Nitin Mishra

About Nitin Mishra

I am a Pega Lead Business Consultant at Anthem, one of the largest healthcare benefits…

Experience

1. Pega Lead Business Consultant

   Anthem, Inc

   Dec 2016 — Present

   Understanding, analyzing the practicability of the existing AUMI systems, developing requirements for Proposed ASPEN systems and upgrades to the current Utilization Management systems.• Lead the business team in gathering requirements and choosing the best way to implement requirements leveraging the Pegasystems software and DCO capabilities.• Conducted JAD sessions with various stakeholders, and tracked leads to elaborate on the developed requirements, discuss, and resolve open issues• Understand business process and business requirements of the customers and translating them to requirements artifacts such as BRD/Functional spec/Use stories.• Help to ensure that the requirements management and facilitation best practices are adhered to include management of artifacts through traceability, version control and change control.• Ensuring that the system design is aligned as per the needs of the users and is optimally utilized. • Engaging actively in user acceptance testing and reviewing the functionality testing of the new systems. • Defining and documenting the business functions and processes of the customers.Anthem uses Facets system for all its Medicaid business in all market segments. This project deals with complying with the state mandate for the enrollment of all Medicaid members for each of the markets.Tools and Technology: Trizetto FACETS 4.71, 5.2, Oracle SQL developer, SharePoint, SQL server, Jira, Confluence.• Expertise in Claims, Billing, Enrollment, EDI 834, and MMS load process and Batch jobs.• Expertise in handling Health exchange files, Roaster files and SPARX• Proficient in FACETS applications like Subscriber/Member, Billing, Provider, Medical plan, Benefits, Claims Processing.

Skills

• Eai
• Design Patterns
• Business Process Design
• Bpmn
• Sdlc
• Software Development
• Business Process
• Lombardi Teamworks
• Testing
• Ibm Bpm
• Enterprise Service Bus(Ibm Wesb)
• Pl/Sql
• Java Enterprise Edition
• Requirements Analysis