Veeresh Godabanahal Lokappa
South Lyon,MI
Summary
Dynamic Technical Consultant with proven track record at Health Alliance Plan, specializing in FACETS and PBM integrations. Expert in requirements analysis and cross-functional leadership, successfully designed scalable solutions that enhanced operational efficiency and minimized vendor dependency, delivering over 45 major initiatives within 30 months.
Overview
20
20
years of professional experience
Work History
Technical Consultant
Health Alliance Plan
04.2025 - Current
- Implemented PBM Carve-Out Integration: Led the end-to-end design and implementation of a Pharmacy Benefit Manager (PBM) carve-out arrangement by establishing automated data transfers between HAP and carve-out vendors. The solution is designed to be scalable to other vendors with no/minimum changes with detailed analysis and solution design for sharing Rx data, medical accumulators, and claims, ensuring seamless coordination across systems and improving data accuracy and operational efficiency.
- Designed and implemented the PBM Carve-Out Integration, enabling scalable automated data exchange for Rx data, medical accumulators, and claims—significantly improving operational accuracy and reducing vendor dependency.
- Automated retroactive eligibility-based claims reprocessing, eliminating manual intervention through a mass-adjustment solution that enhances benefit accuracy and reduces turnaround time.
- Designed data integration workflows, automated inbound/outbound interfaces, with complex pre-processing validations, and ensuring accurate, secure, and timely data transmission.
- Led requirements elicitation, solution design, and stakeholder reviews to ensure alignment with business goals.
- Conducted requirements elicitation and analysis of functional/business requirements, preparing business requirement documents and facilitating review meetings with customers.
- Collaborated with cross-functional teams to gather and analyze requirements, ensuring solutions aligned with business objectives and addressing stakeholder needs.
- Developed and maintained project plans, timelines, and budgets, updating executive stakeholders on progress and ensuring alignment with project goals.
- Partnered with cross-functional teams to deliver reliable, efficient interface and reporting solutions.
System Analyst Lead
Accenture
01.2012 - Current
- HAP is federally qualified and licensed Health Plan operating in state of Michigan and is a subsidiary of the Henry Ford Health System and providing all aspects of health plan operations and services: Quality care, credentialing, member rights and responsibilities, medical records, utilization management, and preventive health care.
- Collaborated with client SMEs and key business users to understand end-to-end business processes and deliver solutions within defined timelines.
- Facilitated communication between business teams and technical developers to ensure accurate interpretation of requirements and alignment.
- Coordinated cross-functional teams within Accenture to deliver comprehensive solutions addressing client needs.
- Analyzed industry trends and business directions to propose value-added solutions and strategic enhancements addressing client needs.
- Documented detailed business and functional requirements; created functional design documents, process flows, design diagrams, and defined functional test cases.
- Performed gap analysis—including As-Is vs. To-Be assessments—and produced future-state business process documents for validation.
- Developed functional specifications across Claims, Membership, PBM, Providers, Capitation, Billing/Accounting, and related business areas.
- Created business use cases, mapped requirements to SRS documents, prepared test plans, executed test scripts in Facets, and supported Go-Live activities.
- Managed end-to-end requirements traceability and tracked requirement status throughout the project lifecycle.
- Provided knowledge transfer to technical and QA teams by creating comprehensive test cases, supplying accurate test data, and conducting domain training sessions.
- Analyzed existing Oracle stored procedures to interpret current-state logic and translate it into future-state business requirements.
- Ensured proper functional flow by consistently communicating with development and testing teams.
- Coordinated daily with offshore teams, managing task assignments and delivery timelines.
- Produced weekly dashboard reports for stakeholders, enhancing visibility into project progress, risks, and performance metrics.
- Worked cross-functionally with business and technical teams to deliver high-quality, effective solutions aligned with project goals.
Client Engagement Delivery Manager – Interfaces and Report
BCBS MI
09.2022 - 04.2025
- Led a team of senior Facets system analysts delivering end-to-end solutions for enterprise interfaces and reporting needs across the organization.
