Health Administration

Health Administration, Texas

Led the start-up of a new business unit for health coverage and cost containment services to large employee groups. Responsibility included definition of offered services, marketing, sales, client engagement member enrollment, claims processing, medical review and contract administration. Full accountability for six contracts with over $1 billion in total premium value. Led a team of 350+ in three locations.

  • Negotiated pilot agreement, and established initial operations within 90 days of contract.
  • Built a new unit successfully providing group health administration for more than 400,000 persons.
  • Saved $1.2 million in annual administrative costs and $24.7 million in claims cost for one client.
  • Added 2 new client groups.

Targeted (Health) Insurance Acquisition Search, Texas

Developed strategy and criteria for acquiring insurance subsidiary. Seeking charter and licenses in multiple states for continuing health coverage. Conducted search, identified “short list” of candidates and conducted negotiations and due diligence with two prospective companies.

  • Engaged actuarial analysis of risks and probable cash flows for candidate companies
  • Developed justification and valuation model for acquisition of insurance subsidiary.
  • Prepared proposal for acquisition
  • Facilitated clarification of strategy and redirection of sales efforts.

Health Administration, Colorado

Led acquisition of all staff and assets of information unit serving major Rocky Mountain health insurer. Built strategic relationship committed to regional health market and served on insurer’s executive staff.

  • Led negations forming new unit providing operational information services at fixed unit cost and $12 million in annual revenues, and strategic relationship in pursuit of new programs
  • Establishing long term relationship providing increased competitiveness and cost reduction, doubling productivity in claims processing and customer services.
  • Provided basis for improved actuarial and underwriting results.

Health Administration, Western New York

Acquired selected assets but not staff in strategic alliance with Western New York health insurer. Formed new unit and acquired staff to provide process innovation and information services to large health insurer in Western New York.

  • Restructured processing of health care claims and customer service, automating disposition for most health care claims
  • Established electronic interaction with key health providers
  • Automated screening (and selected disposition) for medical review

Health Administration, California

Key manager in acquisition of all assets and staff for information unit serving major health insurer. Established strategic alliance with insurer, providing all information services for operations and strategic growth.

  • Added new service serving pharmacy coverage
  • Restructured claims and customer service processes, reducing cost and improving service capability
  • Provided new capabilities in support of actuarial analysis and rate setting, including that for individual categories of coverage
  • Led design efforts for automated processes, for claims, and medical review

Health Administration, Texas

Key person in joint venture to change delivery of health care in Central Texas. Designed health care program serving medically indigent, offering “per capita” funding for medical and hospital care.

  • Provided for acquisition (staff, contracts, selected assets) for major public (teaching) hospital
  • Provided for equitable (accountable) distribution of costs between affected municipalities
  • Engaged local medical society, including primary and specialty care

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