Summary
Overview
Work History
Education
Skills
Projects
Accomplishments
Certification
Timeline
Generic

Pramod Rajula

Hyderabad

Summary

EDI Analyst & AI Product Lead with over 9 years of experience in healthcare EDI. Proven ability to turn complex data and AI technologies into business wins, including automating EDI 834 processes to save over 3,000 hours annually. Known for leading successful pilot projects, troubleshooting critical data challenges, and mentoring high-performing teams. Expert in EDI 834, 835, 837, Power BI, Python, and Generative AI, with a passion for building scalable solutions across functions and geographies.

Overview

9
9
years of professional experience
1
1
Certification

Work History

Data Analyst II

Benefitfocus
Hyderabad
01.2021 - Current
  • Spearheaded process improvements for the EDI 834 validation, creating multiple generative AI-powered Python applications that automated repetitive tasks, and resulted in an annual savings of over 3,000 hours.
  • Coordinated and led the onboarding, training, and mentoring of new data analysts, improving team proficiency, and establishing best practices for EDI 834 file handling.
  • Maintained and enhanced Power BI dashboards to provide real-time visibility into production data services, enabling proactive issue detection and informed decision-making.
  • Partnered with cross-functional teams in Product and Engineering to integrate new clients into production and resolve escalated customer concerns, ensuring smooth and efficient onboarding processes.

Data Analyst I

BCBS Carolina(North & South)
Hyderabad
07.2019 - 12.2020
  • Led the full lifecycle implementation of EDI 835 and 837 transactions, including configuration, testing, and production deployment, for multiple trading partners.
  • Configured and mapped the EDI 835 (5010) specifications and structure within the Cigna claims payment system, ensuring compliance with industry standards and internal business rules.
  • Managed the end-to-end EDI 835 file implementation process, meticulously validating key data elements such as member demographics, claim-level payments (CLP), and adjustment reason codes to ensure accurate and timely payment posting.
  • Drove a comprehensive claims payment system revamp, leading to a significant reduction in overpayments, and an improvement in overall payment accuracy and efficiency.
  • Actively engaged with onshore clients via internal communication platforms to clarify EDI-related concerns, manage expectations, and provide timely updates on issue resolution.

Data Analyst

Benefitfocus
Hyderabad
06.2016 - 01.2019
  • Extracted and transformed member enrollment data (EDI 834) from the internal database, mapping and formatting it to meet trading partner specifications for seamless data exchange.
  • Performed comprehensive validation on inbound and outbound EDI 834 files, analyzing results to ensure data accuracy and compliance with HIPAA, and client-specific business rules.
  • Loaded processed EDI 834 files onto client servers via secure file transfer protocols (SFTP), ensuring timely and accurate member enrollment.
  • Investigated and resolved EDI 834 data discrepancies and errors, collaborating with internal teams and external payers to ensure accurate member eligibility and coverage.
  • Analyzed EDI 834 files to identify and correct data errors (e.g., incorrect member IDs, missing demographic information), reducing rejection rates, and improving data integrity.

Education

Bachelor of Technology - Computer and Science Engineering

Mallareddy College of Engineering- JNTUH

Intermediate -

Royal Junior college

S.S.C -

Viswashanthi High School

Skills

  • Power BI
  • Jira
  • EFT servers (Globalscape)
  • SQL
  • Python

Projects

Benefitfocus is the largest healthcare benefits software provider in USA. Benefitfocus provides powerful cloud-based software, data-driven insights and thoughtfully-designed services, enable employers, insurance brokers and carriers to simplify the complexity of benefits administration and deliver a world-class benefits experience. Benefit focus eExchange is a solution that bridges the integration gap between carrier and employer systems, allowing a seamless exchange of data between the two. Customers use eExchange to consume eligibility and enrollment data from multiple, third-party systems, convert data from one format to another, and manage the flow of employee data between carriers and employers.

Accomplishments

  • Awarded Star of the Quarter, 3 Star of the Month, and 2 Spot Awards for outstanding contributions, demonstrating consistent high performance and impact over a 15-month period (2023–2024).
  • Nominated for the CEO Choice Award and received the AiDE Enabler award for pioneering the effective use of an internal AI tool, which automated key processes and resulted in an annual savings of over 3,000 hours.

Certification

  • Salesforce - Certified AI Associate - Mar 2025
  • Databricks - Generative AI Fundamentals - Apr 2024
  • IBM - Generative AI: Prompt Engineering Basics - Apr 2024
  • Product School - Product Analytics Micro-Certification (PAC)™ - Mar 2024
  • Microsoft Certified: Azure AI Fundamentals - Apr 2023
  • PMI - Certified Associate in Project Management (CAPM) - Nov 2022

Timeline

Data Analyst II

Benefitfocus
01.2021 - Current

Data Analyst I

BCBS Carolina(North & South)
07.2019 - 12.2020

Data Analyst

Benefitfocus
06.2016 - 01.2019

Bachelor of Technology - Computer and Science Engineering

Mallareddy College of Engineering- JNTUH

Intermediate -

Royal Junior college

S.S.C -

Viswashanthi High School

Similar Profiles

CREATE PROFILE
Pramod Rajula