Candidate Information Title Health Insurance Solution Architect Target Location US-FL-Ponte Vedra Beach Email Available with paid plan Phone Available with paid plan	20,000+ Fresh Resumes Monthly     View Phone Numbers     Receive Resume E-mail Alerts     Post Jobs Free     Link your Free Jobs Page     ... and much more Register on Jobvertise Free
Search 2 million Resumes Keywords: City or Zip:	Related Resumes Health Insurance Sales Manager / Assurance Compliance Manager Jacksonville, FL Health Insurance Practical Nurse Gainesville, FL Accounting Manager Health Insurance Jacksonville, FL Solution Manager 4 Hana Jacksonville, FL Customer Service Home Health Jacksonville, FL Mental Health Social Worker Jacksonville, FL Insurance Follow-Up Customer Service Jacksonville, FL

1 of 3Experience in Property & Casualty Insurance domainExperience in the Health Insurance domainInternational (USA, Canada, Belgium, and India) experience in the IT industry, primarily as a Solution ArchitectExperience in Guidewire's InsuranceSuite implementation projects o Leading PolicyCenter configuration tracksConfiguring Suite integration for PolicyCenterManaging teams implementing the Guidewire xCenter interface with legacyExperience in managing Production Support and Application Development teamsExperience working with Global Delivery models like GSC (Guidewire offshore team in Ireland) and System Integrator (Cognizant, EY, PwC) teams in India for Guidewire projects, Syntel/Infosys teams in India for non- Guidewire projectsExtensive experience in architecting and/or implementing projects related to regulatory compliance (ICD-10, FHR(HCR), MLR, Medicare, HIPAA, etc.) and operational excellence.Leadership experience mentoring staff with a diverse backgroundHands-on experience in CICS, VSAM, DB2, COBOL, Object Oriented Analysis, Design & Programming (Java)Very strong in the design and development of business applications. EducationBachelors Degree in Computer Science and Engineering, Mysore University, Karnataka, IndiaUndergraduate course on Principles of Management, Troy University, Alabama, USAPolicyCenter Functional Consultant Certification 7.x, 8.x, 9.x, 10.x - by GuidewireINS-21, INS-22 and INS-23 Certification by AICPCUSun Certified Java 2 Programmer - by Sun MicrosystemsMercator Trading Partner EC (TPEC) Translator trainingHIPAA AS ANSI X12N 4010 Transactions trainingChangeMan - Configuration management tool trainingObject Oriented Analysis & Design TrainingStructured System Analysis & Design TrainingTechnical ExposureHARDWARE - IBM 3090, ES-9000, BULL Mainframe, IBM PCs, HP-9000OPERATING SYSTEMS - MVS/XA, MVS/ESA, MS-DOS, Windows3.1, Windows 95, Windows NT, Unix, GCOSDBMS/ FILE SYSTEM - VSAM, Microsoft Access, Oracle, DB2, Paradox, DM/8TOOLS/TECHNOLOGY/METHODOLOGY -o MAINFRAME - CICS, MQ Series, XPEDITER, GENTRAN, ChangeMan, FileAid, SDF II, InterTest o PC - MS Word, MS Excel, MS PowerPoint, Visio, Word Perfect, Lotus 123 o SDLC - Agile, Waterfallo Others - Rally, JIRA, MS Project, MS Teams, Slack, Primavera, Service CenterLANGUAGE - Gosu, Java, COBOL, Easytreive, REXX, JCL, VBA, TCL, OO COBOL, PL/1, C, Pascal, PALINDUSTRY - P& C / Health Insurance, Retailers, Financial, Marketing Research, Manufacturing Client DetailsVarious - US / Canada - P & C Insurance ClientsCareFirst BCBS, MD - US - Health Insurance PayerUnitrin/ Kemper Auto and Home - US - Auto & Home Insurance CompanyWellPoint Inc - US - Top Health Insurance PayerUmesha Shetty PHONE NUMBER AVAILABLE (CELL)EMAIL AVAILABLE2 of 3Umesha Shetty PHONE NUMBER AVAILABLE(C)EMAIL AVAILABLETarget - US - Retailer - Upscale DiscounterEuroclear / CIMAD - Euroclear - World's premier settlement system- CIMAD - IBM subsidiary (IBM Global Services)IRI, Chicago - US - Market ResearcherGeneral Electric (GE) Appliances - US - Top Appliances Manufacturer Major Mainframe Development AssignmentsFor WellPoint Inco in California (Blue Cross of California, Woodland Hills), managed the Open systems team for a couple of J2EE projects using IBM WebSphere, WSAD, and Sterling Mailbox for EDI Gateway, etc. o in Georgia (Blue Cross Blue Shield of Georgia, Columbus, GA), managed the Mainframe team for nine years continuously for a number of mainframe projects including HIPAA Projects.Sterling Mailbox backend application for EDI Gateway: A Unix-based TCL application integrating the Sterling Mailbox product for receiving HIPAA ANSI transactions from submitters and forwarding them to EDI systems for processing and receiving responses and reports from EDI systems back to submitter mailboxes.Product Database Enhancements and Data Conversion Tool: Product Database is a web application primarily used by business analysts to manage medical products. Business Analysts can maintain product structure, search for products based on a variety of structures, maintain contracts, and interface with the claim processing system.SmartCare:A web application primarily used by customer service representatives (CSR) to answer queries from providers, pharmacies, and members and to perform necessary updates, if applicable.HIPAA Projects:o Was a member