Global New Cards, Balance Transfers

Pega PRPC Technical Lead

Global New Cards(GNA) is a  New Sales application to capture, validate and process new applications for Consumers. The application receives requests from various online resources and on site CCP. The Application perform data, credit  and fraud validations before applying decision by GRE process.

The balance transfer is an additional feature which allows customers to enter balance transfer amount unto 16 BT requests, perform data and fraud validations before taking any decision.

●        Involved in requirements gathering, analysis and design.

●        Involved in design and implementation of fulfillment process for new cards.

●        Involved in creating connectors for Card Assign, Triumph, CAS, EM, CRPS, GRMS systems for Basic and supp applicants.

●        Involved in design and development of eApply dynamic App integration with custom parsing.

●        Involved in design and development CAS Decision, CAS Services, single  payee check process and GRMS services integration for Balance Transfer Process.

●        Created a customized dynamic XML to HTML parser to display on screen for CCP.

Technologies: Web sphere, Smart BPM 7.1.X, Oracle 11g, DB2, UNIX, Windows 7, Data Power

Employer: Multivision

Client Location: Franklin Lakes, NJ

Coverage Management-C360, TPharm Single name

Pega PRPC Technical Lead System Architect

Coverage 360 (C360) is the Pega rewrite of the legacy C++ CMWS (Coverage Management Work Station) application. The coverage management system generates prior authorization for claims if identified as approved case/claim. The process allows to create case, clinical criteria, non-clinical, miscellaneous denial, override approve or denial and submit generated prior authorizations to mainframe. Coverage 360 contains the entire Coverage Review process like creation of case, appeals, reviews etc., Overall Coverage 360 encapsulates the process surrounding authorization of drugs (Clinical or Therapeutic). I have supported BCBS, Premera, United Health Group, Well Point and Government Programs during this time.

●        Involved in Requirements review and LOE

●        Reviewed Use Cases and Code Harvesting to Understand the Requirements

●        Interacting with Legacy CMWS (C++) SMEs to get the Requirements through Code Harvesting and clarifications

●        Followed Agile Methodology to complete the sprints.

●        Managed Off-shore and Onsite teams to meet the deadlines

●        Responsible for design and code reviews

●        Involved in Story Points and estimated the story complexity

●        Lead off-shore team and coordinated with BA, Integration and QA teams

●        Involved in design and development of Declare Pages for managing system settings

●        Involved in design and development of Agents for held cases and Sign of Required Pharmacists

●        Involved in design and development of Services for C360 for  processing auto jobs.

●        Involved in design and development of HTTP-Connectors for calling eligibility services.

●        Involved in design and development of MQ services for consuming Well Point appeals.

●        Extensively involved in Prod Triage, production tickets, defect analysis and fixing

●        Involved in running Pega Tools: PAL, Preflight, DB Trace  for each release and Monitored Pega Logs

●        Responsible to support MCE, CVE and GP client environments.

Technologies: Web sphere, Smart BPM 7.1/6.1 SP2, Oracle 11g, MS-Visio 2007, UNIX, Windows XP, Data Power, Mule, SQL Developer

Employer: Multivision

Client Location: Franklin Lakes, NJ

Order Processing - RDV, BRT Services

Pega PRPC Lead System Architect

Medco is a leading pharmacy benefit manager (PBM), with the nation's largest mail order pharmacy operations. Medco provides pharmacy services for private and public employers, health plans, labor unions, government agencies, and individuals served by Medicare Part D Prescription Drug Plans. To support mail delivery and automate the mail delivery process effectively by checking weather restrictions and user preferences, Medco has chosen Pega PRPC to implement the business rules.

●        Attended Vision meetings, scrum meetings everyday

●        Followed Agile Methodology to complete the sprints.

●        Managed Off-shore and Onsite teams to meet the deadlines

●        Involved in Story Points and estimated the story complexity

●        Designed Visio flows based on use cases.

●        Created HTTP Connectors for get order details, insert protocol, resolve order protocol, get membership details, get drug details, get expedited shipping info, update expedited shipping info, get patient addresses, find patient, get patient preferences, get client profile, get address changes for last x-days, get prescript details..

●        Created SOAP Service to accept requests for address verification.

