Project#1

Health Care Service Corporation / Blue Cross Blue Shield of Illinois

Health Care Service Corporation (HCSC) is a customer-owned health Benefits Company focused on health and wellness. HCSC operates through its Blue Cross and Blue Shield divisions in Illinois, New Mexico, Oklahoma, and Texas, and several subsidiaries to offer a variety of health and life insurance products and related services to employers and individuals.

Health care service corporation (HCSC) is headquartered in Chicago and HCSC having 6 different systems namely,

•          MIP (Membership Interface Process system) 
•          BlueSTAR System 
•          CM/MSP (Consumer Market/Medicare Secondary Payor) 
•          BARS (Billing and Accounts Receivable System)   
•          RE (Reverse Eligibility) 
•          Stop Loss 

Application #1

Application Title

MIP/CM/MSP/WhiteSpace

Client

Health Care Service Corporation

Role

Team Member

Team Size

8

Duration

Mar ’07 – Apr ‘12

Technologies

COBOL, JCL, DB2, CICS, Eztrieve, SPUFI, File Master, Zeke, Endevor, VDR, REXX, Assembler, NDM, FDR

Description:                                   
                        Membership Interface Process system (MIP) formerly know as Current Membership system(CMS) deals with the policy holder and dependents data that are enrolled with the HCSC client. It contains all the master files from these files the data is extracted and it is used for processing the different systems like BARS, RE etc.

                        Consumer Market formerly known as Direct Market is a BCBS plan where individuals or a small group of individuals is insured independently.

                        Medicare Secondary Payer (MSP) is a plan where Medicare is the secondary Payer while BCBS is a primary payer. Claims are first processed by BCBS, and the claim amount over the agreed value is paid by Medicare.

                    Whitespace is a new membership system with extract the data from DB2 tables and process the data and updates the MIP files.

Roles and Responsibilities:     

Ø  Handle Queries and tickets from users or end customers on daily basis and ensuring their timely closure.

Ø  Providing 12x7 production support, which involves monitoring the production jobs and fixing any issues within the stipulated time to assure that the SLA (Service level Agreement) is met.

Ø  Work towards improving the application aligned to the overall Strategic goals of HCSC

Ø  Brought in 3 PI (Process Improvements) and one BVA (Business Value Add) for HCSC

Ø  Worked on Enhancement.

Ø  Worked on sun setting MSP application.

Ø  Worked on CMS Shutdown Project which involved Impact analysis, Identification of Complete and Partial Shutdown procs, Proc updation and Testing.

Ø  Worked on Maintenance, MSP Queries and Enhancement Activities.

Ø  Worked on Adhoc requests to fulfill Customer’s individual needs.

Ø   Since Whitespace is a new application, have attended the KT sessions with Whitespace SME’s to understand the application.

                    Whitespace is a new membership system with extract the data from DB2 tables and process the data and updates the MIP files.

BlueSTAR is a new membership system with data stored in DB2 and Java based front end includes the functionality's of the existing BARS & MIP/CMS systems, with new functionality’s.

Roles and Responsibilities:     

Ø  BlueSTAR Batch Cycle monitoring(BlueSTAR Billing, BlueSTAR Account, BlueSTAR Member & WhiteSpace)

Ø  BlueSTAR Migration Verification which involves verification of the batch and Online packages.

Ø  Developed tools to reduce manual effort.

o    SPUFI Vs LOADLIB Batch and Online verification tool

o    Endevor Package Verification Tool