of the Syntel HIPAA Strategy team involved in finalizing the strategy and selling HIPAA services to new clients.o Involved in finalizing the strategy and identifying projects for HIPAA AS transactions for BCBSGA. o Responsible for all HIPAA-related activities performed by the Syntel team in BCBSGA. o In addition to direct involvement in following HIPAA projects, responsible for the HIPAA awareness training series for the Syntel team and guiding HIPAA enterprise-wide testing and HIPAA transaction validations.Projects under the HIPAA umbrella include: A CICS real-time EDI gateway capable of accepting ANSI HIPAA transactions 270, 276, and 278 from external entities and returning responses for those requests. EDI Gateway has a built-in validator developed in-house. A CICS application capable of accepting intra-plan ANSI HIPAA transactions 270, 276, and 278 from other Blues via Blue Exchange (A BlueCross BlueShield Association solution for inter-plan transactions) and returning responses for those requests. The application is also capable of sending these transactions to Blue Exchange and accepting the responses. This is implemented as a wrapper over EDI real-time Gateway. A CICS application enabling providers to log in to the client system to interact with a real-time EDI gateway to submit ANSI 270, 276, or 278 HIPAA transactions and retrieve responses for those requests. This is implemented as a mainframe-based human interface to EDI real-time Gateway. An Oracle database designed to keep a log of all inbound and outbound transactions to support customer service and legal requirements. This is implemented to provide logging support EDI real-time Gateway and any other transaction processing systems. A Java application that accepts the request about the status of a claim in ANSI 276 format and returns the response in ANSI 277 format. This serves as a source of information for EDI real-time Gateway, in the case of 277.3 of 3Umesha Shetty PHONE NUMBER AVAILABLE(C)EMAIL AVAILABLE A CICS application that accepts the request about the benefits of a patient in ANSI 270 format and returns the response in ANSI 271 format. This serves as a source of information for EDI real-time Gateway, in the case of 271. A EMPI (Enterprise-wide Master Person Index) solution to handle unique id requirements for employers, members, health plans, and providers.Supporting the EDI business (Gateway and core legacy businesses) for clients since then under an annual renewable multi-million-dollar contract.Q/State:Q/Care had to be customized to meet state of Georgia requirements. Existing claim processing systems(TRACS) data and special features are migrated to the customized product  Q/State. TRACS was mostly a traditional healthcare system. Q/Care had functionality supporting managed-care business needs. We introduced TRACS features like efficient duplicate claim checks, enhanced customer service modules, fix for member accumulation problems, etc. into Q/State. We also reduced the membership enrollment errors to zero from 50%, and improved the batch windows to provide almost 24x7 hours of support.Responsible for completing IT activities as part of a multi-million-dollar outsourcing contract with a client. Our activities include 24x7 support using the Offshore team, regulatory enhancements, HIPAA compliance activities in line with Corporate Initiatives, etc.For Dayton Hudson Operation Center (Minneapolis, MN), analyzed and designed an IS project. Responsible for analysis and design of this project. Involved in executing the process of the project.For Euroclear Operation Center (Belgium), developed an IS project. Responsible for application modeling, DD object modeling, team leading, implementation, and integration testing. Involved in planning and executing processes of the project.For Information Resource Inc. (Chicago, IL), developed/ maintained multiple IS projects. Responsible for knowledge transfer, project management, redesign, testing and implementation programs during the maintenance phase.For General Electric Appliances (Louisville, KY), maintained/ developed multiple projects. Responsible for knowledge transfer, redesign, implementation, and testing. Major Non-Mainframe AssignmentsAs the Guidewire Senior Architect / Consultant worked for many P & C insurance companies in US & Canada, implementing Guidewire PolicyCenter.As the Solution Architect in CareFirst BCBS Maryland, architected solutions for projects related to regulatory compliance (ICD-10, FHR (HCR), MLR, Medicare, HIPAA, etc.As the Engagement Manager for Syntel account in Unitrin Kemper Auto and Home in Florida managed the 2+ million annual revenue account. Responsibilities include sales initiatives, delivery to clients, as well as career management of consultants.As a Programmer, implemented quality systems and tools for Infosys Technologies (Bangalore, India). Involved in standardizing the SDLC phases and developing quality tools.As a Lecturer, tutored students in computer programming theory & lab classes for Bapuji Institute of Engineering & Technology. (Davanagere, Karnataka State, India)