Patrick Chance, AAM, AIM, AIC

Specialist Lead in the development of a new go-to-market product and service for Safety and Risk Management focusing on advanced/predictive analytics. Responsibilities included developing the strategic approach of data to be leveraged for advanced predictive analysis, which included claim, employment, employee/claimant demographic, operations, work performance and external data (i.e., lifestyle, financial spending, and neighborhood demographics). This new product and service blended… Show more

Specialist Lead in the development of a new go-to-market product and service for Safety and Risk Management focusing on advanced/predictive analytics. Responsibilities included developing the strategic approach of data to be leveraged for advanced predictive analysis, which included claim, employment, employee/claimant demographic, operations, work performance and external data (i.e., lifestyle, financial spending, and neighborhood demographics). This new product and service blended workforce exposure data with innovative non-traditional external data for customized analysis that produced a scientific outcome that facilitated pinpointing of risk and exposures for more targeted and focused intervention, prevention, and remediation management measures. The new product and service represented an advanced and progressive approach to cost containment, as well as, injury and safety management. Show less

PMO Manager for oversight of external third-party vendor’s delivery and testing of web-based risk management and business intelligence information system modules for an international fire and marine insurance company. Initiated project management quality control checkpoints that identified gaps and corrective actions in the delivery and testing of system modules and database structures. Directed vendor resources in closing gaps in system delivery and testing. Key point of contact and… Show more

PMO Manager for oversight of external third-party vendor’s delivery and testing of web-based risk management and business intelligence information system modules for an international fire and marine insurance company. Initiated project management quality control checkpoints that identified gaps and corrective actions in the delivery and testing of system modules and database structures. Directed vendor resources in closing gaps in system delivery and testing. Key point of contact and facilitator for user acceptance testing. Reported directly to carrier senior on-shore executives on vendor’s progress to address and close gaps in module delivery and system testing. Show less

Subject Matter Lead to project team in insurance operations and system processes. Facilitated readiness and compliance discovery sessions with client team in various operational areas of the organization (i.e., reinsurance, contract and commercial surety underwriting, property and casualty underwriting, surety claims, property and casualty claims). Supervised development of various department control matrix(s) (i.e., control objectives and activities, test activities, testing, gap… Show more

Subject Matter Lead to project team in insurance operations and system processes. Facilitated readiness and compliance discovery sessions with client team in various operational areas of the organization (i.e., reinsurance, contract and commercial surety underwriting, property and casualty underwriting, surety claims, property and casualty claims). Supervised development of various department control matrix(s) (i.e., control objectives and activities, test activities, testing, gap identification and documenting of corrective action items). Primary responsibilities also included direct involvement in readiness assessment of contract and surety underwriting operations for multi-line company and liability line operations (D&O and E&O) for managing general underwriter. Provided industry expert knowledge transfer of insurance operations and system processes to project team. Show less

Principal Consultant and Subject Matter Advisor to client in Data Transformation and Information Technology (IT) Planning efforts. Assessed current state of data transformation/conversion approach and methodology as well as IT alignment with current business operational needs and future strategic business efforts. Addressed current data transformation/conversion challenges by organizing IT efforts with identification of current tasks/activities into an organized approach to meet client… Show more

Principal Consultant and Subject Matter Advisor to client in Data Transformation and Information Technology (IT) Planning efforts. Assessed current state of data transformation/conversion approach and methodology as well as IT alignment with current business operational needs and future strategic business efforts. Addressed current data transformation/conversion challenges by organizing IT efforts with identification of current tasks/activities into an organized approach to meet client expectations and timelines. Provided longer-term approach and disciplined methodology for future data transitioning efforts. Based on assessment of IT resources, processes and current engagement with business operations and stakeholders, recommended areas of opportunity for investment to optimize IT resources to support enterprise sustainability and resiliency. Show less

Project Lead for interviews and surveys of key department agencies of newly integrated federal government department consisting of 22 legacy agencies with more than 180,000 employees. Managed the documentation effort of current risk management information system (RMIS) functionality, benchmarked other government and commercial off-the-shelf systems, and developed prioritized needs and system requirement definitions for RFP issuance.

