Brian O'Shields Email & Phone Number

Bloomington, Minnesota, Us

Oakland, California, Us

Led Actuarial and Analytic activities for Group Health Cooperative through the Kaiser Permanente acquisition. Group Health Cooperative was a Non-profit staff model HMO with for-profit PPO subsidiary, serving 700k members with $4B in revenue; acquired by Kaiser Permanente in 2017 • Drove revenue and pricing strategy / implementation for all commercial and Medicare lines of business, working closely with Sales and Account Management leadership.• Span of control included Actuarial, Underwriting, Medicare/Medicaid Finance, Purchaser Analytics & Reporting, Risk Adjustment Services, Business Intelligence and Provider Contracting Analytics departments.• Led team of over 60, including actuaries, underwriters, nurses, medical coders, programmers, and data scientists.• Developed and presented all pricing and organizational cost reduction activities to the Executive Leadership Team and the Board of Trustees for approval purposes.Accomplishmentso Creation of an analytic infrastructure and discipline to support major cost reduction initiatives and improved forecast assumption development.o Successful implementation of products in the ACA market, achieving growth and margin in all years.o Improved pricing and underwriting performance contributed to margin performance improvement from -$79M in 2011 to +$80M in 2015, with enrollment growth in all lines of business. o Development of financial modeling in conjunction with investment bankers, and lead several management presentations during acquisition process.

Portland, Oregon, Us

Blue Cross Blue Shield plan serving a 4-state region • Led pricing strategy and implementation for small group lines of business, totaling $1.5 billion in revenue.• Drove pricing strategy and implementation for large group lines of business, including insured contracts, alternate funding arrangements, and administrative service contracts (ASC), totaling $3.6 billion in revenue.• Directed product development team across all commercial and Medicare lines of business.• Managed 15 actuaries, 1 clinical analyst, and 1 data analyst; responsible for staff hiring, training, and development.Accomplishments:o Created and led Cost of Care Analytics team responsible for identifying, promoting, and measuring cost improvement opportunities in operational and medical management activities and initiatives. Focus includes both commercial and Medicare lines of business.o Built and led Reimbursement Transformation team responsible for analytics associated with provider contracting strategies across 4 states.o Developed predictive modeling tool for use in large group rating formula.o Performed analysis on predictive power of several commercial diagnostic models; enhanced in-house predictive model through this analysis.o Designed price sensitivity model to be used in enrollment and revenue forecasting models for the organization.o Introduced process to optimize revenue from risk adjustment process for Medicare Advantage, achieving gross return-on-investment in excess of 300%.o Led actuarial department through system integration and common process initiative to streamline business process across four plans in four states.

Oakland, California, Us