Healthcare Executive: CFO, Chief Analytics Officer, Chief Actuary, Thought Leader
Strategy, Financial Performance, Healthcare Optimization, Enterprise Risk Management, Product Development
Financial executive, actuary and management consultant to health plans, providers and employers, with in depth knowledge of financial, operational and clinical trends in healthcare; understands the competencies and technologies required to manage, predict and adapt to the changing healthcare business environment; sometimes referred to by colleagues as the �Chief Innovator.�
Adds value by configuring analytic capabilities to efficiently and effectively monitor performance and make course corrections; finds, develops and grows analytic competence; evaluates and deploys the right technologies and the best tools; sets and manages expectations.
Grows the organization�s competitive position by optimizing the use healthcare resources and maximizing financial performance; enhances organizational competence by advancing thought leadership and developing career opportunities that attract and retain the best talent; initiates and sustains organizational change.
Brings leadership skills that overcome execution gaps between the business and technology; grows competence in decision support; instantiates performance measurement enterprise wide; handles chaos and complexity with ease; establishes a solid framework for executing on strategy and delivering results.
Focuses long term on making strategic initiatives successful; on uniting leadership with analytic improvement and technological advancement; on deploying innovative and adaptive approaches such as BEST STRATEGIES, a cost effective methodology to meet critical strategy needs in a rapid manner.
CORE COMPETENCIES
Leadership Communication � Consensus Building � Change Management � Talent Planning � Organizational Change � Business Valuation � Actuarial Attestation � Underwriting � Project Management � Competitive Analysis & Benchmarking � Government Contracting � Asset Liability Matching � Business Case ROI � Sarbanes Oxley � Technology Alignment � Data Modeling � Metadata � Advanced Analytics � Business Intelligence � Decision Support � Lean Analytics � Vendor Contracting � Product Lifecycle � Risk Remediation � Risk Management � Data Mart Creation � Data Quality � Performance Measurement � Claim Audit � Federal Acquisition Regulations � Workflow Business Rules � Pricing Trends � CAPM � Efficient Asset Portfolio � Optimal Rx Guidelines � Analytic Competence � Capital & Financial Planning � Duration Matching
CAREER HISTORY & TOP PROFESIONAL HIGHLIGHTS
SPECIALTY HEALTH PLAN, a PARENT HEALTH PLAN INC. Company, Chief Financial Officer, Chief Analytics Officer, Chief Actuary, PARENT HEALTH PLAN INC., VP Finance, 2003 � 2008.
SPECIALTY HEALTH PLAN is a specialty health plan with annual operating margin over $75 million. PARENT HEALTH PLAN has annual net income of over $200 million.
Managed budget and planning, financial operations, actuarial, underwriting and data analysis units; led financial strategy and performance, capital investment, clinical profiling, management scorecards and regulatory compliance; guided management�s financial goals enterprise wide and by business unit; implemented federal acquisition regulations and cost accounting policies and procedures; implemented Sarbanes Oxley risk mitigation structure; oversaw business case ROI analysis, approval and performance;
Strategic Leadership - Led a successful multi-year strategy increasing gross operating margin by over 500% in four years by collaborating with operational and clinical leaders to implement and monitor key initiatives against the strategic plan; met Federal Acquisition Regulation requirements leading to an award of nearly a one billion dollars in funding authority.
New Business and Product Development � Created a $100 million government services company; designed, priced and launched a new series of insured products for over five million covered members resulting in higher margin, retention and satisfaction; created performance reports to improve client awareness of positive changes; led actuarial and underwriting research, renewals and client profitability forecasts resulting in better product design and development.
Business Process and Organizational Change Management - Implemented process and competency improvement initiatives in claims, call center, account services and clinical operations reducing costs over $20 million per year; decreased a finance unit of over 50 employees down to 25 saving over $2 million per year; developed, implemented & reengineered over 300 SOX risk mitigation procedures resulting in lower claims errors, higher client satisfaction, better operating performance and greater transparency of operational risks.
