurdles or celebrate achievements
• De-comp sessions with Business Product Owners for backlog creation and As Is process mapping
• Backlog creation and maintenance
• Prioritization of user stories with PO to ensure the requirements are meet
• Grooming Sessions with Scrum team to effort size user stories in the backlog
• Sprint planning to understand workload and total effort points that could be work on in the Sprint.

• Project Manager for transition of legacy system to SNOW (ServiceNow) ITBM to manage Workflows for subsidiary unit that provides care management, employee wellness, and decision support
• Successful implementation implementation of workflows for Telecom, HR and IT teams to SNOW (ServiceNow)
• Meeting and Interviews to understand requirements from Business Process Owners
• Develop User Stories based on the requirements
• Scope discussions and implementation strategies
• Liaison between Development and QA team during the entire development process
• Pre UAT testing and bugs management
• Project Manager for Elixir Clinical Business Systems (PBM) to establish a cloud-based application for their paper-based tracking system across 7 departments
• Team Charter worked with Program manager to form the team and identify Key business partners
• Scope discussions and phase wise approach of project launch
• User License procurement which included obtaining financial approvals and project sponsor by in’s
• Offshore Vendor resource allocation meetings with Account manager and Vendor partners
• Pre Project meetings with Legal department approvals
• Communication, set up regular rhythm for meetings with Cross functional teams to share updates and mitigate risk
• Completion of Requirements gathering and interviews from 4 departments.

• Scrum Master for development of Brand and Expanded Management
• Co Product Owner for Item Issues – Customer Solutions
• Co Product owner and Scrum Master for development of Payment Review – Finance process for Leasing Orders
• Business Analysis and Requirements for Install Network.

• Implementation of LSV.ARBCBS Migration project with significant ROI.

• Successful completion of Medicaid carve out project for West Virginia Family Health Members
• Roll out of Clinical Quality Feedback Loop for Medicare & Medicaid providers within Gateway Health Plan’s provider portal (accessible via NaviNet), channel of communication between Gateway Health Plan provider partners and Gateway Health Plan
• One of those communication channels is through Clinical Quality Feedback an added feature to the “Quality Information “section on provider portal site
• This function allows providers to submit clinical data documented in the member’s medical record to supplement what does not appear in Gateway Health Plan claims data
• Functional Owner for Service Now, Encounters and EOB (Explanation of Benefits) processes for implementation to new Vendor for Pharmacy Benefits Management process and responsible for the overall.

• Functional Owner for finance module for CRM implementation and responsible for the overall development of the modules, training, and testing of the function across GE Healthcare Surgery
• Implementation of CoQ tool Oracle ERP which reduced CoQ in the business by $ 40 MM per annum
• Change management across all locations globally
• Completed Lean Projects and Automations to eliminate NVA (Non Value Added) activities, CAP Workout, LEAN, Kaizen & Rapid Process Improvement Facilitator
• Improved Cycle Time for Collectors by incorporating Internal Monitoring tools & Collection Codes which impacted productivity and increased collections by $ 32 M for 3Q 2009
• Recognized by Call Center Director for taking highest number of calls during 2Q’01
• Pivotal Role in the integration of the Service Dispatch and Customer Service teams for GEHC Clinical Systems Call Ctrs and Parts Inventory for DI and showed a Business Impact of $ 1 MM during their 2033 Physical Inventory
• Super User and part of the Siebel Implementation at GEHC Clinical Systems; worked closely with the IT and Services team to provide design requirements and specification for Install Base project in Siebel that helped timely Implementation of the Software
• Team Manager for 14 FTE’s Customer Loyalty Process.