Adrian Simms Email & Phone Number

Marietta, Georgia, United States

Dayton, Ohio, United States

-Led the Quality and Affordability Initiative program for the enterprise – a portfolio of measurable projects across all business units, driving portfolio management processes to communicate initiative status and drive business owner accountability to achieve targets. This includes the facilitation of steering committee meetings, reporting out on progress-to-goal, and tracking of initiatives from idea to completion-Led the sizing, scoping, contract design, underwriting and financial… Show more -Led the Quality and Affordability Initiative program for the enterprise – a portfolio of measurable projects across all business units, driving portfolio management processes to communicate initiative status and drive business owner accountability to achieve targets. This includes the facilitation of steering committee meetings, reporting out on progress-to-goal, and tracking of initiatives from idea to completion-Led the sizing, scoping, contract design, underwriting and financial reconciliation activities for new vendor partnerships in concert with other teams in the Analytics department, Finance and Actuarial department, Strategic Sourcing department, and business owners-Coordinated with Actuarial Science to inform forecasting and budget planning to account for expected impacts of committed QAIs across savings categories: inpatient, outpatient, retail Rx, revenue, admin-Led and mentored teams of healthcare analysts with diverse backgrounds – establishing measurement analytic approaches based on medical economics and mathematically sound principles relevant and applicable to various healthcare domains-Coordinated with other functions within the Analytics department, including: Population Analytics, Provider Analytics, Medical Economics, Data Science, and Health Informatics Show less

St Louis, Missouri, United States

• Lead an Analytics team of analyst and technical engineers for the purpose of design, developmentand communication of Trends and Outcomes of Population Health Programs• Head the ongoing Development Committee on technical backend and data design for Reports• Head the ongoing QA (Quality Assurance) Committee on Data Quality, UX (User Experience),Internal Consistency, and Functionality of Reporting Packages• Provided specialized analytics and business insights to support… Show more • Lead an Analytics team of analyst and technical engineers for the purpose of design, developmentand communication of Trends and Outcomes of Population Health Programs• Head the ongoing Development Committee on technical backend and data design for Reports• Head the ongoing QA (Quality Assurance) Committee on Data Quality, UX (User Experience),Internal Consistency, and Functionality of Reporting Packages• Provided specialized analytics and business insights to support several internal departments• Lead the creation of process for data inventory, code collaboration, and other efficiencies of atechnical team Show less

St Louis, Missouri, United States

Health Economics Outcome Research

Greater St. Louis Area

Create analytics that identify opportunities to improve outcomes through population health management programsDevelop reporting that measures performance and outcomes for population health programsPerform analysis that informs the advancement and innovation of population health programsAssess and develop reports and analyses in Power BI and Excel assessing clinical performance and quality of post-acute care organizations, aligned post-acute networks, and other providers… Show more Create analytics that identify opportunities to improve outcomes through population health management programsDevelop reporting that measures performance and outcomes for population health programsPerform analysis that informs the advancement and innovation of population health programsAssess and develop reports and analyses in Power BI and Excel assessing clinical performance and quality of post-acute care organizations, aligned post-acute networks, and other providers directly involved in the delivery of care for client episodesCompare and implement Risk models to efficiently focus resources.Risk adjust financials and utilize IBNR Claims Lag Triangle methods to complete ClaimsDesign data marts, procedures, views, tables in SQL to allow for swift and validated reporting on claims financial and population health metrics. Show less

New York

Provided Analytics for internal and external reporting, including Financial Departments, Corporate Leadership, Accounting, and Actuarial departments, external auditors, clients, rating agencies and regulators.Developed and Managed Reports (Compliance, Management, Statutory Reporting, Supplemental Health Exhibits, CMS MLR Rebate calculation)Validate, update and report on Life Reserve, Group Health Claim TrianglesInvestment Allocation, Blue Book Review, Ledger… Show more Provided Analytics for internal and external reporting, including Financial Departments, Corporate Leadership, Accounting, and Actuarial departments, external auditors, clients, rating agencies and regulators.Developed and Managed Reports (Compliance, Management, Statutory Reporting, Supplemental Health Exhibits, CMS MLR Rebate calculation)Validate, update and report on Life Reserve, Group Health Claim TrianglesInvestment Allocation, Blue Book Review, Ledger Reconciliation)Data Management: SQL and Access based Health Data warehouse design, data load, data pull, automation and query designDesign, maintain and test rates, models, calculators and reliability of Quoting softwareProducts Supported: Medical, Life, ADD, STD, Dental, LTD, Vision, Reinsurance Show less

Greater Atlanta Area

Actuarial Pricing (Commercial Group Benefits)Business Projection (Budget, Trend, Claims, Premium, Rate Review)Actuarial Research (Rating Areas, Risk Scores, Competitive Position)Rate Filing (Commercial Small Group and Individual)Underwriting Support (Rate-set Maintenance, Custom Benefit Design)Testing (Test and Oversee changes to process, tools, and systems)Risk Assessment (Work with Plan Actuary to understand the nature of specific risks)

Greater Atlanta Area

Southeast market team support.Recalibrate and Maintain Pricing Models and Ratesets. Conduct Area Factor Studies.Monitor Forecasting and Reserving. Model and Analyze Contractural savings due to Synergry obtained by AETNAs acquisition of Coventry.

Greater St. Louis Area

Lead analyst on high volume and high risk contract reviews with senior leadershipAnalyzed provider, physician, and ancillary contracts involving differing reimbursement methodologies.Developed and maintained data conversion tools in AccessResponsible for team Instruction on the use of our Corporate Contract Analytic Tool.Reviewed IBNR and high dollar claims

Saint Louis, Mo

Used team based instruction to achieve 20% increase in student mathematic proficiency levels. Successfully managed and developed meaningful relationships with over 160 students. Founded and Head Coached a High School track program with three assistant coaches that within two years qualified for the State Championship.