- Solution Design with architecting and leading end-to-end interface solutions that integrate external vendor systems with enterprise healthcare platforms such as FACETS and QNXT. Skilled in designing scalable data pipelines, developing automated inbound/outbound data flows, and ensuring accurate, secure, and compliant data exchange across diverse vendor networks.
- Led the design, development, and governance of interfaces to integrate external vendor data into enterprise healthcare systems. Led cross-functional teams to deliver automated solutions, enhancing data integration and reliability.
- Optimized ETL processes, performing comprehensive pre-processing validations, resolving complex data discrepancies, and enhancing overall interoperability with Proven ability to lead cross-functional teams, streamline vendor onboarding, and deliver reliable, audit-ready integration solutions that improve efficiency and operational performance across the organization.
- Streamlined vendor onboarding and integration processes, ensuring interoperability between internal platforms and third-party systems.
- Conducted system analysis, provided support, and managed implementation of interfaces and reporting requirements.
- Delivered 45+ major initiatives in 30 months, consistently exceeding client expectations.
- Established best-practice frameworks for system development, documentation, quality assurance, and agile execution.
- Led systems analysts in designing, developing, and implementing new systems and enhancements, supporting critical business operations.
- Develop and maintain project plans, timelines, budgets, and communicate progress to executive stakeholders.
- Managing and guiding team on requirement Elicitation, Analysis of the functional/business requirements and preparing Business requirement document and conduct review meetings with the customers.
- Worked with business partners and architects to collaborate to research existing business and system processes and propose system/application solutions to formulate effective solutions based on business requirements.
- Implemented Smart's integration, supporting vendor-driven pharmacy coupon programs to improve member affordability and benefit transparency.
- Architected a scalable monetization model for Buy-Up programs, enabling ASC customers to pay based on value-added services adopted.
IT Lead Applications System Analyst/ Lead Business Analyst/ Lead Product owner
Henry Ford Health System
08.2015 - 09.2022
- Led enterprise solutions across accumulators, benefits, EOBs, IVR benefits, PEGA workflows, member portals, Salesforce (Quote-to-Card), and interoperability platforms.
- Defined product vision and strategy for benefits configuration, collaborating with cross-functional teams to build benefit packages and long-term roadmaps.
- Guided teams in requirement gathering, solution design, and documentation best practices to align system capabilities with business goals.
- Led requirement elicitation and stakeholder discussions; authored Business Requirement Documents (BRDs) and facilitated review sessions to ensure clarity of functional/business needs.
- Created functional specifications and designed custom enhancements to bridge gaps between application capabilities and business requirements across multiple domains.
- Analyzed issues related to accumulators, benefits, EOBs, and IVR benefits.
- Understand and analyze the functional/business requirements for system support and able to translate them into appropriate systems/application specifications.
- Translated business and operational requirements into detailed system specifications for development, configuration, and support teams.
- Played a key role in product upgrades including impact assessments, change-pack analysis, and coordination to ensure smooth transitions during upgrade cycles.
- Designed and implemented icehouse solutions for Medicare EOBs, Commercial EOBs, and custom accumulator transfers to enhance compliance and operational efficiency.
- Designed and delivered custom solutions to resolve complex accumulator issues driven by intricate benefit rules, ensuring accuracy across medical and pharmacy benefits.
- Interpreted CMS guidelines and managed multiple CMS audit universes (ODAG, DMR, SARAG, ODR), creating detailed data-mapping and compliance documentation.
- Working with respective teams to set a vision and strategy for product and benefit offerings and strategy planning for benefits packages and its roadmap and working with configuration team to build the benefits.
Lead Business Analyst
Accenture
03.2011 - 11.2011
- Supported the Build a Better WellPoint (BABW) initiative aimed at identifying overpaid claims and automating overpayment recovery. Developed detection logic and database programs to identify bulk overpayments and validated results across FACETS, WGS, and STAR platforms.
