Healthcare Insurance Expert 522345 CA(N)


Expertise Description

I have more than 30 years experience in the healthcare/health insurance industry. My experience includes, but is not limited to, sales, sales management, sales distribution channels (including internal sales and outside broker/agents/consultants, operations (billing, claims, customer service), underwriting, product, compensation plans, and profit and loss management. My indirect responsibilities included, but not limited to, actuarial, finance, network development and contracting, compliance, and marketing. My experience includes Individual and Group products/business in commercial and government (Medicare) lines of business. I am offering my services as a healthcare expert witness.

Areas of Expertise


Professional Experiences

My professional experience includes working for a healthcare company for over 30 years. I have worked in customer service, underwriting, sales and sales management. I have also run and have been responsible for several business segments in Large Commercial Group, Group Retiree, and Indvidual Medicare. Product lines included medical, dental, and life insurance products. My experience includes, but is not limited to, profit and loss, operations, sales, sales management, compensation plans (internal, external, and executive compensation), internal and external (agents, broker, consultants) distrubition channels, product development, provider network development and contracting, finance, actuarial, compliance, and policy.


Relevant Experiences

My experience and skills that make me a fit is my overall management of Group and Individual medical, dental, and life insurance. My management included the direct and indirect responsibilities of Evidence of Coverage materials, Coverage Determination, and Claim Exceptions.

I have had direct and indirect responsibility and accountability for medical claims and customer service for a large insurance company. There was also a period of time where all large claims in my business unit were reviewed and signed off on by me.


Education

Degree Subject Institution
B.A. Psychology University of California Los Angeles

Awards & Affiliation

Featured in several publications for creating one of the first sub-set provider medical products/networks.
Part of the turnaround team in creating one of the most successful for profit health insurance companies from a non-profit status.


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