sai kumar

Experienced IT professional having good years of experience in developing and supporting multi layered integrated applications. 8 years of experience in BPM methodologies and hands on experience in implementing and supporting pega applications and their integration with other web-based applications and backend platform mainframe systems. Hands on experience in designing and developing reusable Pega applications from scratch.

-Extensive experience in Health Care/Insurance and Health Care Domains.
-Well versed with Pega delivery in both agile and waterfall models.
-Certified CSA Certified
-Certified CSSA Certified
-Certified Decisioning Architect

Experience:

Centene: St. Louis, MO                                                                                                                  Jul 2024 – Present

Pega Senior System Architect

Project Name: Cen PASS (CLAIMSPATH)

Description: Cen PASS (CLAIMSPATH) is designed to automate the routing and management of Pend/Hold claims from Xcelys, streamline claim distribution for processing, and provide a real-time monitoring tool for tracking activities and inventory efficiently.

Roles & Responsibilities:

• Collaborated in a team of 4 members, focused on enhancements and defect fixes for Pega applications. 
• Developed SQL scripts (SQL statements, Stored Procedures, and Triggers) in Oracle to ensure efficient database persistence. 
• Gathered requirements and collaborated with stakeholders to define Case Management workflows and automation strategies.
• Integrated Pega with external systems via SOAP/REST web services using Connectors/Services and Connect-SQL for seamless data exchange. 
• Created and managed Rule Sets, Access Roles, Access Groups, Operators, and Workbaskets to facilitate proper workflow and access control. 
• Participated in requirement refinement sessions with business teams to ensure clear understanding and accurate requirement analysis. 
• Utilized Pega debugging tools, such as Tracer and Clipboard, to identify and resolve errors during development and defect resolution. 
• Engaged closely with stakeholders to gather requirements and effectively translate them into Pega application features. 
• Actively participated in daily scrum calls and internal team meetings to ensure project progress and alignment. 
• Demonstrated completed functionalities and user stories to the business team for feedback and validation.

Technologies: PRPC v8, Pega Infinity, Oracle

Truviq Systems: Hyderabad, India                                                                                             Dec 2021 – Apr 2024

Pega Senior System Architect

Project: 2

Client: Cigna, NJ, USA(Jun 2022 – Apr 2024)

Project Name: Rxp Specialty

Description: This new application for Specialty replaces part of the Oracle legacy RX Home app, focusing on fulfillment by managing drug dispatch requests and ensuring successful delivery. It encompasses intake for specialty verification, payment and responsibility validation through Clearance, prescription referrals, CRM integration, prescription data management, collections, and pharmacist support.

Roles & Responsibilities:

• Participated in refinement sessions with the business team to gather and analyse requirements for Pega applications, ensuring alignment with business needs. 
• Define case lifecycle, stages, and automation rules for seamless case resolution.
• Conducted unit testing for developed functionalities and resolved related defects in UAT (User Acceptance Testing) environments to ensure quality and functionality. 
• Utilized Pega debugging tools like Tracer and Clipboard to troubleshoot and fix errors during development, ensuring smooth application performance. 
• Coordinated with external teams to resolve issues related to third-party systems and integrations, ensuring seamless data flow and application functionality. 
• Designed and implemented complex Pega solutions to automate and streamline various business processes, aligning with organizational goals. 
• Collaborated closely with stakeholders to gather detailed requirements and translated them into effective Pega application designs and solutions. 
• Performed system integrations with third-party systems using Pega APIs, enabling efficient and reliable data exchange. 
• Actively participated in daily scrum calls and internal team meetings to discuss progress, blockers, and project updates. 
• Delivered demonstrations of completed functionalities and user stories to the business team, gathering feedback for further refinement and validation.

Technologies: PRPC v8.6 & 8.7.

