Cheryl Duva 203-733-9005-C Email and Phone Number

Key Areas of Focus:- Leader health care fraud and abuse data analytics detection and prevention services - Strategic planning and solution design and development - Service delivery design leader - Payment Integrity / Anti-fraud and abuse forensics- Operations performance improvement solutions – e.g., operations, financial and risk management- Regulatory compliance – Perform organizational Impact assessments and risk mitigation - Cost Containment Solutions – Focus on detecting / preventing payment inaccuracies - Product/Service Innovation and Development- Medicaid and Medicare managed care regulatory compliance, operational and financial performance improvement- Retail, Mail and Specialty Drug cost containment / trend management- Pharmacy Benefit Management: Operational Improvement, Regulatory Compliance Advisement and Contracting Innovation / Key Accomplishments- Data Analytics and Artificial Intelligence: Designed, developed, launched and operate health care data analytics / cost containment initiatives - Designed and implemented prescription drug revenue / margin enhancement program – secured $40M+ revenue enhancement for major retail client within 4 months ($100M annual revenue improvement)- Spearheaded start-up business unit for a Fortune 5 company- Designed and implemented a ground up compliance department and FWA solution for national Third Party Administrator

Responsibilities Included:- P&L Responsibility for a $500 Million Health Plan Business Unit- Strategic planning, operations, product development- Prescription drug benefit administration, management and cost containment- Drug trend management- Specialty drug program administration, design and management- Clinical program management- Vendor management- Fraud , waste and abuse program design/implementation; and - Customer Service Help Desk OversightInnovation• Data Analytics: Designed drug trend and pipeline management solution to analyze and mitigate risks associated with medical and specialty drug costs• Spearheaded innovative benefit design modeling applications Finance / Growth• Renegotiated PBM contract resulting in $30 million dollar cost savings plus additional year over year savings achieved via a shared savings arrangement • Increased compliance performance outcome for government sponsored business lines• Implemented cost containment solution - $10M cost savings

Spearheaded Health Plan Business Unit Transformations Primary focus on Managed Care, State and Federal Government Program Sector that includes Medicare, Medicaid, Child Health Plus and ACA - Health Insurance MarketplaceKey Areas of Expertise:- Client Relations Management - Regulatory Compliance- New Business/Program Development- Health care reform (ACA) / Public Health Insurance Exchanges (QHPs):- Administrative, Organizational, Operational Structure Design- Medicaid Expansion o Dual Eligible (Medicare/Medicaid) Program Development o Claims payment accuracy – Overpayment and fraud, waste and abuse detection/analysis detection / prevention- Business Transformation of Integrated Health Plan Business unit: o Operations and financial performance improvement o Contract negotiations / renegotiations o Compliance: e.g., State / Federal, CMS Medicare Parts D and B, ACA o Benefit Design / Development- Strategic Planning- Data Analytics and use case development - Dash board reporting - Clinical service offering development- Talent Acquisition: Staff recruitment/Retention- Financial and Operational Performance Improvement - Health Plan M&Accomplishments- Thought Leadership: - Authored / Co-Authored multiple white papers on leading healthcare topics that included, Health Insurance Exchange; Healthcare for Medicaid Dual Eligibles and Fraud, Waste and Abuse detection and prevention - Public speaker (e.g., NHCAA, AHIP, HCAA)

Health Care Executive focused on key areas such as:- Payment Integrity / Fraud, waste and Abuse- Medicare (Part D and B), Medicaid, Uninsured program design and financial modeling- Pharmacy Benefits Management (PBM): cost containment solution development- Enterprise Solutions and Complex Operating Models- Product Development, management and operations- Pharmacy drug cost management (fraud, waste and abuse)- Financial and Operational performance improvement evaluations, - Strategic planning, Consulting and Business Development- Medical Home designInnovation- New Business Unit Start-ups- Designed and launched “1st of its kind” cost containment/ recovery program (e.g., Claims Overpayment, Fraud, Waste and Abuse detection)Finance / Growth- Achieved $10 million new sales in under 13 months

Responsible for the Managed Care / Payer Practice. Transitioned to Optum (aka Ingenix) to lead the Connecticut and New York offices and Oversee Optum's Pharmacy Data Analytics Business Division.

Senior Health Care ConsultantMedicare subject matter expertPharmacy benefit management subject matter expertProject LeaderInternational market- strategic planning for UK health care pharmacy benefit delivery system

Sr. Executive responsible for the senior market retention strategy (8+ million lives)- Developed innovative 1st of kind nationally recognizedprescription drug cost containment program/service: * Recovered > $26M within 16 months for fortune 50 employer group clients

Provider Network Management and Contracting; Medicare Managed Care; Medicaid Managed Care