Financial and Analytic Competence - Integrated finance, actuarial and underwriting improvement initiatives resulting in higher quality analytics; built ongoing planning and performance monitoring into monthly workflow and close calendars leading to faster plan revisions and performance feedback; reengineered analytic competencies and data warehouse capabilities to delivery higher quality reports and analysis.
Innovative Analysis and Data Integration � Reorganized the patchwork of planning capability across financial, administrative and clinical operations resulting in more timely and insightful forecasting; led ROI research of clinical interventions to reduce claims trends; led assessment and installation of Cognos and SAS applications bringing a comprehensive claims, account services, medical management and provider contracting BI capability to the business, clients and providers
Enterprise Risk Management � Led risk assessments across SPECIALTY HEALTH PLAN and PARENT HEALTH PLAN; implemented technology solutions to create risk mitigation work flow procedures as needed; managed enterprise liquidity, product, capital, customer and pricing risks.
CONSULTANCY A, Senior Consultant, 1999 � 2003
International management consulting; over $2 billion in annual revenue
Led managed care consulting intellectual capital development; grew client engagement revenue by leveraging benchmarks, market research and provider network quality and cost analysis tools.
Innovative Advanced Analytics � Created and sold the OPTIMAL HEALTH AND DISABILITY ANALYSIS TOOL advisory services to over 30 Fortune 500 companies; Focused on reducing utilization and cost trends by optimizing care management initiatives from employee population health and disability resource projections; researched and implemented client centered disease management and wellness capabilities.
Practice Profitability - Managed revenue, workflow and technical staff performance resulting in profitable growth; grew client relationships through enhanced financial tools; trained analysts and consultants to more productively utilize financial and clinical data analysis resources for client assignments and marketing efforts.
CONSULTANCY B, Principal, 1995 � 1999
International actuarial consulting to health plans, insurance companies, and employers; over $250 million in annual revenue.
Grew managed care consulting with provider delivery system and health plan clients; expanded client base for commercial, Medicaid and Medicare delivery systems projects; jointly and profitably managed health industry practice at CONSULTANCY B; conducted actuarial pricing and underwriting training; led intellectual capital development and expanded analytic tool capabilities.
Innovative Analytics - Created prescription drug therapeutic guidelines used by hundreds of payer and provider clinicians; installed small group underwriting guidelines in health plans to raise margins; reducing annual cost and utilization trends by 10% to 30% using medical management healthcare resource demand models; researched clinical treatment protocols & formularies to provide benchmarks of optimal treatment protocols.
CONSULTANCY C, Senior Manager, 1994-1995
CONSULTANCY D, Managing Director, 1984-1994
EDUCATION AND PROFESSIONAL DESIGNATIONS
Certified Enterprise Risk Analyst (CERA) � PENDING - Demonstration of significant expertise in evaluating and managing business risks enterprise wide; the most intensive requirements for demonstrating ERM technical and leadership competence.
Member of the American Academy of Actuaries (MAAA) � The organization that sets professional and ethical standards of practice for actuaries; requires all actuaries clearly identify their qualifications to their clients or principals.
Fellow in the Society of Actuaries (FSA) - Professional examinations are equivalent to the coursework for a master�s degree in finance, public policy or economics; includes significant overlap with CFA, CPCU and RF professional examinations.
Enrolled Actuary Under the Department of Treasury � Retired � Demonstrates financial expertise in retirement plan solvency and funding requirements.
STATE Life, Accident and Health Insurance Agent License No. XXXXXXXX - Active, expires MMDDYY � Required by the STATE for any professional that may provide advice leading to the design and implementation of health and disability financial or insurance arrangements.
BA in Pure Mathematics.
REPRESENTATIVE DATA ANALYSIS AND FINANCIAL SOFTWARE EXPERIENCE
SAS, Cognos, Business Objects, Hyperion, Access, SQL, Showcase, EssBase, Crystal Reports, Fortran |