●        Created Flow, Activities, Decision tables, Collections to support Address verification functionality

●        Created Enterprise framework to validate address and recap the changes made for patients addresses.

●        Created a collection framework to validate addresses for various types of drugs.

Technologies: Web sphere, Smart BPM 6.1 SP2, Oracle 11g, MS-Visio 2007, UNIX, Windows XP, Data Power, CPM HC

Employer: Multivision

Client Location: Manhattan, NY

Price Reporting Platform

Pega PRPC Lead Developer

Platts publishes news, research, commentary, market data and analysis, and more than 9,000 price assessments daily that are widely used as benchmarks in the physical and futures markets. Its products and services include real-time news and price information; end-of-day market data; newsletters and reports; geospatial data and maps; conferences; and a weekly television program broadcast in the US and online.

As part of Platts price assessment and reporting, they have chosen Pega PRPC as BPM and BRE tool to perform the daily workflow operations. The tool was selected to support global/distributed workflow. I have involved in Application Design, User story discussion and distributed event modeling and PRP development using Pega PRPC.

●        Reviewed high level business requirement documents.

●        Captured use cases using DCO

●        Created ECS class structure

●        Provided LOE (effort estimations) for all requirements.

●        Lead the effort for Design and development of global distributed workflow functionality.

●        Lead the effort for Design and implementation of Soft Artisan interaction.

●        Lead the effort for Design and implementation for heards ingestion

●        Lead the effort for Design and implementation for Trader Data for power commodity

●        Created File service for Trader data ingestion

●        Created JMS service for heards ingestion

●        Created Workflows for assessment process.

●        Created HTTP service for workbook interaction

●        Created SOAP connector for custom DB update

●        Involved in replication framework and conflict detect and resolution frameworks.

●        Involved in event framework to code events for distributed workflow

●        Involved in correction and replay workflows

●        Involved in creating basic custom dashboard to display the status of assessments using Weblogic HTTP publish subscribe API.

●        Involved in modification of JMS connector to support sonic order of delivery of messages for data replication.

●        Used PEGA AJAX API in Dashboard implementation to interact with Pega server.

●        Presented POC effort to business users and internal teams.

Technologies: weblogic 10.3, Smart BPM 6.1 SP2, Jquery, AJAX, Oracle 11g, MS-Visio 2007, UNIX, Windows XP, Soft Artisan Excel Writer, Sonic ESB

Client Location: Manhattan, NY

E-Planner / Custom Report Framework

Pega PRPC Lead Developer/Mentor

The client has been providing enrollment management solutions to university admissions offices for over 10 years. The client is one of the first web-based college application providers. The client initial success was based on product innovation that offered colleges a fully web-based solution to their admission administration needs. The client also provides financial assistance for needy to complete their college/school education. To accomplish this client has chosen Pega PRPC to design their user interfaces and interact with various educational financial institutions. We have used Ajax as a part of user interface to make an asynchronous call to pega prpc without refreshing the screens. The system is designed to support 10 million users and 1000 concurrent users at any time.

I have involved in custom report framework; the framework takes data table name parameter and provides available columns in the table. The complete report is displayed with paging based on the selected columns in the previous screen. This report also provides a powerful rich text feature (not the one which pega is using with YUI API) where user can add header pages and insert images, tables, change colors, supports most of the ms word features. The report can be plugged-in to any project and run without any issues. This custom report framework also supports exporting to pdf/word/excel/text reports. It has a print capability for the selected sections. The editor has a variable insertion capability to make template letters. The framework supports displaying selected alternative colors, fonts, header colors, image display and merging rich text as header/footer etc.

●        Reviewed high level requirement document and created a technical design document.

●        Reviewed business rules and created a scope document

●        Involved in installation of PRPC for development and QA environments.

●        Involved in code reviews.

●        Created JavaScript library functions for client validations and prpc interactions.

●        Used HTML JavaScript, CSS, AJAX and JQuery for User Interface animations (sliding, hide/show the sections).

●        Created Screens for E-Planner administrator to input roles and questionnaire using Harness, Section, Flow Actions.

●        Designed Personal info, Family Info, Educational Info, Tests and work experience using HTML, JavaScript, CSS, AJAX, JQuery and Pega JSP Tags.