Specialist Operations Expert for strategic analysis of a sensitive claim and stat actuarial executive study to define and calculate the amount of work completed by claim adjusters when first confident reserve is set on claim files. The impact of this study was paramount to efforts in ULE reserving accuracy. Lines of business analyzed included Workers’ Compensation, Auto, Malpractice, General Liability, Auto Physical Damage, Garagekeepers, Auto No Fault, Burglary, Glass, Marine, Boiler… Show more

Specialist Operations Expert for strategic analysis of a sensitive claim and stat actuarial executive study to define and calculate the amount of work completed by claim adjusters when first confident reserve is set on claim files. The impact of this study was paramount to efforts in ULE reserving accuracy. Lines of business analyzed included Workers’ Compensation, Auto, Malpractice, General Liability, Auto Physical Damage, Garagekeepers, Auto No Fault, Burglary, Glass, Marine, Boiler, Fidelity, Surety and Fire. Show less

Provided Subject Matter and Specialist Expertise to Internal Audit Department of this Top 3 Global Automobile Manufacturer. Tasked with leading the review and audit of an internal Integrated Disability Management team’s monitoring and over-sight of a Top-Tier TPA. Key findings included lack of claim life-cycle management oversight, gaps in subrogation identification and follow-up, and under-utilization of cost containment services.

Managed development of business requirements related to layoff, placement and set-up of treaty and facultative reinsurance imbedded within underwriting operations of various profit-centers. Supervised the execution of an extensive, detailed and coordinated effort of reinsurance treaty analysis (346 reinsurance treaties reviewed and analyzed). Coordinated and scheduled resources involved in the reinsurance treaty analysis, including client and consulting personnel. Supervised interview teams… Show more

Managed development of business requirements related to layoff, placement and set-up of treaty and facultative reinsurance imbedded within underwriting operations of various profit-centers. Supervised the execution of an extensive, detailed and coordinated effort of reinsurance treaty analysis (346 reinsurance treaties reviewed and analyzed). Coordinated and scheduled resources involved in the reinsurance treaty analysis, including client and consulting personnel. Supervised interview teams conducting in-depth and focused interview sessions with various profit -centers. Show less

Analysis Lead in compiling similar exposure industries, chemical, oil and gas peer group survey results and generating summary observations and recommendations. Formatted findings and developed Power Point Report presentation with a focus on global locations and employee counts (by region) including, health management philosophy, reporting and record management, health impact assessment, health management, industrial hygiene and workplace environment, health risk assessment, medical emergency… Show more

Analysis Lead in compiling similar exposure industries, chemical, oil and gas peer group survey results and generating summary observations and recommendations. Formatted findings and developed Power Point Report presentation with a focus on global locations and employee counts (by region) including, health management philosophy, reporting and record management, health impact assessment, health management, industrial hygiene and workplace environment, health risk assessment, medical emergency management, health surveillance, promotion for good health and travel medicine. Report presentation included graphics, pie charts, percentages of participation by industries and peer group(s). Identified core health, safety and environmental best practices and reporting frameworks for client implementation. Show less

Project Manager for team of senior level managers and consultants in the identification of opportunities to incorporate best practices in claim handling processes, jurisdictional compliance and licensing issues impacting current operation of global retail organization with large in-house claim administration operation. Supervised the review of multi-line and mono-line claim handling and operational processes. Presented findings and best practices to client executive team to address gaps in… Show more

Project Manager for team of senior level managers and consultants in the identification of opportunities to incorporate best practices in claim handling processes, jurisdictional compliance and licensing issues impacting current operation of global retail organization with large in-house claim administration operation. Supervised the review of multi-line and mono-line claim handling and operational processes. Presented findings and best practices to client executive team to address gaps in production operations, compliance, licensing and jurisdictional market perceptions. Show less

Implementation Manager for Hamilton, Bermuda, based Reinsurance Company. Managed evaluation, selection, design, configuration and implementation of reinsurance system within 14 week time-frame. Directed vendor’s SVP of implementation and client’s corporate and business line executives to deploy system within compressed time-frame and budget. The new system included a repository for broker and agent information, policy, treaty, contract, claims related data, supported regulatory reporting… Show more

