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Kotesh - Pega CSSA

[email protected]

Location: Bedford, Virginia, USA

Relocation: Yes

Visa: H1B

Kotesh 469 598 1989 Profile 10+ Years of IT industry experience worked as a Pega Senior Developer in the areas of design, development, testing, Have close to 6 years of experience in PEGA Practices , certified as CSSA. Proficient in requirements gathering, specification writing, enhancement/problem analysis, problem resolution, coding, testing and full life cycle of migration and implementation. Good hands on experience in implementation of Declarative Processing features - Expressions, Constraints, On Change, Decision Rules like Decision Table, Decision Map etc. Extensive debugging skills in PRPC using TRACER, Clipboard, and Rule Inspector Designed PRPC flows, Assignment, utilities, Decision, Spin-off and Split- Join shapes. Well-versed in PRPC flows, interpretation of all Flow Shapes Expertise in PRPC integration services Rule-Connectors and Rule-Services, activity creation, validate Rule Types such as Rule-Obj-Validate, Rule-Edit-Validate Worked on Agents, SLA, and UI rules Expertise in developing User Interfaces, screen layout using Harness, Section. Extensive familiarity in Decision, Process, Technical, SysAdmin Categories of rules Experience in Creating Decision Rules like Decision Tree, Decision Table, Map Value and When Condition, activities, edit input, Obj-validations Thoroughly worked on reporting wizard, list view, summary view, activities, Obj-Validation. Work exposure on Integration (SOAP, REST, SQL) with PRPC. Good communication skills, interpersonal skills, self-motivated, quick learner, team player. Certifications: PEGA Certified Senior System Architect PRPC PEGA Certified System Architect PRPC Skill Set PEGA: Expertise in PEGA PRPC V8.4,V7.2, V7.1, V6.2, JAVA/J2EEE Application Server Apache Tomcat 5.5/6.0, Web Sphere Databases Oracle9i, MySQL, PostgreSQL Operating Systems Microsoft Windows, macOS, Linux CentOS/ RHEL6, , OS/400 Methodologies Agile, Scrum, Design Patterns AS/400: Languages : RPG/400, ILE-RPG, SQLRPG, CLLE, CLP. ILE free format, SYNON, Core Java DBMS : DB2/400, QUERY/400 Operating System : OS/400, Windows 98, XP Tools : Jira, SDA, ALDON, ABSTRACT, ROBOT, HPSM, HPQC,SYNON, BIX,Splunk Other Skills : MQ Series, Tivoli Workload Scheduler, XML parsing, Web Services, HTML-5. Domain Knowledge : Healthcare PBM(RxCLAIM) , Manufacturing, Telecom Education: Master of Computer Applications, Osmania University. Bachelor of Computer Science, Nagarjuna University. Professional Experience: Anthem Inc., Norfolk, VA Pega Sr. Developer. March 2020 - Till Date Anthem, Inc . is an American health insurance company founded in the 1940s, prior to 2014 known as wellpoint, inc. It is the largest for-profit managed health care company in the Blue Cross and Blue Shield Association. It handles huge amount of provider data though applications SPS and PLM. FUSE - To have a stable and scalable scalable tool that aggregates all OHI inventory into one system that allows for automated assignment, optimize timely processing and KPI/metric tracking to assist OHI in achieving the yearly cost avoidance financial goals, serve our members timely and enhanced the user experience. FUSE is an inventory management system created for the OHI team to monitor and complete inventory, reduce duplicative efforts, process work more efficiently, and attain metrics necessary for continuous process improvement. PLM- Provider Lifecycle Management. From Anthem perspective, a Provider is an entity that renders a medical service for our members. This includes Physicians, nurse practitioners, physician assistants, medical groups, hospitals, clinics, diagnostic labs, ambulance services. PLM manages all change requests for provider data by creating work objects and routing to appropriate associates. SPS - Strategic Provider Solutions. SPS provides single source of truth for provider administration with standardized UI across all markets Increased automation throughout the provider life-cycle with workflow and built in data governance and quality rules Streamlined ability for provider self-service. scalable architecture that supports anthem and future growth. clarity of purpose within components that simplify design. Responsibilities: Interacted with Business users to understand expectations and requirements PEGA PRPC Technical design and configuration against documented requirements for