Jim Cunningham Email & Phone Number

Greater St. Louis

Lead operations supporting all payer and provider services for the Payments and Communications businesses.Functional service areas include:Clients: Implementation, Client Experience, Communications Channel OperationsProviders: Compliance & Risk, Network Implementation, Service Center, Payment Remittance, Payee Identification & Network Security (PINS), FraudInternal Shared Services: Strategic Enablement, Payment Operations, Project Management Office, CX Operations, Workforce Planning, Operational Site Expansion, Business Insights & Reporting, Quality

Greater St. Louis

Led operations supporting payer and provider services for the Payments business.Functional service areas include:Clients: Implementation, Client Experience, Communications OperationsProviders: Network Implementation, Service Center, Payment RemittanceInternal Shared Services: Strategic Enablement, Project Management Office, Workforce Planning

Remote/Greater St. Louis

Healthcare practice M&A advisor, engaged in:• Buy side diligence• Integration strategy• Asset optimization• Operational scale and readiness• Provider and patient engagement• OPEX and CAPEX recommendations

Remote/Greater St. Louis

Transitioned from Express Scripts to Evernorth following Cigna’s $67B acquisition in December 2018.Expanded scope to serve as COO leading all operations supporting $60B pharmacy benefits business unit, and integrate operations to enable enterprise service model.Scope included 10K global resources & $600M budget.Functional service areas included:Clients: Benefit Configuration, Eligibility, Consumer Driven Health (CDH), Client Service CenterMembers: Customer Service, Claims, Communications & DistributionProviders: Prior Authorization/Utilization Management, Medical Benefit Drug ManagementNetwork Pharmacies: Retail Pharmacy Help DeskInternal Shared Services: Project Management Office, Analytics, Quality & Continuous Improvement, Workforce Planning, Business Process Outsourcing (BPO) & Supplier Management, Corporate Real Estate, Business Continuity

Greater St. Louis

Promoted to improve operations supporting $60B pharmacy benefits business unit.Responsible for strategy & service across team of 3.5K global resources & $200M budget.Functional service areas included:Clients: Benefits, Eligibility, Consumer Driven HealthMembers: ClaimsProviders: Coverage Review/Prior Authorization, Medical Benefit Drug ManagementInternal Shared Services: Project Management Office, Analytics, Facilities Strategy & Planning, Workforce Planning, Quality & Continuous Improvement, Corporate Real Estate, Business Continuity

Greater St. Louis

Selected to launch new operating models for Benefit Services & divisional Shared Services organizations.Scope included team of 400 people & $40M budget.Functional service areas included:Benefit Configuration, Analytics, Quality & Continuous Improvement, & Program Management

Greater St. Louis

Transitioned to lead new organization focused on omnichannel contact strategy & >500M annual patient interactions following $29B Medco acquisition.Led 3 functions with >200 resources & $200M operating budget.Service areas included:Member ExperienceCampaign Management, database marketing operationsCommunications Fulfillment, with >500M outbound communications through omnichannel delivery

Greater St. Louis

Promoted to integrate $4.7B NextRx acquisition & implement Express Scripts’ largest client.Delivered largest client implementation in company history, spanning 12 health plans and >17M patients in only 18 months.Led $120M budget & team of 350.Functional Service Areas included:Implementation, Prior Authorization, & Customer Experience & Strategy

Greater St. Louis

Promoted to lead concurrent turnarounds across 2 operations.Led team of 160 employees across 4 sites responsible for >20K annual plan changes & comprehensive clinical program portfolio.Functional services included:Client Benefit Administration and Campaign Management

Greater St. Louis

Promoted to lead operational recovery & profitably grow book of Commercial Division clients with $39M in annual gross margin.

Greater St. Louis

Selected to establish Medicare Ombudsman office for company’s entry into new regulated Medicare Part-D market, & to transform service resolution & reporting teams for non-regulated business.

Greater St. Louis

Selected to improve internal & external service levels & quality of clinical outreach programs.

Greater St. Louis

Promoted from Consultant to lead divisional turnaround for integrated data products/services supporting all health plan clients.

Greater St. Louis

Responsible for in- & outpatient cardiopulmonary care, and community wellness programs.Promoted to lead wellness programs across three network hospitals.