- Gathered and documented project requirements and specifications in alignment with full SDLC processes.
- Collaborated with client and Accenture SMEs to capture business rules for new and enhanced analytical queries.
- Designed, developed, and executed complex SQL queries against enterprise data warehouses for data mapping, validation, and ad-hoc analysis.
- Delivered design documentation to development teams and provided guidance during build and unit-testing phases.
- Executed system test scripts and validated outputs, preparing test result summaries to ensure query accuracy.
- Coordinated and supported User Acceptance Testing (UAT) with client and Accenture teams.
- Conducted data-driven analyses to optimize claims identification logic and support audit and testing activities.
- Calculated and forecasted overpayment recovery savings, presenting insights to leadership teams to inform decision-making.
- Participated in testing of the Member Portal application, including requirements analysis and ad-hoc reporting from backend portal data.
- Scheduled, extracted, and distributed daily operational and leadership reports.
- Collaborated with business users, developers, QA teams, and onsite/offshore resources to ensure successful delivery.
- Reviewed SRS documents prepared by peers and junior analysts for quality and clarity, ensuring alignment with project standards.
- Translated business requirements into detailed use cases, activity diagrams, state models, and workflow documentation.
- Created process flow, use case, class, and interaction diagrams to represent complex business processes.
- Defined and executed functional test cases within FACETS; logged defects and tracked issue resolutions.
- Ensured compatibility testing across platforms, operating systems, network environments, and integrated systems.
Facets Business Analyst/ Test Team Lead
Accenture
05.2010 - 11.2010
- Lovelace offers a full portfolio of managed care plans, providing insurance coverage for more than 190,000 people in communities across New Mexico. Our health plans cover more than 2,000 employer groups and thousands of Medicare-eligible individuals and their families with access to a large, continually expanding network of doctors and health care centers, as well as a full range of benefits.
- Served as senior team member for FACETS interface and reports SIT team. Conducted requirements gathering, analysis, and system integration testing for inbound and outbound interfaces and reports across claims, enrollment, finance, provider, and customer service modules in Facets.
- Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
- Served as an expert in claims data analysis and provided analytic consultation to other business areas, leadership, and external customers.
- Managed defect process from offshore, triaged defect calls, and tracked defects through various statuses.
- Performed SME review of test case documents and provided inputs/comments on changes.
- Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
- Developed SQL statements and stored procedures in Oracle to extract and write data.
- Worked as a Point of liaison between business and development/testing teams.
- Analyze data and summarize utilization and profitability performance using summary statistical procedures.
- Ensured effective communication with developers to address modifications and requirements, monitoring revisions throughout the process.
Report Developer and Business Analyst
Computer Science Corporation (CSC)
03.2008 - 04.2010
- Blue Cross and/or Blue Shield insurance companies are franchisees, independent of the association, offering insurance plans within defined regions under one or both associations’ brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every US state. They also act as administrators of Medicare in many states or regions of the U.S. and regularly can be found providing group coverage to state government employees, as well as the U.S. Federal government under a nationwide option of the Federal Employees Health Benefit Plan (FEHBP) established by the association on their behalf.
- BCBS RI was migrating from their current legacy system to package application solution. TriZetto’s flagship product Facets is the chosen solution by BCBS RI. This project involved migration of the existing system to Facets. Reporting and Integration activities are part of the implementation process.
- Requirement Analysis, Design, implementation and testing the Reports and Letters using Crystal Reports and Sybase for a FACETS migration Project.
- Led reports development team in project tasks, tracking efforts and reporting project status to ensure alignment with objectives.
- Analyzing and understanding the requirement and the mapping documents and analyze the Facets database and write the stored procedure to match the requirement and Business rules.
- Experience in creating LLD, Unit Test Cases to match the requirement and develop reports using Crystal Reports adopting the standards and perform Unit/ System testing.
