Ryan Phillips Email & Phone Number

Saint Paul, Mn, Us

Minneapolis, Minnesota, United States

· Coordinate the pricing for certain segments of new and renewal employer group cases on Gravie’s proprietary products within designated authority limits.· Coordinate and review Individual Health Questionnaires (IHQ) to derive the cost projections for each individual enrolled in the plan.· Underwrite level-funded and self-funded cases with both individual and aggregate stop loss offerings, relying on claims experience, medical health questionnaires and other related data/information.· Review underwriting case preparation work from analysts and request and/or add analyses as necessary to accurately assess risk and recommend pricing for cases. Synthesize a variety of materials related to employer groups’ health plan performance to prepare cases for underwriting review, as well as make recommendations to Underwriting leadership.· Identify missing information or additional information that would be helpful; work with other teams to source this information, and in some cases, find creative ways to move ahead without it.· Use Gravie’s proprietary underwriting engine; add my experience and judgment when underwriting cases; and contribute to the improvement and evolution of Gravie’s underwriting practices.· Collaborate with Gravie teams and third-party underwriting and actuarial vendors as needed· Work closely with Sales Operations, Underwriting, and Analytics teams, as well as third party vendors, to support Gravie’s busy and growing pipeline of quotes successfully and efficiently· Work closely with Account Management and Underwriting Leadership on strategies and pricing to support the retention of existing customers.· Contribute to the development of Gravie underwriting strategies, guidelines, and tools to enhance the overall performance of the business and process.

Eden Prairie, Minnesota

- Independently work through complex issues to resolve all types of claims, recoveries, and resolutions for different health plans ranging from commercial customers to government entities- Establish strict adherence to state and federal compliance policies, reimbursement policies, and contract compliance- Consistently process recovery claims that met or exceed goals of $2.4 million dollars for the subrogation department by utilizing time management skills to effectively and efficiently process claims- Analyze, investigate, and pursue recoveries and payables on subrogation claims and file management through the SubroTrack and Cosmos systems- Examine, assess, and document business operations and procedures to the highest degree to ensure data integrity, data security, and process optimization- Motivate young professionals through Optum’s eMentors program to enrich their knowledge about the health industry as a mentor- Review current industry knowledge and utilize to leverage and negotiate with attorneys to adhere to state and federal laws in Optum’s favor

Eagan, Minnesota

- Reviewed, processed, and adjusted claims for several unique specialized functions such as auto, homeowners, and workers compensation which ensures timely and accurate payment or denial for the primary insurance- Coordinated and communicated benefits with other auto, homeowners and workers compensation carriers and verifying coverage limits- Communicated to injured members, attorneys, other insurance companies, and medical providers through inbound and outbound calls - Conducted high level research and investigating claims to determine other part liability by having up-to-date industry knowledge regarding specific state and federal laws about subrogation- Efficiently exceeded productivity goals by double by completing 100 claims a day with the department goal of being of 50 with no errors- Streamlined BlueCore’s claims processing by implementing a new macro that helped double productivity and created a workflow for the department to implement as well which saved time and money for BCBS

Edina, Minnesota

- Efficiently reviewed and processed formulary exceptions and prior authorization of medications for Medicare members- Exceeded hourly goals set by Prime while maintaining high industry and company standards of 99% accuracy - Communicate clearly to nurses, doctors, and pharmacists about medical histories of Medicare members to get the members medication approved- Handled Medicare members inquiries and requests about medication approvals from states such as Florida and Texas- Advised and collaborated with pharmacists to review the contraindications for Medicare members for approval