Project-3 Experience
Navigator -Claims
Project Description:
Claims Navigator is a healthcare claims workflow and inventory management application that extends the power of core claims processing systems. Key features of Claims Navigator are, Claims Work Object Creation, Flexible Workbasket (work queue) Generation, Claim Prioritization, Skills & Rules based Routing, Claim Auto-Fetch and Display, Correspondence Generation and Management of Control and Reporting.
As Enterprise Architect at NASCO, analyzed business requirements and provided end-to-end architecture solutions with a strong focus on secure interactions between NASCO and external BCBS plan accounts. Designed and implemented Case Management, Data Models, Situation Layers, Security frameworks, and Integration components from the ground up.
Led and mentored an offshore team of Pega developers to deliver high-quality, scalable designs aligned with enterprise standards. Architected and governed integrations involving HL7, X12, FHIR, and other healthcare data formats to enable seamless interoperability across payer and provider systems. Ensured compliance with HIPAA, PHI/PII protection policies, and enterprise healthcare data governance standards while optimizing system performance and data integrity.
Key Responsibility:
- Develop a logical diagram to interpret functional requirements
- Participate in requirement validation, analysis, design, and implementation
- Interact with the business team and understand the detailed requirements
- Understand the requirement document based on the discussion with Business Analysts and Solution Architects.
- Understand the solutions which were provided by solution architects
- Understand the design and responsible for the implementation
- Involved in application UI design.
- Involved in the application Design document
- Creating workflows based on the requirements.
- Working on the Production Defects
- Support in designing the technology architecture for the asset
- Develop the required & defined reusable tech arch components
- Build and showcase a reference application leveraging the technology architecture developed
- Maintain the technology architecture, ref application
- Work on upgrading the platform on the new versions of products are released for recertification
- Support the opportunity team to understand the requirements and create a gap analysis document.
- Support the client teams to resolve issues and bugs found.
- Manage the team members and assign the work.