Prescription Drugs, Network Medical Claims, Out-of-Network Medical Claims, Organ Transplant Claims, Dental, Claims Re-pricing, Actuarial Functions. Operation Functions, Identification Cards
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Actuarial

  • Designed, priced, and monitored health insurance plans
  • Audited TPAs, vendors and insurers
  • Worked with insurers, reinsures, TPAs, and consultants
  • Communicated actuarial issues with over 40 insurance departments
  • Keen analytical, project management and problem solving skills
  • Specialized mathematical knowledge and strong computer skills
  • Good business know-how of finance, accounting and economics

Pharmaceutical

  • Resolved pharmaceutical issues with PBMs
  • Formulary selection
  • Financial and pharmaceutical impact of new generic drugs
  • Pharmaceutical experience at commercial and academic institutions
Negotiations
  • Vendor negotiations
    • PBMs, PPOs, and Organ transplant networks
    • Fee Negotiators, Claim re-pricing
    • Hospitals
    • ID cards
    • Over $50 million in annual savings
  • Negotiated insurance rates with state insurance departments
  • Superb negotiating efforts consistently recognized

Marketing

  • Owned insurance agency
    • Marketed auto, home, life and health insurance products
  • Communicated with local and regional field offices
    • Vendor issues
    • Financial issues
    • Provider issues
    • Health insurance questions
    • Rating issues
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