• Established the Compliance Department to ensure compliance with CMS, DHCS, & DMHC regulations.• Led strategic direction for committee governance, policy governance, and regulatory implementations.• Developed new workflows and secured new systems to enhance operational efficiency.

• Transformed operations, technology, training, policy & procedures resulting in zero audit errors for DHCS & NCQA audits• Directed system-wide improvements via change management efforts to improve CAHPS survey results, health outcomes, & benefit administration• Served as a Chair & key speaker on various quality committees & PHC Board Meeting

• Led growth strategy for California TPAs, ensuring revenue targets were met.• Negotiated contractual agreements with new TPAs to drive business growth.• Represented TPA Product across enterprise• Developed retention strategies & trained Account Executives

Represented the Chief Information Office (CIO). Established positive relations and leadership guidance to 14 state Plan Presidents, Large Group Sales, and Account Management executives regarding emerging technologies, new product recommendations, contract negotiations, and client strategies. Ensured Anthem’s IT capabilities were well represented in RFP/RFR bidding process to secure and retain business. Provided leadership across the enterprise to ensure that IT successfully delivered products and services, mitigating risks on enterprise-wide initiatives. Successfully secured implementation of private exchanges and 200K life employer group.

Overall responsibility for client satisfaction, renewal negotiations, mergers & acquisitions, service, growth, and strategic relationships for a Book of Business (BOB). Create unique strategies with brokerage firms to ensure successful renewal negotiations. Cross-sell ancillary products on existing business. Customize service solutions to large brokerage firms creating trusted platforms to sale additional business. Provided leadership to account team to ensure excellent customer service to customers. BOB has been comprised of employer groups ranging from 51-120,000 lives. Manage $100M in revenue. Work with the top national brokerage firms/consulting houses.

Overall responsibility for client satisfaction, contract negotiations, renewals, and contract compliance for a BOB. BOB comprised of Fortune 500 health plans, one national and 10 western-regional health plans. Accountable for all lines of business within each health plan. Responsibilities included P&L, client retention, and upsell goals. Increased revenue by 17% within the first 5 five months of BOB assignment, though creatively successful upsell opportunities and aggressive RFP efforts.

Responsible for implementation of multi-million dollar cost saving initiatives, oversight of PBM’s service to WellPoint, and served as a pharmacy and medical benefit subject-matter-expert to sales, contracts, legal, and customer service. Managed formulary modifications, product development, pharmacy website, and compliance to all governing regulatory agencies. Key speaker on all operational activity for internal and external WellPoint health care and P&T committees

Overall account management responsibility for large group, small group, Medicare, and state-sponsored programs for one Fortune 500 health plan with 5 million lives. Managed strategic relationship, accurate benefit administration, system enhancements, and PBM’s overall service to client.

Project Manager on multiple company-wide initiatives that improved the auto-adjudication rate for medical claims from 4% to 53%. Subject matter expert on all medical benefit designs within various products. Created test plans, business requirements, project work plans, issue logs. Responsible for medical benefit analysis and programming (M204, COBOL) on adjudication platform of new operating system.

Specialized in customer service, claim processing, and membership functions. Responsible for production of 21 team members in a multi-functionality call center environment. TraveledCalifornia giving Medicare presentations to 200+ attendees in senior community centers.