Project:2

Project Name: Pharmacy Audit Recovery Platform (PARP)( Dec 2021 – Jun 2022)

Description: The Pharmacy Audit Recovery Platform (PARP) is a web-based application designed to enhance the auditing process for identifying and reporting fraudulent pharmacies. By enabling faster and more accurate fraud detection, PARP streamlines audits, increases the number of fraud findings, maximizes dollar recoveries, reduces bad debt, minimizes costs, and facilitates timely implementation of pharmacy corrective actions.

Roles/Responsibilities:

• Worked as part of a 7-member team, focusing on enhancements and defect fixes for Pega applications. 
• Designed and implemented Data Pages for lookup data, utilizing source rules such as Activities, Report Definitions, and Data Transforms to streamline data retrieval. 
• Developed user interfaces and screen layouts using Harness, Sections, and HTML, ensuring an intuitive and responsive user experience. 
• Collaborated closely with other developers to address and resolve development challenges, ensuring timely and effective solutions. 
• Analysed functional requirements and contributed to translating them into technical solutions for Pega applications. 
• Created and maintained technical documentation for existing Flows and Flow Actions, ensuring clarity and alignment across the team. 
• Utilized Splunk for monitoring and debugging application logs, ensuring efficient issue resolution and system performance. 
• Actively participated in daily Scrum or stand-up meetings, contributing updates and discussing any blockers. 
• Participated in Sprint Retrospective Meetings and Backlog Refinement Meetings to improve team processes and ensure alignment with project goals.

Technologies: PRPC v8.6, HTML, Oracle.

CGI: Hyderabad, India                                                                                                                    Jul 2020 - Nov 2021

System Architect

Client: PNC

Project Name: Risk Rating Platform Banking & Financial Services Capital Markets

Description: The Risk Rating Platform (RRP) leverages credit scorecards—mathematical models that quantitatively assess the likelihood of specific customer behaviors, such as loan default, bankruptcy, or delinquency, based on their current or proposed credit position with a lender. RRP evaluates various Credit Risk Rating models, including Probability of Default (PD), Loss Given Default (LGD), Leveraged Lending (LL), High-Risk Customer Identification (HRCI), Transition Matrix Model (TMM), and Direct Rating, to enhance risk assessment and decision-making.

Roles & Responsibilities:

• Actively participated in requirements gathering sessions with Business Product Owners and Business Analysts, ensuring alignment between business needs and technical solutions. 
• Gained experience with data flows, dataset strategies, and scorecard models, contributing to the design and implementation of scalable data-driven solutions. 
• Developed PL/SQL scripts for batch processing, financial data reconciliation, and risk management in a high transaction banking environment, ensuring accurate and efficient data handling. 
• Collaborated with data architects and business analysts to design and develop high-performance, scalable database solutions for mortgage processing systems. 
• Conducted thorough code reviews and applied Oracle best practices to improve the efficiency of stored procedures and queries, resulting in enhanced system performance. 
• Participated in the system design, data migration, and testing phases for Oracle database systems used in credit and loan applications, ensuring data integrity and system stability. 
• Successfully optimized transaction processing times by 25% through query optimization and schema restructuring, improving overall system performance. 
• Automated the generation of risk compliance reports, reducing manual intervention and ensuring timely, accurate reporting for stakeholders.

Technologies: PRPC v7.2.2, HTML, CSS, JavaScript, Tomcat server, Oracle.

LTI (HSBC): Hyderabad, India                                                                                                         Jul 2016 - Jul 2020

System Architect

Project: 3

Client: HSBC(Jan 2019 – Jul 2020)

Project Name: Pega Smart Dispute for Issuers

Description: The Smart Dispute solution framework enables front-line customer service representatives (CSRs) to efficiently capture all necessary customer information at the initial point of contact, allowing them to resolve even complex disputes without call transfers or extensive manual intervention. Its deployment significantly improves processing rates while reducing the need for extensive CSR training.

Roles & Responsibilities 

• Worked on integrating with various APIs for Visa and MCOM, ensuring seamless data exchange and functionality between systems. 
• Configured agents and data pages to optimize data retrieval, processing, and system performance. 
• Interacted with users, developers, and the project manager to gather business requirements, understand the business process, and identify areas for enhancements. 
• Actively worked on addressing and resolving production defects, ensuring the smooth functioning of the application in a live environment. 
• Participated in Sprint Planning Meetings, Sprint Retrospective Meetings, and Backlog Refinement Meetings, contributing to project planning, continuous improvement, and backlog management.