Implementation Manager for Hamilton, Bermuda, based Reinsurance Company. Managed evaluation, selection, design, configuration and implementation of reinsurance system within 14 week time-frame. Directed vendor’s SVP of implementation and client’s corporate and business line executives to deploy system within compressed time-frame and budget. The new system included a repository for broker and agent information, policy, treaty, contract, claims related data, supported regulatory reporting requirements, and provided the capability to capture and report on specific agency data needs. Show less

Supported client’s business transition and transformation efforts, including new product launches, system changes and complex facility consolidation by organizing overall integration approach and resources. Managed planning and collaboration across all functions of parent company and acquisition by utilizing leading practices and standing up a TMO. The TMO was comprised of client teams that were tasked with developing and executing plans to integrate their areas within the enterprise… Show more

Supported client’s business transition and transformation efforts, including new product launches, system changes and complex facility consolidation by organizing overall integration approach and resources. Managed planning and collaboration across all functions of parent company and acquisition by utilizing leading practices and standing up a TMO. The TMO was comprised of client teams that were tasked with developing and executing plans to integrate their areas within the enterprise organization. Developed and launched a governance model and process to track integration tasks and activities progress, communication plans, workstream interdependencies, ongoing issues, and risks, while leveraging road maps to ensure timely milestone delivery. Successfully integrated all acquisition employees into the parent company human resource systems, built out the first phase of the new office space in a brand-new building, stood up the IT network and moved all acquisition employees to a new modern office location and building. Show less

Senior Program Lead for the participation readiness and implementation of one of the leading national health plan carriers into the largest and most complex state health benefit exchanges promoting an "active purchaser" model. Managed a combined client and consulting team of over one hundred (100) engagement resources, including resources from Benefit Operations, Product, Rating, Network & Service Area, Clinical, Continuity of Care, Nurseline, Pharmacy, Quality Management, Marketing, Finance… Show more

Senior Program Lead for the participation readiness and implementation of one of the leading national health plan carriers into the largest and most complex state health benefit exchanges promoting an "active purchaser" model. Managed a combined client and consulting team of over one hundred (100) engagement resources, including resources from Benefit Operations, Product, Rating, Network & Service Area, Clinical, Continuity of Care, Nurseline, Pharmacy, Quality Management, Marketing, Finance, Appeals & Grievances, Independent Medical Review, Provider Dispute Resolution and other enterprise operational departments. Focused engagement resources on the remediation, compliance and fulfilment of regulatory and contractual business as well as business system requirements, including the development and collection of physical evidence to demonstrate to state and regulatory stakeholders compliance and fulfilment with readiness and implementation expectations. Show less

Senior Project Manager for the implementation of health plans and products in a productional state health insurance exchange for one of the largest health carriers in the United States. Expeditiously on-boarded some 80 plus internal business operations and technology stakeholders to prepare for the “official” launch of a partner state’s health insurance exchange for small business groups. Engaged state’s third-party administrators supporting the exchange and identified gaps and issues in… Show more

Senior Project Manager for the implementation of health plans and products in a productional state health insurance exchange for one of the largest health carriers in the United States. Expeditiously on-boarded some 80 plus internal business operations and technology stakeholders to prepare for the “official” launch of a partner state’s health insurance exchange for small business groups. Engaged state’s third-party administrators supporting the exchange and identified gaps and issues in current exchange business and system processes impacting carrier community. Lobbied state project manager to address gaps and issues and facilitated internal feedback to proposed state health care reform amendment legislation. Show less

Client Relationship and Project Manager supporting nation-wide initiative of Benefit Schedule completion, quality analysis and SERFF Binder Template filing and submission. Managed client relationship involving Senior Vice President of Legal & Regulatory Affairs and four (4) Regional Regulatory Directors. Managed team of ten (10) consultants and contractors responsible for the cross-walk of health plan portfolio grid data into schedule of benefit forms and templates. In addition to benefit… Show more

