Himanshu Singh

Payment integrity on the post-pay side — expanding Medicare coverage, automating recoupment, and moving claims recovery onto a cloud-native stack.

• Implemented the Medicare line of business in existing .NET post-pay applications, expanding claims-processing coverage across the payment integrity platform.
• Automated key post-pay functions and implemented Auto-Recoup for Proclaim and Facets, reducing manual recoupment and speeding overpayment resolution.
• Onboarded new vendors into the payment integrity ecosystem and coordinated Credit Balance and Subrogation claims across vendors.
• Built a Power BI vendor-performance dashboard so leadership has on-demand recovery metrics.
• Migrated a legacy .NET application to Node.js/Angular on AWS and SSIS packages to AWS Glue.
• Led the SQL Server build and migration from 2016 to 2022 using Unity, extending vendor support and improving performance.

L.A. Care Health Plan

Cloud-migration architecture for L.A. Care’s QNXT landscape — roadmap, RFPs, and a smaller hosting footprint before the move.

• Delivered a cloud-migration roadmap for QNXT and related applications at L.A. Care Health Plan.
• Developed techniques to bring data centers in-house from vendor-managed hosting and reduced lower-environment size ahead of migration.
• Participated in vendor RFPs, tool evaluation, and sourcing negotiations.
• Analyzed business processes, data flows, and IT artifacts; researched and recommended approaches for complex architecture challenges.

Cigna Healthcare

Led an Agile .NET team on Cigna’s Medicare claims platform — QNXT integrations, reporting, and post-adjudication.

• Led an Agile team of .NET developers delivering features for Cigna’s Medicare claims platform.
• Integrated back-office applications with QNXT scheduled adjudication, AutoQ, and payment-run processes.
• Developed SQL Server / SSIS / SSRS reports with custom stored procedures, views, and functions.
• Built post-adjudication modules and analyzed claims discrepancies for faster issue resolution.

Molina Healthcare and earlier payer programs

Technology Analyst · Senior Systems Engineer · Systems Engineer

Twelve years on payer platforms — from NASCO automation through leading Molina’s appeals, grievances, and payment-integrity integrations.

• Appeals & Grievances, UM Denials, Inovaare integration, and payment integrity for Molina Healthcare (Apr 2019 – Jun 2021).
• Led an Agile .NET team on a system used by 1,200 users; mentored six engineers with uninterrupted 24/7 offshore support.
• Integrated the Provider Portal with the A&G system via REST APIs and connected QNXT to Inovaare through AWS API Gateway for Duals and Medicare compliance.
• Built SSIS payment-extract integration with Change Healthcare for on-time EOB/EOP and 835 delivery; implemented Optum Web.Strat and Cotiviti pricing via BizTalk and SSIS.
• Converted legacy web-service calls to REST APIs consumed by MVC applications; monitored with AppDynamics, Azure Monitor, and SolarWinds.
• Earlier roles: NASCO process automation with Open Connect, CCS-to-NASCO gap analysis across 180+ IRS/RRD documents, and .NET portals, SSRS/SSIS, and HRO process work in Birmingham.