Tom Gildea Email & Phone Number

Scottsbluff, Ne, Us

Advisor/Consultant, Innovative Health Holdings, independent sales firm for small employer group health plans for clients and broker partners. 2020 to present. • IHH is a start-up organization based in the Denver, CO area. • Currently acting in an Advisory/Consultant role. Primary responsibilities include supporting the ongoing efforts of raising capital investment funds and broker/client procurement. • Responsible for P&L and service delivery of administrative services. • Negotiate and manage all service vendor contracts and deliverables.• Responsible for service strategies and process improvements with all business partners. • Specific responsibility for daily communication and monitoring of TPA operations and service requirements. • Development and support of inter-departmental policy and procedures. • Support of Sales initiatives as well as growth of annual revenues.

Scottsbluff, Ne, Us

Scottsbluff, Ne, Us

Responsible for the oversight and successful management of the following departments and functions within Regional Care, Inc.: Claims and Customer Service, Membership/Eligibility, COBRA, Billing, Accounts Payable, Stop Loss/Funding, UM/Case Management, FSA/HRA/HSA and Project Management. Primary responsibilities include:1. The accuracy and quality of the output from each direct report/department.2. Manage the company wide processes for billing and accounts payable department.3. Providing guidance and direction for the project management team.4. Communicate internally and externally with clients, vendors and employees to assure timely responses. 5. Mentors internal direct report Management team to assure successful achievement of goals. Responsible for the performance of each Manager and Director. 6. Responsible for the implementation of process improvements that streamline departmental processes.7. Responsible for assuring compliance with all RCI agreements, policies and formal documents, in regards to the HIPAA Omnibus rules and regulations on Privacy, Security and Breach Notification.8. Accountable for achieving annual goals and meeting budget.9. Responsible for researching client complaints and following up with a timely response. 10. Coordinates audits, legal requests or Request for Proposals.

NTSP, a Third Party Administrator (TPA) of healthcare solutions for Medicare Advantage plans. • Responsible for the service delivery of $100M+ of annual revenue.• Manage multiple operational departments with a combined staff of 70+.• Manage all operational services to meet the needs of the provider community and 80,000 Medicare Advantage members. • Delegated service administrator for four major health plans. • Active in provider relations and resolutions for benefit and service related challenges. Lead contact for the health plans.

Little Rock, Ar, Us

HealthSCOPE Benefits is a Managed Care company that provides Third Party Administration (TPA) for self-funded employers nationally and internationally; as well as Claims Administration for broker companies selling on and off exchange medical plans in three different states. Responsible for all operational functions, Claims Administration, Eligibility Administration, support of Sales and Account Management and revenue rentention of multiple regional offices.

Richardson, Texas, Us

HealthSmart is a Managed Care company that provides Third Party Administration (TPA) for self-funded employers nationally. Responsible for the operational functions, customer service, support of sales and account management and revenue rentention of four regional service offices.Merger and aquisition transfer of all operations from one location to another. Included systems and operarational functions that resulted in annualized expense savings of $800k. Specialties: M&A, Turnaround, Strategic and Operational Planning, Forecasting, Budgeting, Cost Control, Customer Support, Call Center, Quality, Marketing, Business Development, Insurance, Workers Comp, Negotiations, Contracts.

Irvine, Ca, Us

CorVel Corporation provides review management of hospital and physician bills, negotiation and appeal resolution for Insurance carriers, Reinsurance carriers, Third Party Liability cases and self-funded employers. All operational and customer service are are provided nationally. Responsible for the Negotiation savings, revenue, operations, customer service and P&L. Resolved appeals through negotiation, arbritration and mediation.Negotiated savings and revenue increased over 100% in the first two years.Specialties: M&A, Turnaround, Strategic and Operational Planning, Forecasting, Budgeting, Cost Control, Customer Support, Call Center, Quality, Marketing, Business Development, Insurance, Workers Comp, Negotiations, Contracts.

Baltimore, Maryland, Us

Transamerica Insurance provides operational adminstration for claims, customer service, underwriting and policyholder service for fully insured and self-funded individuals and employers.Managed the client's helath benefit costs by providing cost management services through PPO, case management, nurse reviews, health plan design and underwriting.Specialties: M&A, Turnaround, Strategic and Operational Planning, Forecasting, Budgeting, Cost Control, Customer Support, Call Center, Quality, Marketing, Business Development, Insurance, Workers Comp, Negotiations, Contracts.

Greenwood Village, Co, Us

Great-West Life Insurance Company is both an Insurance Company and a Third Party Administrator (TPA) for self-funded employers for their health, dental and disabilty plans. Great-West provides managed care cost savings through their expertise in the areas of health plan design, PPO assignments and credentialing, underwriting, policyholder service, claims administration and customer service. Services are provided in all regions of the U.S.Specialties: M&A, Turnaround, Strategic and Operational Planning, Forecasting, Budgeting, Cost Control, Customer Support, Call Center, Quality, Marketing, Business Development, Insurance, Workers Comp, Negotiations, Contracts.

Rolling Meadows, Illinois, Us

Gallagher-Woodsmall is a privately owned Third Party Administrator (TPA) that provides multiple services to the self-funded employers thoughout the Midwest region; including adminstrations of claims operations and customer service. Gallegher-Woodsmall provided unique and specialized plan designs to support the client's health plan needs.Specialties: M&A, Turnaround, Strategic and Operational Planning, Forecasting, Budgeting, Cost Control, Customer Support, Call Center, Quality, Marketing, Business Development, Insurance, Workers Comp, Negotiations, Contracts.

Lincoln, Nebraska, Us

Specialties: M&A, Turnaround, Strategic and Operational Planning, Forecasting, Budgeting, Cost Control, Customer Support, Call Center, Quality, Marketing, Business Development, Insurance, Workers Comp, Negotiations, Contracts.