Develop, implement, measure and refine an organization-wide multidisciplinary Customer Care Strategic Plan. Accountable to the Chief Deputy Executive Director and the Executive Director for formulating and implementing short, near and long-term consumer-centric policies across the organization. Provide a comprehensive and authoritative view of the consumer to create Covered California’s strategy to maximize a positive consumer experience for new, renewing and prospective consumers. Participate in decision-making with the Chief Deputy Executive Directors and the Executive Director on highly sensitive, political and complex issues impacting Customer Care. Set strategy and develop organizational agreements, metrics and performance measures that are aligned with the strategic goals and priorities. Use metrics and performance measures to formulate Customer Care policy initiatives with an enterprise-wide, multidivisional organizational focus on serving California's diverse communities and building consumer loyalty. Lead enterprise-wide workgroup(s) to identify, document, resolve, and collaboratively develop mitigationrecommendations, policy guidance, and communication plans for large scale consumer problems stemming from system defects or other consumer experience issues.

 Accountable for Public Sector and Owner accounts representing nearly half of Western Health Advantage membership enterprise-wide. Deliver on “zero fail” account management strategy ensuring proactive issue identification, transparent communication, accurate and essential client reporting, and seamless partnership with external vendors on behalf of client base. Critical understanding of public sector employer groups including collective bargaining agreements and labor negotiations. Full understanding of operational capabilities and extensive knowledge of implementing custom programs, networks, and client-specific initiatives. Creation of dedicated Public Sector business unit with Western Health Advantage, with a team of 4, groomed to deliver on promises and ensure customer and member satisfaction.

 Ideation, creation and implementation of University of California programs and initiatives furthering PCP-directed total care management, custom network reimbursement models, vendor platforms, data integration touch points, programmatic sustainability and scalability. Trusted advisor and consultant to UC Care Chief Medical Officer and Clinical Program Consultant to scope, define, and operationalize custom networks, program capabilities and reporting parameters to support dedicated population health management programs. Program driver for legacy claims modernization for the University of California account migration of 50,000+ members including development of detailed business requirements, risk/escalation and mitigation planning, UAT and risk resolution, and client management and communication of project milestones. Key stakeholder responsible for informing metrics, requirements and parameters for reporting catalog, definition and delivery of scheduled, ad-hoc, and new program reporting. Owner of processes, documentation and integrity of custom-tiered network and reimbursement methodology.

 Leadership of Account Management team including talent management and succession planning, individual goal setting, and coaching. Guidance and counsel regarding creation of Region/Affiliate-specific white papers or reporting requests related to overall plan design, future strategy, cost containment and program innovation. Overall operational management of (9) benefit plans including development of actuarial rating and multi-tiered premiums in collaboration with Director, Plan Operations, custom reporting requests to support labor negotiations and total compensation standardization, vendor integration and management for carve-out services such as claims administration, PBM, care management, utilization review, disease management and wellness. Critical participate in ideation and implementation of SutterSelect’s Population Health Management strategy including scope identification, vendor selection, success measures, custom reporting, long term sustainability/add-on services to grow and manage populations, and quality metric development to identify the “rising risk” within the member pool. Requirement for overall integration of multi-vendor system interface including EPIC, Orion and vendor technical requirements. Liaison to Clinical Operations including attendance and participation in weekly census calls, high dollar case review, appeals and grievance issues, daily authorization logs and workforce planning, development of system-specific prior authorization policies, and benefits management programs. Using LEAN principles, end-to-end (E2E) oversight for plan operations for eligibility/enrollment defining workflow and desk level procedures for Sutter Health’s newly developed Shared Services call center. This E2E service partnership extends to the health plan’s current and future role in open enrollment strategy, communication and internal stakeholder alignment on SutterSelect future healthcare initiatives.

 Consultative analysis of complex medical benefits for large employer groups, including claims detail review, census analysis, and design tailored to employer needs utilizing Blue Shield’s self funded capabilities. Implementation of group health initiatives including tiered network designs, custom concierge services, gate-keeping PPO platform, customized reimbursement methodologies, and employer-specific authorization/medical management policies. Detailed Health Reform knowledge specific to the self funded landscape. Development of ongoing self funded strategy related to market strength via new product offering, sales self service, virtual broker marketplace, and increased automation delivering efficient and repeatable design. Leverage Blue Shield enterprise-wide initiatives to bring increased visibility to self funded capabilities. Management of dedicated self funded design team accountable for new sales/renewal work, health reform interpretation and application, identification and development of technology enablers, identification of enterprise-wide gaps in administration of self funded plans, project management for key product initiatives, and client services and consultation. Managed enterprise-wide implementation of SBC template, coordinated approval and tracking of grandfathered health plans, sought executive approval for mini-med plans and then collection of Federally-approved waivers, and ensured compliance with out-of-pocket maximum guidelines, and co-accumulation rules related to health reform. Versed in fully insured products, product line management and governance, regulatory requirements, and health reform impacts.

 Strategically position Blue Shield through a comprehensive understanding of Blue Shield products and processes. Recognize opportunities to capitalize on Blue Shield strengths via products and programs that are relevant to client needs. Database / Data Management & Maintenance including maintenance and continuous improvement of the BDU knowledgebase: updating older information, archiving new information, and editorial rewrites and signoff on existing files. Continuous maintenance of knowledgebase with SMEs. Time management and prioritization skills adjusting workflow as appropriate to meet the needs of the BDU writers, SMEs, and other internal Blue Shield team members.

 Oversaw CalPERS public and State agency book of business in excess of 350+ agencies totaling over 100,000 members including onsite wellness meetings and open enrollment support, member benefits resolution and VIP claims issue liaison. Accountable for special projects including annual Evidence of Coverage booklet production with Blue Shield Legal, Marketing and Consumer Operations departments in partnership with CalPERS designees, analysis and delivery of contractually-stipulated service area ZIP code report, provider disruption analysis and reporting, identification and process improvements in connection with cost of healthcare initiatives, and other projects as assigned by the Director of Account Management. Credentialed as an Associate Project Manager by Blue Shield’s Center of Excellence/Project Management Office.

 Accounting functions including reporting, forecasting, projections, P&L, bank reconciliation (for 12 accounts), trust accounting, escrow account maintenance, accounts payable/receivable, billing, collections and payroll. 401(k) plan administrator – successfully researched, proposed and moved the Firm’s 401(k) plan from a third party administrator to the ABA Members Retirement Program where plan administration was free, investment options were doubled, and employee wealth management resources were immediately available. Human resources accountability including analysis of annual benefits renewal (medical, dental, long-term/short-term disability, life insurance and employee assistance programs), benefits enrollment, employee performance reviews, talent acquisition and management, staff morale projects and revision of employee handbook. Office administration including management and renewal of all Firm insurance policies such as professional liability, general coverage, employee dishonesty, workers compensation, and Shareholder supplemental life and disability policies. Project manager/coordinator involved in the overhaul of the Firm’s technology, library/records retention policy and systematization, and creator of protocol handbook documenting best practices and standardized work flow and time tracking.