●        Generated SOAP Connector to send Student information to institutions for financial aid.

●        Generated SOAP Connector to submit Student information to colleges.

●        Involved in Design of class Structures and Properties for E-Planner.

●        Created declarative page to manage configuration data.

●        Creation of Declarative expressions for a value change on the properties.

●        Created E-Planner DB tables on Oracle.

●        Created Admin, Student, Evaluator Portals for user Groups.

●        Created custom report framework to provide dynamic creation of reports and export facility with rich text features.

Technologies: JBOSS 5.1 CE, Pega PRPC 5.5SP1/Smart BPM 6.1 SP2, JQuery, Oracle 10g, MS-Visio 2003, CentOS, Windows XP.

 Quote to Bill 

 Sr.Pega PRPC Developer

CareFirst, Inc. is the not-for-profit, non-stock company affiliates that do business as CareFirst BlueCross BlueShield.  CareFirst is the largest healthcare insurer in the Mid-Atlantic region, serving nearly 3.4 million members. CareFirst is helping its brokers and DBE’s to provide quotes for small business corporations and individuals, CareFirst has developed their own sales process to sell their products to small business groups in Maryland, DC and Virginia jurisdictions. Once group is enrolled the system performs the auto renewal of the groups for the following year. Incase the group is not renewed in auto renewal process; it creates a work object which needs to be renewed manually. CareFirst has developed their own format of PDF forms to fill and submit by Firm Executives. Now CareFirst has decided to automate this service in order to avoid paper based process. CareFirst has chosen to implement this process by using Pega PRPC.

●        Created technical design document  based on business requirement documents

●        Reviewed business rules and created a scope document

●        Created a sales process to capture prospect details and census details using flows, flow action, section and activity rules.

●        Involved in code reviews.

●        Created a Quote process to capture products (Medical/Dental/Vision) and to create a quote sheet PDF.

●        Created XSD document to define the gMAX elements and structure.

●        Implemented DWA to capture beneficiary signature electronically.

●        Generated SOAP Connectors to interact with a J2EE based web service to get the PDF streams for Quotes, Disclaimer and plan Benefits.

●        Integrated PegaRules services with the J2EE environment to generate PDF forms.

●        Involved in Design of class Structures and Properties.

●        Developed Flows and activities in the application

●        Developed JSM service to receive data from TIBCO after data collection on benefit focus system.

●        Developed JMS connector to connect to TIBCO integration bus to send delivery confirmation.

●        Created data table to update configuration elements.

●        Created flows to handle Exceptions in the system.

●        Creation of Declarative expressions for a value change on the properties.

●        Creation of validation rules to implement business logic validation. 

●        Implementation of decision tables to manage product category and BSBS codes

●        Created roles, broker users and portals

Technologies: Web Sphere 6.1, Pega PRPC 5.4SP2, Pega SPM 6.3, Facets 4.3/4.5, Oracle 10g, MS-Visio XP, AIX, Windows XP.

Employer: Multivision

Automated Enrollment – TPM module

Pega PRPC Consultant

The Automated Enrollment is designed and developed to manage the 834 file requests. The 834 is a HIPAA electronic standard eligibility file. The AE (Automated Enrollment) project converts 834 ANSI format to xml format and parse and create the work object. The automated enrollment process checks the request type and member/dependent eligibility for each request and sends response back. The automated enrollment has two other sub modules are called, error handling and group search. The error handling is about exceptions, while checking the eligibility, the system creates a work object and assign to a work basket for manual resolution. The group search is about searching for a group and updating with various parameters.

●        Involved in performance boost of automated enrollment

●        Involved in Group Search Module to design UI screen.

●        Involved in writing SQL scripts to retrieve data from TPM data base.

●        Involved in creating portals for error handling users and group search users.

●        Involved in creating desktop for both application portals to switch between the applications without logging in again.

●        Involved in Design of class Structures and Properties.

●        Developed Flows and activities

●        Created declarative page to manage configuration elements.

●        Created data table to update configuration elements.

●        Created flows to handle Exceptions in the system.

●        Created roles and user portals

Technologies: Web Sphere 6.1, Pega PRPC 5.4SP2, Oracle 10g, MS-Visio XP, AIX, Windows XP.

Perfecting the Risk Management Environment - PRiME