the PRPC application. Worked on developing enhancements provided by CMS and maintaining existing PEGA PRPC Applications. Worked on modifying certain Activities to Data Transforms as per PEGA Guardrails. Attended Business meetings to discuss and finalize the CMS PEGA Mandate tasks. Implemented routing logic to newly added stated based on defined criteria. Involved in upgrading List Views to Report Definitions. Involved in skimming the rules to highest ruleset versions. Extensively using Tracer, Clipboard tool and Rule Inspector to perform unit testing during Application development and debugging. Created Agents to automate the weekly basis Reports for Work Managers. Worked on modifying and adding new Word Templates to PEGA upon Business request. Involved in CMS Retention Plan Meetings with Product Owners and helped them in providing Data Definitions. Involved in redesigning the existing flow by adding new Flow Actions, Sections, SLA and Correspondences. Automated the Letter delivery functionality to the Providers which improved the productivity of the Work Users. Environment: PRPC V 8.4, Oracle 10g, Web LOGIC Delta Dental of Alpharetta GA Pega Sr. Developer. Dec 2017 Feb 2020 Senior PEGA Developer Description: Onyx is the current system used for management of group sales, RFP proposal initiation and implementations, group contracts and ongoing service management, renewal and benefit change management. Sales opportunity forecasting and activities are being managed offline. Delta Dental is planning for retiring existing onyx system by replacing with a new CRM application which will address the scalability, feasibility and workflow management functionality. Meta Vance (MTV) is the core business platform to execute the day to day insurance business functions. Systems like EFS, RMB, HRMS, Gamma, EIVR, EMA, formworks and other reporting tools are used to support the Delta Dental business. The main objective of this application is to have operational efficiency in sales process and P2E application is broadly classified into three phases i.e., Pre-Sale to Quote(P2Q), Quote to Sale (Q2S) and Sale to Enrollee(S2E) and is implemented both on Pega and SFDC. Responsibilities: Involved in business meetings for requirements translation. SPOC for pega team at client location and responsible for deliverables and support of application. Good understanding of enterprise class structure and application rule set stack. System design and estimates Designed and implemented complex user interfaces using Sections, Harness and HTML stream rules. Designing and implementing integration components using SOAP service between Pega and OSR, REST service between Pega and Salesforce. Creation of SDLC artifacts Functional specifications document, detailed design document, Test Plans. Involved in resolving production issues. Analyze and fix the defects in Jira. Implemented many Enhancement Change Requests (CR s) within the Project. Testing and debugging using Clipboard, tracer and rules inspector, Agent trace. Administration activities like creation of Access Groups, operator IDs, rule set versioning and locking, taking wraps and importing on QA machines for Quality Assurance. Created product rules and migrated zip files from development to QA, UAT & monitored Performance regularly. Environment: PRPC v7.1.6, Oracle 10g, Web LOGIC KIRANAM TECHNOLOGIES : CVS Caremark, Richardson, TX CVS Health Inc. Jun 2016 Dec 2017 CVS Health (previously CVS Corporation and CVS Caremark Corporation) is an American retail pharmacy and health care company headquartered in Woonsocket, Rhode Island. CVS Caremark provides comprehensive prescription benefit management services including mail order pharmacy services, specialty pharmacy and infusion services, plan design and administration, formulary management and claims processing. The company s clients are primarily employers, insurance companies, unions, government employee groups, health plans, Managed Medicaid plans and other sponsors of health benefit plans and individuals throughout the United States. Project # PAS (Prior Authorization System) Duplicate Check Description: The Prior Authorization System (PAS) is used to process member and provider requests for a member to receive a medication that is not on the member s formulary. Prior Authorizations can be initiated by a member or by a provider. Currently, issues are encountered when a user enters a new case and does not merge the cases when a duplicate case is