Nilesh Kharche

Client Name – Humana Inc.

Project Description:

• The project scope primarily involved supporting operations for various enrollment functions, such as the intake of member data in a specific format from the vendor to the Humana system, member data processing and validations, along with downstream feeds to areas like billing, claims processing, ODS, EDW, etc.

Roles and Responsibilities:

• Single point of contact at the client location for all critical operations issues in the Automated Enrollment Application. Led a 7-member team that includes both onshore and offshore members.
• Represented the team on triage calls for high-priority tickets and collaborated with related applications teams to analyze the root cause, workarounds, and provide a permanent resolution for the issue.
• Managed internal work allocations aligned to business priority.
• Identified redundant and manual processes in the application and instituted automation techniques, which reduced manual work and increased workflow efficiency.
• Responsible for creating status reports, including application availability and KPIs, and presenting them to client leadership and business.
• Analyzed high CPU-consuming jobs and provided recommendations for performance improvement and MIPS reduction.

Client Name – Anthem Inc.

Project Description:

• Project scope involved various modernization initiatives and maintenance projects for claim processing and adjudication application (WGS-Claims).
• The modernization initiative's scope included platform consolidation for claims adjudication applications distributed across various markets to a target modernized platform.
• Claims SSCR's maintenance team was formed to provide a quick turnaround for business-critical, small enhancement requests from the claims processing and adjudication area.

Roles and Responsibilities:

• Worked as the mainframe onshore lead on the modernization project for the ITS Home and Host process, and SSCR (small enhancement project).
• Involved in requirement analysis, function/technical design, development, enhancement, unit testing, debugging, and implementation using COBOL, JCL, IMS, DB2, sort utilities, IBM Debug Utilities, and ChangeMan.
• Knowledge transfer to the offshore team with business functionality and new requirements.
• Resolved the defect identified and logged in JIRA while SIT and UAT were completed within the timeframe.
• Involved in monthly release activities during the implementation of the project and worked with the business for post-production validation.
• Responsible for preparing and presenting the status report for the project to the client and business stakeholders.

Client Name: Humana, Inc.

Project Description:

• The project scope involved multiple development, maintenance, and support projects for various processes like.
• Physician payment and accounting processes, claim payment, claims expense, capitation calculation, capitation payment, and reconciliation.

Roles and Responsibilities:

• Worked as the mainframe onshore lead in the service fund application. Led a team of up to seven team members, which includes onshore and offshore.
• Involved in requirement analysis, function/technical design, development, enhancement, unit testing, debugging, and implementation using COBOL, CICS, JCL, IDMS, DB2, sort utilities, EZYTRIVE, stored procedure, Xpeditor, REXX, ISPW, and Topaz Workbench tool.
• Worked on a major project as a technology migration project, IDMS to DB2 migration, and claim expansion project from 9 bytes to 11 bytes.
• Service Fund plays a major role in a number of physician payment and accounting processes, including claim payment, claims expense, capitation calculation, capitation payment, and reconciliation.
• Developed TSO utilities using REXX in the system to increase workflow efficiency.
• Analyzed high CPU-consuming jobs and provided recommendations for performance improvement and MIPS reduction.

Client Name: Humana Inc.

Project Description:

• The project scope involved multiple development, maintenance, and support projects for various processes like.
• Physician payment and accounting processes, claim payment, claims expense, capitation calculation, capitation payment, and reconciliation.

Roles and Responsibilities:

• Worked as the mainframe production support in the service fund application.
• Involved in requirement analysis, function/technical design, development, enhancement, unit testing, debugging, and implementation using COBOL, CICS, JCL, IDMS, DB2, sort utilities, EZYTRIVE, stored procedure, Xpeditor, REXX, ISPW, and Topaz Workbench tool.
• Analyzed high CPU-consuming jobs and provided recommendations for performance improvement and MIPS reduction.
• Production job monitoring and resolution of abends within SLA.