Client Relationship and Project Manager supporting nation-wide initiative of Benefit Schedule completion, quality analysis and SERFF Binder Template filing and submission. Managed client relationship involving Senior Vice President of Legal & Regulatory Affairs and four (4) Regional Regulatory Directors. Managed team of ten (10) consultants and contractors responsible for the cross-walk of health plan portfolio grid data into schedule of benefit forms and templates. In addition to benefit schedules completion, managed the quality review of benefit schedules completed by client filing staff as well as external vendor and recommended remediation of gaps identified (including the completion of benefit schedules that were incorrectly submitted to client for filing by external vendor). Supported client's SERFF Binder filing and submission efforts by scheduling and assigning consulting and contractor staff by region and state to perform SERFF Binder submission by priority of filing deadline date. Show less

Program Management Director supporting national health plan's most complex region for SERFF Binder Template completion and filing efforts. Organized various multi-market and operational departments to support SERFF Binder Template completion (e.g., product, actuarial, pharmacy, provider network, administration and regulatory). Stream-lined binder template completion and submission efforts by eliminating over-reliance on volumes of emails and bringing key stakeholders together via Agile… Show more

Program Management Director supporting national health plan's most complex region for SERFF Binder Template completion and filing efforts. Organized various multi-market and operational departments to support SERFF Binder Template completion (e.g., product, actuarial, pharmacy, provider network, administration and regulatory). Stream-lined binder template completion and submission efforts by eliminating over-reliance on volumes of emails and bringing key stakeholders together via Agile Methodology technique of Scrum Meetings/Conference Calls on a weekly, bi-weekly basis or more frequently as needed based on state filing deadlines that were often moving targets. Centralized communications on state filing date deadline changes (emanating from the states or jurisdictions) through the PMO so market and operation leads supporting template completion efforts would have one source for changes to jurisdictional filing due dates (this eliminated confusion and unnecessary email correspondence). Based on these and other program management techniques implemented on an expedited basis, the client was able to meet multiple state and jurisdictional SERFF Binder filing deadlines on time based on requirements communicated by the jurisdiction (which changed often in some jurisdictions). Show less

Project Manager for all-inclusive review of insurance trust business system applications. Reviewed core insurance trust technology environment and business process from an “as-is” and “to-be” perspective for accounting, underwriting / policy, client database / membership services and claims administration. Facilitated the identification, evaluation and selection of an integrated software solution that was successfully implemented into the current technology and hardware infrastructure of the… Show more

Project Manager for all-inclusive review of insurance trust business system applications. Reviewed core insurance trust technology environment and business process from an “as-is” and “to-be” perspective for accounting, underwriting / policy, client database / membership services and claims administration. Facilitated the identification, evaluation and selection of an integrated software solution that was successfully implemented into the current technology and hardware infrastructure of the insurance trust. Show less

Provided project management and support to client by facilitating walkthrough of narratives and documentation with process owners. Initiated testing and selection of appropriate test samples, documented test results and communicated results to process owners and agency financial management. Supervised audit team in test sample selection, testing, test outcome and result deliverables. Engaged agency’s SVP of Finance on test results and findings before closing meeting. Led closing meeting… Show more

Provided project management and support to client by facilitating walkthrough of narratives and documentation with process owners. Initiated testing and selection of appropriate test samples, documented test results and communicated results to process owners and agency financial management. Supervised audit team in test sample selection, testing, test outcome and result deliverables. Engaged agency’s SVP of Finance on test results and findings before closing meeting. Led closing meeting, presented test findings to client executives and management. Show less

Subject Matter Lead in the review, validation and update of prior legacy system migration to newer technology platform feasibility report - benefit calculation, costs and risks. Identified, analyzed and defined available options that would support $2 billion specialty line book of business, including analysis of options across core system functionalities, impact to infrastructure and organization, as well as, considerations in technology, change management and training.

