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Thomas Everett personal email
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I am a seasoned operations executive with a proven track record in delivering strategic solutions for Medicare, Medicaid, and Commercial health plans with revenues exceeding $120 billion. My expertise lies in driving cost reduction, enhancing claims and payment integrity, and optimizing processes through automation and advanced analytics.Throughout my career, I have spearheaded initiatives that resulted in significant cost savings, including reducing annual expenses by $6 billion and recovering millions through strategic vendor partnerships. I have successfully led large-scale operations, overseeing teams of up to 900 employees and managing complex claims adjudication processes that handle 90 million claims annually, achieving 99.5% financial accuracy.As a forward-thinking leader, I have consistently improved operational efficiency by implementing cutting-edge solutions like AI/ML-based payment integrity tools, driving a 20% year-over-year productivity improvement. My expertise extends to managing multiple claims platform migrations, optimizing reimbursement strategies, and enhancing provider payment accuracy, all while maintaining compliance with industry standards.In my recent roles, I have advised major health plans on cost containment strategies, improved payment integrity, and streamlined processes that significantly reduced operational risks and enhanced compliance by 30%. My passion for driving change through data-driven insights and technology has allowed me to deliver impactful results, such as enhancing audit controls, reducing overpayments, and achieving 100% SLA compliance with vendors.I thrive on challenges and excel in roles that allow me to drive innovation, build high-performing teams, and deliver sustainable financial outcomes. Let’s connect to explore how I can leverage my skills and experience to contribute to your organization’s success.
Health Care Industry Business & Operations
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Advisor Health Plans And Insurance IndustryHealth Care Industry Business & OperationsOdessa, Fl, Us
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Advisor Health Plans & Insurance IndustryHealth Care Industry Business & Operations Jan 2024 - Present- 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 operationalinefficiencies.- Consulted with five major health plans on optimizing claims management processes, enhancing theirnational footprint.- Delivered recommendations that improved payment integrity and compliance by 20%.
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Sr. Director ClaimsCentene Corporation Apr 2021 - Apr 2024Saint 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, ensuring accuracy in benefits coordination and primacydetermination.- Implemented risk assessments that decreased operational risks by 30%, enhancing compliance -
Senior Director Of OperationsCentene / Wellcare Corporate Nov 2016 - Oct 2021- 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.- Improved pre-payment audit accuracy by 15%, reducing overpayments and unnecessary medicalspending.
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Senior Director Claims AuditWellcare Health Plans Mar 2015 - Dec 2016Tampa, 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 improve system configuration, increasing financial accuracy from97% to 99.25%. -
Vp | Health Insurance, OperationsOmniclaim, Inc. Apr 2014 - Mar 2015- 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.
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Senior Director Provider Configuration & Coding | HealthcareWellcare May 2012 - Apr 2014Tampa, 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.
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Corporate Finance Project DirectorAlbany Medical Center Jun 2011 - May 2012Albany, Ny, UsExecutive 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. -
Director Connecticare Claims & Liability And RecoveryConnecticare, Inc. 2002 - Sep 2011Business 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 include adjudication, eligibility, primacy, appeals, clinical coding, technical analysis, SOX reporting, data base maintenance, front-end, fraud and abuse, and payment recovery. A Business owner that achieves strong member centric performance results such as with 99.5% financial accuracy, auto-adjudication rates at 93%, and audit savings at 9% of overall medical claims expense annually. Other key responsibilities include managing clinical staff for provider appeals, fraud investigations and stakeholder for such corporate projects as ICD 10 remediation and migration to new core claims systems
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Director Federal Employee Program & SystemsEmpire Bcbs Apr 1999 - Jun 2002Executive 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 Cross Association & Office of Personnel and Management). Act as Product Management Lead to create and implement annual business plan valued at $17 million dollars with a member base of 90 thousand lives and $300 million dollars in medical and dental claims expense in a twenty-eight-county metropolitan area in New York State.
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Director Nyship & Febhp ClaimsEmpire Bcbs 1995 - 1999General 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 responsible for medical, dental and mental health claims, coordination of benefits, other party liability determination and savings, benefits analysis, systems testing, and corporate projects.
Thomas Everett Skills
Thomas Everett Education Details
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Elmira CollegeCriminal Justice And Technology -
Elmira CollegeSociology & Information Systems
Frequently Asked Questions about Thomas Everett
What company does Thomas Everett work for?
Thomas Everett works for Health Care Industry Business & Operations
What is Thomas Everett's role at the current company?
Thomas Everett's current role is Advisor Health Plans and Insurance Industry.
What is Thomas Everett's email address?
Thomas Everett's email address is ev****@****ail.com
What is Thomas Everett's direct phone number?
Thomas Everett's direct phone number is +181349*****
What schools did Thomas Everett attend?
Thomas Everett attended Elmira College, Elmira College.
What skills is Thomas Everett known for?
Thomas Everett has skills like Process Improvement, Insurance, Medicare, Managed Care, Health Insurance, Leadership, Management, Healthcare, Medicaid, Claim, Strategy, Business Process Improvement.
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