Technologies: PRPC v7.2.2, HTML, CSS, JavaScript, Tomcat server, Oracle.

Project: 2

Client: Express Scripts(Jan 2017 – Dec 2018)

Project Title: End to End Benefit Management (Pharmacy Benefit Management)

Description: Prior Authorization, also known as “coverage review,” “preauthorization,” or “prior approval,” is a process used to assess whether a medication is medically necessary and cost-effective. Express Scripts' Prior Authorization program enhances plan savings and patient safety by overseeing the dispensing of high-cost and potentially misused medications. The coverage review program ensures prescription benefits align with the plan’s intent while maintaining a positive experience for both members and physicians.

Roles & Responsibilities:

• Worked as part of a 10-member team, focusing on application enhancements and defect fixes for Pega-based solutions. 
• Developed SQL scripts (SQL statements, Stored Procedures, and Triggers) in Oracle to ensure effective database persistence and smooth data handling. 
• Involved in integrating Pega with SOAP web services using Connectors/Services and Connect-SQL to ensure seamless data exchange between systems. 
• Created and managed Rule Sets, Access Roles, Access Groups, Operators, and Workbaskets to maintain proper access controls and workflow management within Pega applications. 
• Prepared detailed analysis documents following PRPC coding standards to ensure clarity, consistency, and compliance with best practices. 
• Contributed to the preparation of technical and application deployment documents, supporting smooth deployment and system maintenance. 
• Worked with MySQL for user interaction with the database, ensuring efficient data management and queries. 
• Involved in upgrading the application from Pega 6.3 to Pega 7.1, including executing migration scripts and ensuring compatibility with new features. 
• Actively participated in Sprint Planning Meetings, Sprint Retrospective Meetings, and Backlog Refinement Meetings, contributing to the Agile process and continuous improvement.

Technologies: PRPC v7.2.2, HTML, CSS, JavaScript, Tomcat server, Oracle).

Project: 1

Client: Barclay(Jul 2016 - Dec 2016)

Project Title: End to End Benefit Management (Pharmacy Benefit Management)

Description: Client Lifecycle Management (CLM) at Barclays aims to enhance client management by automating key processes, positioning the bank as the preferred choice. CLM focuses on streamlining onboarding and maintenance for all Investment Bank products and clients, ensuring appropriate service levels, and reducing regulatory upkeep by identifying and deactivating inactive or dormant clients/accounts in a controlled manner, following established Guiding Principles. It also introduces BAU Dormant Account Guidelines and system enhancements for a repeatable offboarding process. Built on the Pega KYC Framework, CLM features predefined workflows for regulatory information collection during New Business Onboarding, covering multiple stages of the KYC process.

Roles & Responsibilities:

• Designed low-level design documents based on application functionality, ensuring clarity and proper alignment with business requirements.
• Worked as part of an 8-member team within the CLM (Client Lifecycle Management) project, focusing on enhancements and defect fixes.
• Translated complex business rules into Pega decision tables, decision trees, and Map Value pairs, improving decision-making efficiency.
• Reviewed existing decision rules, identified key defects, and implemented fixes to optimize the business logic and functionality.
• Developed SQL scripts (SQL statements, Stored Procedures, and Triggers) in MS-SQL to manage database persistence and ensure smooth data processing.
• Designed and implemented Declare Expressions, Declare Triggers, Decision Tables, and Decision Trees to optimize rule execution.
• Integrated Pega with external systems using SOAP web services through Connectors/Services to enable seamless data exchange.
• Involved in Sprint Planning and daily Scrum meetings, managing task distribution in an offshore/onshore coordination model to ensure efficient project execution.

• Bachelor of Technology in Information Technology, Jawaharlal Nehru Technological University, India – 2012.