Managed IT assessment of target’s IT applications and systems, infrastructure, organization, projects, budget, and staff. Direct interaction with target’s EVP & CIO and Investment Bank Management. Led the development of final IT assessment deliverable and identified current state and future direction of IT infrastructure, including IT department support of target’s business vision. Key issues identified within the target’s IT area included network, infrastructure gaps, turnover of key… Show more

Managed IT assessment of target’s IT applications and systems, infrastructure, organization, projects, budget, and staff. Direct interaction with target’s EVP & CIO and Investment Bank Management. Led the development of final IT assessment deliverable and identified current state and future direction of IT infrastructure, including IT department support of target’s business vision. Key issues identified within the target’s IT area included network, infrastructure gaps, turnover of key executive leadership, and lack of strategic planning. Show less

Subject Matter Expert to client’s internal Sarbanes Oxley Department for one of the industry’s largest Domestic and Canadian claim home office and field operation business and system environments. Managed client’s resources on the creation of test plans for three distinct and separate Domestic claim divisions (Primary, Financial Lines and P&C Severity) as well as Canadian claim division. Provided claim subject matter knowledge, supervision and leadership to testing team of combined consulting… Show more

Subject Matter Expert to client’s internal Sarbanes Oxley Department for one of the industry’s largest Domestic and Canadian claim home office and field operation business and system environments. Managed client’s resources on the creation of test plans for three distinct and separate Domestic claim divisions (Primary, Financial Lines and P&C Severity) as well as Canadian claim division. Provided claim subject matter knowledge, supervision and leadership to testing team of combined consulting and client resources to address compliance deficiencies. Show less

Director and Senior Project Manager for the evaluation of mobile/digital applications and technology vendors and solutions to meet unique client business requirement needs for a new mobile/digital application. This new mobile/digital application provides health plan members with access to pharmacy benefit information that will help them select between choices of pharmacies based on prescription cost and location. Additional objectives included real time access to ePrescribing capabilities… Show more

Director and Senior Project Manager for the evaluation of mobile/digital applications and technology vendors and solutions to meet unique client business requirement needs for a new mobile/digital application. This new mobile/digital application provides health plan members with access to pharmacy benefit information that will help them select between choices of pharmacies based on prescription cost and location. Additional objectives included real time access to ePrescribing capabilities through an EMR system, pharmacy benefit information, and strong accuracy of prescription cost and pharmacy location. Developed an organized plan to approach the mobile/digital application and technology marketplace, vet and compare vendor/solution capabilities based on the client's unique business requirements, developed and distributed a detailed Request for Proposal (RFP), evaluated and scored proposals and oral presentations, and supported selection of a vendor/solution finalist. Assisted the client in positioning contract negotiations with the vendor/solution finalist selected and developed a high-level project development and implementation plan to move project toward production launch. Show less

Managed the comprehensive review of medical management software marketability outside a single state implementation, including assessment of the organizational readiness and support necessary to expand into other national markets relative to medical management and cost containment. Identified current technology and infrastructure capabilities and developed foundation for the execution of leading practices in application development, technology operations and organizational dynamics.

National Risk Administrator selected for 15 month assignment at national account world headquarters to manage domestic claim administration program and improve claim customer service practices by claim staff. Client renewed contract annually for 5 years based on service improvements and increased cost containment penetration. Initial client contract renewal included an additional $2 million gain-sharing plan bonus.

Managing Director for a new West Coast health plan that needed assistance in development of a qualified health plan proposal for the largest state run health benefit exchange in the country. Responsible for on-site client stakeholder engagement and for proposal content development of a remote proposal writing team and proposal coordinator. Employed an Agile Methodology technique of early morning daily scrum meetings/conference calls with the writing team and proposal coordinator who were… Show more

Managing Director for a new West Coast health plan that needed assistance in development of a qualified health plan proposal for the largest state run health benefit exchange in the country. Responsible for on-site client stakeholder engagement and for proposal content development of a remote proposal writing team and proposal coordinator. Employed an Agile Methodology technique of early morning daily scrum meetings/conference calls with the writing team and proposal coordinator who were located on the East Coast. In addition to daily communication of key client capabilities and abilities for proposal content development by the remote writing team, provided proposal progress reports on a weekly basis to key client leadership. The Phase I Technical Proposal of some 265 pages was submitted early to the state health benefit exchange and positioned the client to have further conversations and dialogue on exchange market participation opportunities. Show less

