- Saved over $10M in provider reimbursement and payment decisions compared to status quo-Network analytics-Provider negotiations -Provider reimbursement -Value-based care- Provider record services

•Responsible for the development and implementation of provider alternative payment models, including accountable care organizations, patient-centered medical homes, and quality-based reimbursement programs aimed at improving healthcare quality and outcomes while managing costs.• Collaborated with staff from other divisions to enhance and develop innovative care models such as collaborative care models.• Oversaw the value-based programs staff, managing daily activities related to program administration and provider reimbursement. • Developed Reimbursement Strategies: Managed the presentation and study of proposed changes in reimbursement for alternative-based payment models, including recommending updates and additions to provider pricing structures.• Assisted in developing negotiation tools for the provider contracting process and managed the presentation of new and existing value-based pricing and methodology to providers.• Supervised the collection and analysis of financial data from providers and affiliated entities, collaborating with consultants and financial experts to ensure data accuracy and relevance.

• Led the team that prepared all statewide annual rate filings for BCBSKS to the Kansas Insurance Department, ensuring compliance with state and federal regulations. • Facilitate communication across departments and handle board exhibits and related presentations.• Brought structure and cohesion to the pricing team, including the introduction of a task tracker system for clear goals and increasing the pace of crosstraining and knowledge sharing. • Steered the team to receive successful approval of all rate filings during the 2023 rate filing season as filed and proposed.• Implemented several operational improvements, including automation in the filing processes processes. • Spearheaded a new simpler and more clear file/folder structure within actuarial.

• Serving as lead pricing actuary for pet health insurance.• Built and lead a strong team of 4 direct reports while directing overall pet health pricing strategy.• Reduced Loss Ratio over 5% through execution of rate action strategy while growing the number of pets insured by over 81% • Spearheaded the development of a Python Indication process that allows the generation of all states through a streamlined process.• Developed a new proprietary model in conjunction with data scientists to prospectively predict risk and lifetime value (LTV).• Designed a Looker and Excel dashboard for experience monitoring to view business by segments such as breed, age, and veterinary cost zones.• Working with senior leadership on setting strategy, goals, and machine-learning initiatives for the pet insurance business.• Mentored junior insurance staff including actuarial associates, filing analysts, and data analysts. • Leading project to implement machine learning models into all segments of the pet insurance business.• Serving as signing actuary for pet rate filings while coordinating with the DOI on responses and communications.• Led the team in choosing an industry-leading credibility standard, based on both theoretical principles and a retrospective experience analysis.• Provided actuarial guidance in forming considerations for the now public Chewy and Lemonade partnership.

• Serve as actuarial expertise on a working group responsible for the development of a new pet product• Act as subject matter expert for human health insurance and managed care products to utilize insights to pet insurance.• Presented actionable opportunities from health insurance to apply to pet insurance.• Assist with forecasting and rate filing processes.

• Designed and created a Generalized Linear Model (GLM) in RStudio that replaced multiple legacy Excel studies. • Produced a board forecast to project results such as rate actions, membership, expenses, and underwriting gain• Designed and created sub models such as a projection model for predicting cohort rate actions and plan changes.• Successfully forecasted results and developed forecasting assumptions amidst the COVID-19 pandemic.• Performed monthly analysis of IBNR reserve workbooks in collaboration effort between pricing and valuation

Large Group Fully Insured Pricing

Provider eBusiness Services• Delivered ad-hoc reports using Microsoft SQL Server, Teradata SQL Assistant, Cognos, and Splunk.• Analyzed and proposed business solutions derived from claim, inquiry, and EDI transaction data.• Designed, improved, and maintained Microsoft Access Databases for staff to self-report.• Collaborated with others to use data to improve workflows and create new tools or processes.

Subject matter expert for difficult, complex, and large claims. Trained new claims examiners on the claims process. Manually calculated and overrode system for complicated claims, including for emerging ACA guidance and considerations.

Medical claims processing. Focused on:• IL Small Group Fully Insured• IL Large Group Fully Insured• OK Small Group and Individual Market• TX Small Group and Individual Market