James Clauss Email & Phone Number

St. Louis, Mo, Us

Greater St. Louis

Selected to create small group center of excellence and consolidate underwriting for 14 separate state Blue Cross Blue Shield plans. Required implementing standardized yet flexible processes and systems to replace multiple legacy approaches, reorganizing approximately 70 associates into 1 team and effecting consistent risk management and rating methodology for various small group products.Collaborated with internal process engineers, local sales and underwriting experts and centralized… Show more Selected to create small group center of excellence and consolidate underwriting for 14 separate state Blue Cross Blue Shield plans. Required implementing standardized yet flexible processes and systems to replace multiple legacy approaches, reorganizing approximately 70 associates into 1 team and effecting consistent risk management and rating methodology for various small group products.Collaborated with internal process engineers, local sales and underwriting experts and centralized sales support unit, identifying best practices and designing coherent approach for all states.Participated in end-to-end business transformation project, providing guidance on business requirements, system architecture and automation options, and supporting new integrated operating structure. Incorporated machine learning and predictive analytics into risk evaluation process to maximize profitability and membership growth.Represented group on COVID-19 task force, evaluating potential market disruption and financial impact to customers and implementing solutions to provide relief for affected groups and members. Show less

Greater St. Louis Area

Managed underwriting and pricing for Anthem, MO local large group, network rental, and TPA affiliates, representing more than $1B of total revenue and $100M operating profit. Directed team of 12 with annual $1.5M budget. Key member of local executive team. Met with clients to explain rating actions and discuss benefit / funding alternatives to help control costs. Interacted with consultants and brokers to negotiate rates, address customer concerns, and build alliances resulting in mutual growth… Show more Managed underwriting and pricing for Anthem, MO local large group, network rental, and TPA affiliates, representing more than $1B of total revenue and $100M operating profit. Directed team of 12 with annual $1.5M budget. Key member of local executive team. Met with clients to explain rating actions and discuss benefit / funding alternatives to help control costs. Interacted with consultants and brokers to negotiate rates, address customer concerns, and build alliances resulting in mutual growth opportunities.- Exceeded operating gain and membership targets in 8 of most recent 10 years by implementing risk management and sales strategies to deliver profitable membership growth in highly competitive environment. - Established distinctive, flexible funding arrangements with multiple consortiums of public and private schools, resulting in market share over 50% of primary / secondary education groups in service area.- Created group specific strategies, with unique product combinations and financial arrangements, resulting in sales to several "jumbo groups", representing more than 170K members.- Acted as Agile business visionary for enterprise underwriting system development, providing direction to project team, accelerating progress, and resulting in adoption by 9 of 14 states within months.- Led DOL 5500 reporting mandate project, coordinating cross-functional team of almost 100 business, IT and IM associates to gather consistent data from more than 60 systems and databases to generate reporting of direct and indirect compensation, ensuring compliance with government regulations.- Influenced enterprise results by leading or participating in company-wide strategy development, planning, and projects related to insured risk evaluation and underwriting, ASO pricing, products, systems, generating consistency across all 14 properties. Show less

Greater St. Louis Area

Greater St. Louis Area