Subject Matter Expert and Business Process Leader for the design and development of a new case management system for one of the largest fraud, waste and abuse (payment integrity) operations in the industry. Responsibilities included representation of client business and leadership stakeholders in the analysis and design of an automated case management system. This new workflow system consolidated disparate technology silos and tools into one integrated solution while also automating numerous… Show more

Subject Matter Expert and Business Process Leader for the design and development of a new case management system for one of the largest fraud, waste and abuse (payment integrity) operations in the industry. Responsibilities included representation of client business and leadership stakeholders in the analysis and design of an automated case management system. This new workflow system consolidated disparate technology silos and tools into one integrated solution while also automating numerous manual processes and previous operational workarounds. The new workflow system also provided the ability to electronically intake data from various detection engines allowing discovery output consumption regardless of detection methodology used and/or which portion of the payment integrity library enabled. Show less

Project Manager for operational and technology initiative that eliminated 65-75% of manual paper processing by national claim staff on medical bill review, managed care, utilization review and prescription network referrals by enhancing on-line claim system functionality and integration resulting in increased medical cost containment penetration by over 20%.

Project Manager for the development and implementation of national claim staffing models for workers’ compensation, personal and commercial line group divisions that supported monthly branch claim office staffing requirements based on evaluation of staff earned comparisons with current staff counts. Identified over-staffed and under-staffed branch claim offices and recommended appropriate right-sizing strategies and approaches.

Facilitated client’s executive, director and management staff through readiness and assessment of reinsurance policy administration for both treaty and facultative reinsurance. Supervised development of flow and narratives for treaty and facultative premium and policy processing. Identified control activities and process improvements to enhance compliance and reduce cost.

Subject Matter Lead on IT assessment of insurance company specializing in personal insurance programs. Assessed applications, systems, databases, infrastructure, organization, projects, budget, staff and governance. Consulted with target’s COO, VP and AVP of IT, IT Management Staff and Global Investment Bank’s Management Director on IT operations. Assessed current state and future direction of IT infrastructure, including IT Department support of target’s business vision. Key issues and… Show more

Subject Matter Lead on IT assessment of insurance company specializing in personal insurance programs. Assessed applications, systems, databases, infrastructure, organization, projects, budget, staff and governance. Consulted with target’s COO, VP and AVP of IT, IT Management Staff and Global Investment Bank’s Management Director on IT operations. Assessed current state and future direction of IT infrastructure, including IT Department support of target’s business vision. Key issues and corrective actions identified included IT infrastructure costs, strategic IT vision and staffing considerations. Show less

Subject Matter Lead on IT assessment of MGA specializing in catastrophe peril coverage. Assessed applications and systems, infrastructure, organization, projects, budget, data and network security, staff and governance. Identified current and future direction of IT department and infrastructure, including IT support of target’s strategic business vision and long-term profitability IT support opportunities.

Provided subject matter expertise in Risk Management Operations & Solutions for this 117,000-employee operation with locations in more than 90 countries. Tasked with comparing SAP’s Insurance and Financial Risk Management Solution to the client’s “To-Be” Risk Management Vision as well as comparison of SAP to other Risk Management Solutions. As the client had already invested in SAP’s HR, Financial and EH&S Solutions (including SAP’s Plant Maintenance Module), a critical strategic decision was… Show more

Provided subject matter expertise in Risk Management Operations & Solutions for this 117,000-employee operation with locations in more than 90 countries. Tasked with comparing SAP’s Insurance and Financial Risk Management Solution to the client’s “To-Be” Risk Management Vision as well as comparison of SAP to other Risk Management Solutions. As the client had already invested in SAP’s HR, Financial and EH&S Solutions (including SAP’s Plant Maintenance Module), a critical strategic decision was required regarding further investment in SAP. Identified key considerations and issues including Regulatory Compliance, Data Conversion, Pricing, Testing (unit, function, system, UAT, etc), PMO Structure, Change Management and Business Ownership of Project (Executive Sponsor, Steering Committee, Project Manager, etc.). Show less

