Lead a diverse team of business and clinical talent that is responsible for product management & development, strategy, implementation, and sales support for the Highmark large group buy-up product portfolio.

Serve in the lead role on the Senior Markets Product Strategy team in the administration of all phases of product development with a focus on benefit design, comprehensive market knowledge, and strategic projects. Ensure product initiatives are in line with overall company strategy. Responsible for engaging matrix partners across the organization for the purposes of coordinating all aspects of product strategy and development. Ensure all product development opportunities are in compliance with CMS rules and regulations. Responsible for thorough comprehension of the Medicare markets that we serve. Responsibilities include owning an intimate knowledge of competitor plans/benefits, analyzing the market for growth opportunities including optimum micro-market segmentation and pricing, and using the information to inform product design and strategy. Responsible for designing a complete portfolio of plan benefit packages for Highmark’s most competitively positioned Medicare Advantage plans. Engaged management and matrix partners to ensure product changes are financially sound while ensuring the portfolio is competitive in the markets that we serve using the market knowledge described.Designed and implemented several packages of supplemental benefits which will enhance our member experience and improve competitiveness. Directed all phases of benefit design and implementation including conducting market research, vendor engagement, serving as the liaison between Highmark and clinical health partners, and coordinating system integration.Implemented a low-cost standalone Prescription Drug Plan for Medicare Supplement members in two markets in partnership with another BCBS plan. Serve as the project manager responsible for sales strategy, contracting, member-facing collateral, enrollment reporting to senior management, commission payment set-up and reconciliation, and agent certification.

Successfully managed the certification process mandated by the Affordable Care Act (ACA) by which Highmark’s health insurance plans appear on the public health insurance exchange for three companies in three states for plan year 2014. Developed the process for certification from the ground up, including: building relationships with key business owners, keeping abreast of volumes of regulations, communicating relevant regulations and guidance internally, establishing business processes and procedures, establishing best practices, and forging new relationships with state and federal regulators. Manage all other state and federal product filings as required by the ACA including plans sold outside of the exchange, enrollment reporting, vendor management, data correction, and marketing information. Serve in the lead role of the certification and filing team including: providing subject matter expertise, acting as the lead point of contact for internal and external stakeholders, project planning, coaching/mentoring, workload management and distribution, reporting to senior management, maintaining real time status for all ongoing projects, and providing input for staffing initiatives. Developed and continue to maintain excellent, productive working relationships with key stakeholders including internal business units, policy leaders at trade organizations such as AHIP and BCBSA, and state and federal regulators. Required to meet aggressive, inflexible deadlines set by state and federal government which is critical as non-compliance exposes the organization to financial penalties, negative media coverage, and the loss of access to critical markets.Was selected as one of only a handful of Blues plans to test beta versions of systems that the federal government developed for the health insurance exchange which was critical to Highmark gaining an advantage in the exchange implementation process.

Ensured compliance with internal control provisions of Model Audit Rule (MAR), which are similar to Section 404 of the Sarbanes-Oxley Act. Developed walkthrough and testing procedures and performed walkthroughs/tests of key controls for Highmark and subsidiaries. Managed the remediation process for issues identified during MAR documentation updates, walkthroughs, and testing. Coordinated and performed updates and optimization of documentation pertaining to business cycles for Highmark and subsidiaries.

Coordinated independent appraisals of Highmark’s performance in processing claims on behalf of group customers. Prepared claims for review and audited claims for pricing accuracy. Interfaced with Blue Cross and Blue Shield plans across the country to obtain and review documentation supporting the overall audit process. Coordinated meetings with operational staff, senior management, auditors, and group representatives in order to respond to audit inquiries and to resolve outstanding issues. Engaged in perpetual communication with senior management, executives, representatives from the client, external auditors, and internal staff to resolve potential issues identified in the audit and to provide support throughout all stages of the audit. Prepared and documented Highmark’s responses to the findings presented in the auditors’ Draft Reports.