Mark Gallagher Email & Phone Number

Washington, DC, US

Tampa, Florida, US

• Managed the creation of Provider Scorecards from ideation to requirements gathering to rapid iterating to implementation
• Overlooked dozens of medical expense savings initiatives for Medicare Advantage and Medicaid members across 5 markets
• Created a financial Performance vs Plan dashboard to highlight deviations in utilization and unit cost with drill-downs through business unit, market, Payer, and claims category
• Leveraged disparate data sources and activity trackers to provide leading indicators and project medical expense savings
• Led ideation sprints with medical directors to optimize care and identify new avenues for savings
• Trained off-shore resources on optimizing data models, efficient query writing, and automation to maintain the dashboards I developed

• Committed to understanding a customer’s needs and delivering value
• Developed customized KPI dashboards with SSMS automation
• Wrote documentation and trained analysts on process maintenance

Baltimore, MD, US

• Responsible for instituting actuarial best practices within the MedicalEconomics and Finance teams
• Created IBNR and seasonality models used to improve the timelinessof the monthly financial close process by 7 days
• Advanced the predictive analytics models with k-means clusteringalgorithms utilized to identify persistently high-cost patients withchronic conditions fitting our care models
• Developed performance dashboards to monitor utilization trends,spot rising-risk patients, and forecast shared savings incentives forvalue-based contracts
• Designed operational data stores with integrated SSIS ETL procedures

New York, NY, US

• Charged with creating actionable intelligence across all departments
• Managed a team of 12 analysts with a broad range of skillsets, bothonsite and fully remote
• Introduced AI/ML to fraud, waste, and abuse toolsets that increasedannual recovered claims dollars by 15%
• Replaced Excel Power Pivot worksheets with Tableau dashboards,increasing Quality Management’s efficiency by 20%
• Implemented sales force automation to the customer relationshipmanagement tools for commercial products
• Redesigned the team’s operating model to bolster communicationwith clinical staff, data scientists, and executive leadership

New York, NY, US

• Accountable for the pricing of all Medicaid and Medicare products
• Presented pricing proposals and negotiated rates directly with clients
• Successfully renewed over 5 million member lives whilesimultaneously improving the average MLR by 30 basis points
• Developed the winning bid for Utah’s 2019 Medicaid Dental RFP
• Responsible for presenting IBNR projections to Corporate for themonthly adjustments to loss reserves
• Constructed a provider scorecard to inform value-based purchasingdecisions and achieve HEDIS goals

New York, NY, US

• Entrusted with leading the new Actuarial department
• Gave technical training seminars on SQL Server, Excel, and Tableau
• Founded an actuarial student program and internship program usedto hire 4 actuaries
• Built benefit-specific workday and seasonality models that wereutilized to enhance underwriting and IBNR projections
• Produced a financial health dashboard to track the MLR of allcontracts, products, and lines of business verses annual targets

Phoenix, AZ, US

• Focused on developing internal-facing analytics
• Led a small team of junior analysts focused on national utilizationtrends within managed care
• Enhanced loss reserves forecasting through the development of newIBNR models