Jorge Restrepo Email & Phone Number

Greater St. Louis Area

Greater St. Louis Area

Within the claims division, responsible for managing operations’ financial planning, data analytics, as well as the Medicare and Exchange product operations teams. Included leading claims automation, training, implementation of new businesses and expansions within all of Centene’s product lines. Also responsible for improving claims quality and payment compliance with state and federal agencies, and contract benefit and payment configuration for products in 15 states. 7 direct, staff 100+.• Led the Medicare and Exchange Product Operations team and Medicaid Implementations• Identified and implemented claims automation and process improvements generating 50+ FTE avoidance, and reducing the cost per claim by 13%.• Responsible overseeing division’s $40m budget and planning initiatives. • Led data analytics team that developed new performance management reports, executive dashboards and inventory alerts for daily and monthly tracking of claims aging and inventory as well as Key Performance Indicators that identified opportunities leading to improved SLAs and KPIs.

Greater St. Louis Area

Responsible for developing, implementing, and maintaining technology initiatives for $10b client. Included overseeing cross-functional projects spanning multiple technology platforms to meet business/client needs (CRM, end-user applications, claims adjudication, systems validation, reporting, web, mobile, B2B). Also, responsible for ensuring 100+ annual projects and initiatives are delivered, while managing risks and developing mitigation plans as needed. Staff of 15 (on/off shore) and $20M+ portfolio.• Led development of dedicated self-service, end-to-end claims processing validation environment. • Managed systems integration medical management (prior authorization) work stream, delivering 50+ unique client-specific capabilities.• Managed Joint Application Requirements (JAR) and Joint Application Design (JAD) sessions to maximize ROI meeting client expectations established time and budget constraints.

Greater St. Louis Area

Responsible for maintaining ongoing relationships of top ten Pharma and Biotech clients supporting Specialty Pharmacy, Specialty Distribution, Reimbursement, Patient Assistance and complex clinical mandated programs. Included, developing staffing models, trending analysis, strategic dashboards and financial reports used to monitor results and aid strategic decision-making. Also, responsible for optimizing contractual performance and handling strategic client relationships providing increased annual sales ($2M+), and securing client retention. Staff of 5 and $15M gross margin contribution.

Greater St. Louis Area

Responsible for supporting operational and regulatory components associated with $10b Medicare/Medicaid client (1.2m members). Included supporting migration of systems, adapting and transforming processes, and leading team’s cultural adaptation from NextRx to ESI. Also, responsible for ensuring operational and systems compliance to Medicare and Medicaid regulations. Staff of 6.• Federal and State Regulatory Compliance • Claims processing, financial reconciliation (PDE), member communications (EOBs), formulary, pricing and benefits.

Greater St. Louis Area

Responsible for operational oversight of Managed Care’s 20+ Medicare and Medicaid clients. Included development and delivery of PBM programs to meet Federal requirements, as well as identifying/implementing process improvements and enhancing core product offering (cost-financial-operational-compliance reporting, claim adjudication, financial analysis/reconciliation, audit support, development of policies/procedures, Prescription Drug Event – PDE, and rebates). Also, responsible for managing clients’ encounter files creation and error resolution. Staff of 2.• Led design and development of automated claims re-processing system.• Advised clients on wide range of Medicare Part D regulatory compliance topics. • Developed solutions spanning cross-functional teams, improving member experience, and avoiding regulatory sanctions.

Greater St. Louis Area

Responsible for supporting SVP developing company’s Medicare Part D product, defining strategy and building complex financial models to establish target market. Included leading development and execution of budget and resource plans and defined pricing strategy. Also, responsible for leading the design and implementation of the low-income claims adjudication system (retro LICS).

Greater St. Louis Area

• Led the analysis and development of pricing strategies for new and existing products (Mexico, USA)• Consolidated, reviewed, and analyzed monthly financial performance results for global operations to include actual and forecasted results (at various levels: product, country, manufacturing plant)• Developed reporting and forecasting of manufacturing variances at the global and area level, preparing templates, analysis, and presentations for review to senior management• Developed consistent COGS reporting between manufacturing locations and markets and worked closely with product management, finance and plant managers to explain COGS variances, product cost drivers, and identify VA/VE (value added-value engineering) opportunities generating over $10 million in increased revenue with minimal cost• Participated in New Product Development analysis, stage-gate product development, rationalizing resources, identifying value added/engineering opportunities, and pursuing profitable new products• Assisted senior management with due diligence and financial modeling of targeted acquisition in Mexico and determined divestiture value and business impact of a manufacturing facility• Created and analyzed a Voice of the Customer and Voice of the Sales surveys used to strengthen the brand, identify market trends, determine new product opportunities and create value added features

Medellin, Colombia

• Led the development of a new credit risk analysis work flow application integrating multiple platforms (AS400 mainframe, LotusNotes, DB2)• Implemented and improved credit risk scoring models developed in conjunction with Fair Isaac to improve the precision, consistency and analysis of credit applications• Presented credit requests to bank’s CEO, CFO and Regional Risk Managers• Led the creation of a new Collections business unit and developed required IT applications to focus on high-end customers with past due obligations. Recovered $8M during the first six months of launch (outstanding due balance $20M).• Developed dashboard to track Credit Card, Personal Loans, and Overdraft default rates performance• Managed the integrated DB application used by 25 geographically dispersed collections agents

Medellin, Colombia

Family-owned Consumer Packaged Goods (CPG) company specializing in the development, manufacture and sales of vitamin enriched dairy based products.• Restructured the company's financial position: established new lines of credit, managed cash flow, decreased the DSO ratio, increased sales. Overall improved the financial analysis functions within the company.• Developed the new branding and marketing strategy for the company and its existing line of products. Developed new products based on market segmentation and positioned the brand within its market. This led to increased revenue as well as an improved market positioning.• Optimized manufacturing processes, began ISO 9000 certification program and introduced lean manufacturing. • Increased manufacturing efficiency more than 10% with no capital expenditures.• Dealt with international trade (US and Europe): LOC, imports, duties, insurance, and government regulations.

Master Of Business Administration (M.B.A.)

Bachelor’S Degree

High School