Specialist Leader for multiple work-tracks involving a State Health Benefit Exchange re-launch effort for 2015 Affordable Care Act (ACA) Open Enrollment. Work-tracks responsible for and/or involved with included Program Determination (Medicaid), System for Electronic Rate and Form Filing (SERFF) for Qualified Health Plans (QHPs) and Appeals Business Processing. Provided overall management of consulting and client resources in the analysis and implementation of complex Medicaid program… Show more

Specialist Leader for multiple work-tracks involving a State Health Benefit Exchange re-launch effort for 2015 Affordable Care Act (ACA) Open Enrollment. Work-tracks responsible for and/or involved with included Program Determination (Medicaid), System for Electronic Rate and Form Filing (SERFF) for Qualified Health Plans (QHPs) and Appeals Business Processing. Provided overall management of consulting and client resources in the analysis and implementation of complex Medicaid program determination functionality in a new Health Benefit Exchange (HBE) portal replacing last year’s portal technology. Lead and supported junior consulting resources with subject matter knowledge in leveraging QHP product data (provided by health plans via SERFF templates) in the electronic loading and population of health plan information into the new exchange portal for consumer shopping and selection. Lead the development of business requirements for the storage, retrieval and production of member application and profile data for Appeals business processes and hearings. Show less

Specialist Lead in the collection and analysis of internal state Medicaid program information and other external state and federal government sources of Medicaid data in relation to TPL and F&A strategic transformation initiatives. Obtained clear understanding of revenues generated by current TPL efforts, conducted independent evaluation of available TPL operating and system models and developed business case analysis, key findings, and series of recommendations to guide upcoming leadership and… Show more

Specialist Lead in the collection and analysis of internal state Medicaid program information and other external state and federal government sources of Medicaid data in relation to TPL and F&A strategic transformation initiatives. Obtained clear understanding of revenues generated by current TPL efforts, conducted independent evaluation of available TPL operating and system models and developed business case analysis, key findings, and series of recommendations to guide upcoming leadership and executive decision-making. The F&A analysis focused on external sources of information, including the review of strategic leading practices from other state Medicaid programs and marketplace research of operational and system model alternatives from various insurance and claim industry sources with an emphasis on innovative techniques and strategic operational and system approaches used to prevent and detect F&A. Show less

Project Manager for IT transformation of financially challenged state fund to profitable privatized insurance company. Managed core technical applications (policy administration, underwriting and claim) and infrastructure assessment, application roadmap development (with marketplace software/solution assessment and evaluation) and facilitated enhancement of claim system. Trained key client change leaders on proper strategic planning techniques for future releases of enhancements to claim… Show more

Project Manager for IT transformation of financially challenged state fund to profitable privatized insurance company. Managed core technical applications (policy administration, underwriting and claim) and infrastructure assessment, application roadmap development (with marketplace software/solution assessment and evaluation) and facilitated enhancement of claim system. Trained key client change leaders on proper strategic planning techniques for future releases of enhancements to claim system (module release scheduling, staffing/resource requirements, and timing of releases supporting strategic business initiatives over 2-3 year time-frame). Trained client business and information technology staff on leading practice Project Management techniques, SDLC methodology, JAD sessions, Use Case approaches, and System Testing Life-Cycle methodology. Show less

Co-Region Lead (teaming with client’s Northeast Region Lead) and Manager responsible for reporting work-stream. Facilitated client establishment of PMO operations focused on tracking, reporting, and communicating progress regarding commission appeals of national and regional dealers. In addition to managing development of new executive/management level reports focused on commission appeals inventory, initiated analysis to identify and pinpoint source of commission appeals being filed and… Show more

Co-Region Lead (teaming with client’s Northeast Region Lead) and Manager responsible for reporting work-stream. Facilitated client establishment of PMO operations focused on tracking, reporting, and communicating progress regarding commission appeals of national and regional dealers. In addition to managing development of new executive/management level reports focused on commission appeals inventory, initiated analysis to identify and pinpoint source of commission appeals being filed and engaged client IT resources on efforts to address system related issues causing commission appeals. Supported client’s Northeast Region Lead in day-to-day activities regarding appeals management processing and monitoring. Show less