Help Medicare Advantage plans develop and implement strategies to improve their Star Ratings. Assess the needs of each health plan client and develop a specific strategy to improve their Star Ratings, based on their unique internal and external challenges. Launch and lead initiatives for clients around all aspects of the Star Ratings program, including member engagement, provider engagement, data collection, reporting, forecasting, and operational improvements.Ensure that each client realizes maximum value from our engagement by providing best-in-class service.In some cases, serve as interim Star leader for Medicare Advantage organizations that are either too small to justify a full-time Stars leader or are in need of a Stars expert to lead the program until a permanent Stars leader is recruited.

Overall accountability for Star Ratings, Operations, and the Member Experience related to Cambia's Medicare Advantage line of business.Led enterprise-wide Star Ratings strategy, achieving 4 or 4.5 Stars in all eight PPO and HMO Medicare Advantage contracts across four states. Overcame the challenges of being loosely-managed, broad-network PPO plans with 100,000 members spread across rural and metropolitan geographies. Transformed the organization's engagement with members, providers, and cross-functional teams.Oversaw Medicare Operations, including Appeals & Grievances, Claims, Membership, and award-winning Customer Service. Drove improvements for the Medicare member experience through multiple outreach and education initiatives. Enhanced the experience of members receiving calls from vendors calling on the health plan's behalf by improving the campaign management, vendor management, and knowledge management related to every vendor outreach.

Drive enterprise-wide strategy to improve Medicare Star Ratings in a matrix organization for nine Medicare Advantage contracts across four states. Lead Medicare Advantage Operations division responsible for claims, enrollment, customer service, appeals & grievances, and the customer experience.

Oversee enterprise-wide Medicare Star Ratings program for all Medicare Advantage plans within matrixed organization. - Chair the Medicare Star Ratings Oversight Committee, which governs multiple subcommittees focused on clinical outreach, member and provider engagement, operations, pharmacy, and data management initiatives. - Collaborate with internal and external partners to develop, secure funding for, and launch innovative programs to positively influence Star Ratings. - Manage team of project managers and analysts responsible for leading cross-functional projects, gap analysis, and forecasting. - Serve on various enterprise-wide committees and workgroups focused on Quality Improvements.

Customer Service leader working with domestic and off-shore call center partners to support Training, Quality, and Operations initiatives to improve the customer experience.Liaison between the Markets and Operations focused on customer feedback, issue resolution, and root cause analysis of knowledge and process gaps.Lead Customer Service initiatives related to Annual Readiness, HEDIS, and CMS Star Ratings.Responsible for content creation of the Evidence of Coverage for all Medicare Advantage plans.Quality Assurance for all customer collaterals.Responsible for Knowledge Management content and usability.

Developed and managed CIGNA HealthCare’s relationship with multiple producers in 25+ consulting/brokerage firms in Houston.Crafted responses to new business opportunities involving Medical, Stop Loss, Prescription Drug, Flexible Spending Account, Behavioral, Dental, and Vision coverages.Determined appropriateness and necessity of offerings such as Disease Management, Medical Management, Utilization Review, Alternative Funding Methodologies, and High-Performance Networks.Strategized internally and with Brokes/Consultants on how to position CIGNA HealthCare to solve prospective client’s needs and secure the case.Negotiated internally with underwriters and management to provide proposals priced and packaged as aggressively as possible.Delivered formal and informal presentations to educate consultants, brokers, and prospective clients on CIGNA HealthCare’s capabilities, differentiators, and solutions to rising healthcare concerns.Promoted CIGNA HealthCare’s name and reputation in a positive manner in the healthcare marketplace through participation in industry events, healthcare-related committees, and community outreach.

Served as Senior Benefit Consultant on $900K+ book of business. Managed client interaction, expectations, and deliverables from beginning to end with CEO, CFO, and VP of HR. Oversaw all client/vendor relationships. Negotiated renewals and new business proposals with medical, dental, vision, life, disability, and stop loss vendors.Acted as Team Leader overseeing team of 4 Benefit Analysts.Orchestrated and conducted enrollment meetings for employees to educate them on new or revised benefits.Prepared and delivered sales presentations to prospective clients. Brought in by Sales Professionals as “Benefits Expert” to close sales.Designated as Training Champion for Houston office. Trained Benefit Analysts on alternative funding, establishing rate equivalents, employer contribution strategies, etc…Served on national Client Deliverables Standardization Committee. Goal was to create “Best Practice” uniform reporting packages for clients across all offices.

Managed overall benefit programs for national clients. Served as the point person for the executive-level client contact.Oversaw all vendor relationships. Ensured that vendors and clients were on the same page regarding expectations and deliverables.Completed and delivered financial reports for self-funded programs showing actual claims, accumulated liability, IBNR, and fixed costs.Prepared communications materials for clients to deliver to their employees. Materials varied from one-page “Highlights” flyers to several-page booklets explaining benefit changes in detail.

Provided analytical support to clients and senior consultants.Conducted competitive analyses and benchmarking presentations for clients to support plan offerings.Prepared renewal reports, experience reports, and Form 5500 filings.

Created mainframe-based data queries and utilized the information to determine and support plan design decisions. Forecasted future claims, managed care savings, and effects of plan design changes to benefit plans. Calculated incurred claims, reserve balance, and trend factors.Delivered monthly benefits presentation to the Corporate Treasurer.