Jon Gilbert Email & Phone Number

Naperville Il

Working closely with Cognizant's clients that use Cognizant's Facets product (a health claim adjudication system) to meet the client's business needs through configuration and optimization of Facets.

Greater Chicago Area

Holding leadership roles in the implementation of technical and business requirements in the health care insurance industry.

Chicago, Illinois

Leader in the successful implementations of Federal and State regulations:• Led successful implementation of ICD-10 (7 years) an enterprise wide clinical, technical and business implementation, ANSI 5010 (3 years) a technical implementation, and Mental Health Parity, among many other projects; completed on time with no critical issues and within budget.• Ensured technical and business solutions, approaches, and timeframes had limited financial and operational impacts to HCSC through on-going impact discussions across technical and business areas and across corporate initiatives.• Identified and managed scope, stakeholders, risks, communications and procurement.• Established then managed budget through monitoring and approval processes for budgetary changes.• Directed technical, business, and project management teams to a coordinated effort through planning, on-going communications and open dialog.• Facilitated constant communication between business areas to identify and eliminate areas of conflict or impact.

Chicago, Illinois

Created the polices and process for the Regulatory Program Management Office. Managed the Regulatory PMO. Evaluated and determined corporate impacts of federal and state legislation. Coordinated the education and review by the appropriate business areas and assisted in developing a business plan to address the implementation of the regulation. Ensured staff used best practices in managing the regulatory implementations.

Greater Chicago Area

Headed the Project Management Office for regulatory implementations for Health Care Service Corporation. Lead the enterprise implementation of a number of regulations impacting both business operations and technical requirements, such as HIPAA Privacy and HIPAA Administrative Simplification standards.

Greater Chicago Area

• As product manager, identified industry needs and developed software solutions to meet needs for the health care insurance industry, such as adding Workers Compensation capabilities to product line. • Worked with clients to identify, design and develop solutions unique to their business: o Image management solutions o Electronic claims submission formats and processing (prior to HIPAA Standard Transaction and Code Sets regulations) o Provider network arrangements• Established and managed RIMS as an application service provider (ASP) of RIMS' health insurance claims payment and eligibility system to several 3rd Party Administrators, which helped lead to the purchase of RIMS by Trizetto.

Greater Chicago Area

• Directed the requirements, design, development, maintenance, quality assurance, and implementation support teams (total staff of 70) for CAPS Claims Payment and eligibility system used at several mid and major US health insurance companies as well as 3rd party administrators.• Worked with clients to identify, design and develop customized solutions:o Claims adjudication calculations to accommodate client’s unique product offerings (deductibles, out of pocket, accumulations, and other calculations)o Reimbursement solutions, for example, unique provider PPO arrangementso Reporting systems with user driven parameters used for analysis, policy holder report packages, fraud and abuse, and other purposeso Modifications to meet client’s specific technical architecture needs• Installed the software at client locations working as the project manager for the efforts utilizing clients staffing along with ASA staffing.