found. There is no way for the system to catch these duplicate cases after the fact. Not catching these duplicate cases results in inappropriate reopening, incorrect denials, and missed turnaround times. This change is for adding measures to the PAS system to prevent incorrectly processed redeterminations by catching duplicate cases as they are entered. Incorrectly processed redeterminations may result in Medicare Corrective Action Plans up to and including sanctions Responsibilities: Interacted with Business users to understand expectations and requirements PEGA PRPC Technical design and configuration against documented requirements for the PRPC application. Generated List and Summary reports and enabled security levels on the reports so that particular access group can view them Created Rules for Validation, Integration rules like Rule-RDB-SQL using methods like OBJ Save, OBJ Open, RDB List, Creation of Work Objects, assigned to Operators Developed Portals, Gadgets as per the client's requirement created simple to complex Activities using page-new, page-copy, page-merge-into, properties-set etc. Involved in the SOAP service for the service Request and WSDL deployment Performed integration by developing rules pertained to rule-connect and rule-service. Major tasks involved integrating with SQL databases to fetch data and with SOAP/ Web services to review particular data Involved in making changes and adding new parameters to the already existing Functions Created the File Listeners to copy the XML files from a shared location to temporary folders Used the TRACER to examine the rules and to minimize the execution time Performance test of all activities and rules using PRPC-PAL Tool. Participated extensively in designing application security which involves setting up Access groups, Access Roles, Operators, Application ID, Org Divisions, Org Units and Work groups Extensively worked on writing activities for Validations and Error Handling. Involved in conducting Unit testing, Regression testing, Integration testing, System testing Performance testing and End-to-End testing Prepared Technical and Conceptual Design documentation and Estimation hours for the modules Involved in Bug Fixing Activities for Harness, Declare Expression and When Rules NetCracker Tech. , Orlando Florida System Analyst May, 2013 Jun 2016 NetCracker Technology is the proven partner for communications service providers and cable operators, offering comprehensive, end-to- end BSS, OSS, and Enterprise Applications supported by extensive delivery capabilities to optimize their business Roles and Responsibilities: Principal responsibility will be ensuring nightly and billing and month end processing is completed per established service level agreements for all clients. The Production Control Analyst will be the first level (Tier 1) contact for problems encountered within the customer batch cycles. Providing the problem analysis and escalation to the ICOMS Support Team for any issues encountered within the batch cycles. Should be able to support in shifts on 24/7 basis. Worked on Network Inventory Management(NIM) maintenance. Having effective and efficient communication under stressful environment. Worked on Telephony module and NIM system . Responsible for executing, monitoring, troubleshooting and reporting on production jobs. Critical processes based on shift checklists and clearly defined procedures and policies. Respond to the Production group and Sev1 group support tickets, which are assigned to the Technical Services team. Monitor and execute trouble escalation procedures in support of core data center support systems. Execute and monitor EOD, EOW and EOM production job streams in support of company s primary applications. Monitor and execute trouble escalation procedures in support of core operating processes and applications. Takes the ownership and responsibility of cases while escalating whenever appropriate. Demonstrates the ability to work flexible hours, alternate shifts and the ability to carry a pager as required by support team. Environment: OS/400, RPG400, RPGLE, ILE, Free-format, COBOL/400, CL/400, CLLE, DB2/400, SQL, SQL/400, XML, PDM, SEU, DFU, SDA, EZVIEW, WRKQRY, ROBOT, Job scheduler, Web Services, Change Managements software s too - ALDON. Web Desk for ticketing tool. QC for defect tracking tool. PCR for any emergency fixes. Keywords: quality analyst user interface message queue information technology Georgia Idaho Texas Virginia