Experience
Developed a roadmap and business case for a 5-year, > $100M investment to modernize health benefit administration and claims processing for a major government health plan.
Project included producing industry insights and capabilities to guide the formulation of future state models, identification and prioritization of opportunities, and a rough order of magnitude (ROM) business case. These were used to develop and prepare a set of executive level presentations used to secure approval of the overall 5-year investment, and established the baseline for execution.
Contracted by the COO of a government health plan to assist in the onboarding of ~30K new members.
Facilitated the development of call and field outreach processes as part of a new integrated health maintenance program launch. Established and managed a “command center” for the onboarding of ~30K special needs members as part of the service launch. Developed a database including feeds from operational systems with daily executive dashboards. Onboarding call center and field outreach designed within 6 weeks.
Provided executive program management execution assistance for a major behavioral health firm in support of an enterprise-wide goal.
Work included oversight of a set of enterprise IT initiatives designed to create operational efficiencies. Developed a cohesive framework, communications plan, project guidance, executive level reporting, call center readiness plan, and IT roadmap. In addition a high-level provider network operational strategy was produced.
Facilitated division business strategy and operating plans including health care reform and future vision, goals, strategic IT initiatives and measureable objectives for a major commercial health plan’s government programs, individual and small group insurance.
Led program delivery of a web-based consumer sales portal and integration of a vendor packaged software system for online individual underwriting.
Led the IT delivery of support for the Medicare Modernization Act, Private Fee for Service and Pharmacy capabilities. Delivered an internal member-level database / repository to support risk adjustment and data analytics.
Directed numerous IT programs, including financial reporting, actuarial, major commissions systems vendor package upgrade, integration of Hyperion, PeopleSoft H/R Data Analytics and Billing and Enrollment.