- Conducting Walk through with the onsite teams in analyzing the requirements.
- Trained and Guided the Teams efficiently during the project tenure.
- Mentoring and guiding the junior team members.
- Prepared release notes and the release build after reviewing the code to assure functionality and coding standards.
- Conducted JAD sessions to synchronize stakeholder objectives, providing developers with a clear understanding of project requirements.
- Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
- Managed various tests, stored test information, reviewed and analyzed test results.
- Presented Q/A test results and analysis to stakeholders and users, documenting modifications and requirements for clarity and accountability.
Interface Developer/Onsite Coordinator
Computer Science Corporation (CSC)
01.2006 - 03.2009
- Executed analysis, design, implementation, and testing phases for over 100 interfaces across Membership, Claims, Provider, and other QNXT modules.
- Designed and developed interfaces and reports, conducted unit testing, and provided system integration support as a business analyst and onshore coordinator for the interface development of the QNXT migration project for the Health Alliance client.
- The work involved is in enhancing the application previously developed in AS400\MC400 to .Net using C# as front-end language and SQL Server 2005 as database for Health Alliance client. The Interface loads the Vendor data into QNXT and Extracting data from the QNXT and generating extract files for various vendors involved in the business. Integration is a continuous scheduled load and extracts process. Major modules covered as part of Interfaces and Reports are Membership, CCMS, Claims, Plan/Product, and Providers.
- Collected user requirements for new reports via JAD/JAR sessions, eliminating duplicate and obsolete data to ensure a uniform reporting environment across multiple trading desks.
- Facilitated requirement gathering and analysis, supporting analysts in business changes through brainstorming sessions and participation in daily status calls and leadership meetings.
- Analyze and work with stakeholders to prioritize application defects/enhancements and participate in developing a change management process
- Prepared and maintained System Rules Spreadsheets (SRS) identifying Rules, Triggers and corresponding data fields from Legacy to target application.
- Provided support to the testing team during system integration testing.
Education
Master of Technology (MTech) - Computer Application in Industrial Drives
Visvesvaraya Technological University
Karnataka, IndiaBachelor of Engineering (BE) - Electronics and Communication
Visvesvaraya Technological University
Karnataka, IndiaSkills
- FACETS
- QNXT
- Jira
- ServiceNow
- HP QC
- RequisitePro
- Visio
- Oracle
- SQL Server
- Sybase
- MS Access
- Crystal Reports
- Cognos
- Power BI
- Windows
- MacOS
- VSS
- SharePoint
- Enterprise Solution Design
- Process Optimization
- Operational Efficiency
- Claims
- Accumulators
- PBM Integrations
- Eligibility
- Cross-Functional Leadership
- Stakeholder Management
- Requirements Analysis
- BRD
- FRD
- JAD Sessions
- Agile
- Waterfall
- SDLC
- RUP
- Interfaces
- Database Analysis
- Vendor Management
- Training
- Mentoring
- Team Leadership
References
Available upon request
Timeline
Technical Consultant
Health Alliance Plan
04.2025 - Current
Client Engagement Delivery Manager – Interfaces and Report
BCBS MI
09.2022 - 04.2025
IT Lead Applications System Analyst/ Lead Business Analyst/ Lead Product owner
Henry Ford Health System
08.2015 - 09.2022
System Analyst Lead
Accenture
01.2012 - Current
Lead Business Analyst
Accenture
03.2011 - 11.2011
Facets Business Analyst/ Test Team Lead
Accenture
05.2010 - 11.2010
Report Developer and Business Analyst
Computer Science Corporation (CSC)
03.2008 - 04.2010
Interface Developer/Onsite Coordinator
Computer Science Corporation (CSC)
01.2006 - 03.2009
Master of Technology (MTech) - Computer Application in Industrial Drives
Visvesvaraya Technological University
Bachelor of Engineering (BE) - Electronics and Communication
Visvesvaraya Technological University