Thomas Everett Email & Phone Number

Odessa, FL, US

- Provided strategic guidance to clients, contributing to 15% improvement in cost containment acrossmultiple health plans.- Analyzed and monetized market drivers, delivering insights that generated $500K in savings throughAI/ML-based payment integrity solutions.- Advised on the implementation of big data and analytics tools, leading to 10% reduction in.

Saint Louis, MO, US

- Directed initiatives that resulted in $6B in annual cost savings and reduced accounts receivable by$200M.- Managed recovery efforts with five collection vendors, achieving $5M in recovered revenue annually.- Conducted system audits and optimized claims adjudication processes, reducing claim expenses by15%.- Scaled operations to serve 19M members.

- Oversaw 900 global employees to process 90M claims annually, achieving 99.5% financial accuracyand reducing turnaround time (TAT) to three days.- Streamlined end-to-end claims processes, leading to 20% year-over-year improvement in productivity.- Directed $23B claims payment operation while meeting SLAs for dispute resolution and appealsprocessing..

Tampa, Florida, US

- Led the corporate SOX audit program, ensuring compliance across multiple business units andreducing financial inaccuracies by 2.25%.- Enhanced vendor performance metrics, achieving a 100% success rate in meeting SLAs.- Reduced enterprise risk by implementing automated processes that improved audit controls andaccuracy.- Managed cross-functional teams to.

- Launched data science-driven claims overpayment recovery solution, capturing $50M in cost savingsfor commercial payers.- Led team in implementing machine learning technologies, reducing claims overpayment errors by40%.- Partnered with four major insurers (United Health, Cigna, Emblem Health, and Aetna) to enhancepayment integrity initiatives.

Tampa, Florida, US

- Managed a 140-member team responsible for Medicare and Medicaid provider data and fee scheduleconfiguration, achieving 100% TAT on all updates.- Led coding and policy editing operations, reducing system errors by 12% and improving paymentaccuracy.- Implemented automation tools that decreased manual workflows by 20%, driving faster claimsadjudication.

Albany, NY, US

Executive Project Director for hospital operations to implement Soarian Financials business systems from Siemens. Leading a diverse team of technology, business, financial and clinical business owners to obtain greater efficiency, adopt new technology and improve revenue cycle management and patient access.

Business leader for a nationally accredited Health Plan responsible for all claims processing functions and customer centric service levels for all lines of business: HMO, Medicare Advantage, Consumer Directed Health Plans, High Deductible Health Plans, Individual, and Self-Funded accounts. Responsible for management teams and staff with functions that.

Executive that is responsible for Account Management and Dedicated Service Center Operations (Claims, Customer Contact Center, Provider Service, Membership, Audit, Finance and Business Systems). Responsibility includes General Manager with accountability for customer satisfaction, profitability and relations with stakeholders (Members, Providers, Blue.

General Manager with responsibility for claims administration and business delivery systems (claims engines -multiple, imaging document system, COB databases & outsource vendors) that spans two major accounts for benefit groups with 990,000 members and $663 million in claims expense. Oversaw claims processing at national and local levels and was.

Bachelor Of Science - Bs, Criminal Justice And Technology

Bs, Sociology & Information Systems