• Set up paperwork system for new HMO/insurer - Med One.
• Colorado Market Conduct Survey for Sierra Health and Life Ins. Co.
• Developed computerized data base system to control policy forms.
• Compliance Bulletin system for Boston Mutual covering 20+ states.
• Developed computer automated 'wrapper-type' policy issue form.
• Re-drafted insurance policies, certificates and applications for seven insurers and filed them nationwide.
• Designed a unique policy page system to reduce issue time, costs and errors in accordance with Federal and local laws.

• Analyzed and applied complex contract, statutory and regulatory information to subject, product and operations;
• Solved problems using numerical, logical and legal analysis.
• Analyzed, interpreted and explained statutory provisions in a dynamic and interesting fashion to laypersons.
• Supported, participated in and monitored company implementation activities in response to regulatory and legislative enactments and appraise management of changes, implementation, progress and status.
• Investigated and organized complex fact case scenarios to develop strategic resolution plan while minimizing employer liability.
• Analyze and computer flow-charted a reorganization of work flow:

• Developed user friendly publications which present technical and complex information in an easy to read style and format.
• Consensus Builder - able to resolve issues while promoting teamwork and commitment to excellence and to the organization.
• Demonstrated written communication skills conveying correct and accurate business and technical information.
• Developed and maintained user friendly publication that present technical and complex information to laypersons.

• Analyzed case for insurance coverage and liability for insurer's General Counsel and recommended a course of action.
• Evaluated and selected insurance defense litigation counsel.
• Inspected and audited files and business practices of subsidiary companies for potential liability.
• Audited legal counsel's billings for consistency and accuracy.

• Advised Asian and European nationals regarding multi-million dollar contracts.
• Drafted specialized contracts in the British, French and American styles for circulation and reconciliation among multiple parties.
• Acted as liaison to geographically remote financial backers to new ventures.
• Visited and consulted to remote profit centers for NYX financial corporation.

• Drafted cover letters and implemented amendments to physician and hospital provider networks.
• Successfully negotiated contract benefits with outside providers and various state DOIs.
• Proven ability to draft and maintain insurance policies and HMO forms in compliance with changing state laws in many states, including small employer group laws.
• Re-drafted insurers' policy portfolio to modern standards; computerized and streamlined production methods while reducing policy issue time; lessened issue errors and costs while increasing jurisdictional filings.

• Handled customer grievances for major financial institutions in a manner designed to avoid lawsuits
• re-designed computer screen prompts to aid customer service department in tracking complaints and identifying service problems without making legal admissions against interest.
• resolved disputes brought by customers to state regulatory agencies against financial institutions.

• Formed, filed and maintained corporate records and minutes.
• Financial disaster planning analysis for Am. Honda Financial Corp.
• Risk management and reinsurance coverage analysis for Med One.
• Developed contract compliance program for Prudential and Boston Mutual.
• Developed boilerplate contract language for Med One, Farmers Insurance Group, Columbia General, and Boston Mutual.
• Service marked and trademark work for Med One and private law clients.

• Experienced at bringing health care and provider contracts up-to-date in compliance with state and federal regulations and legislative enactments.
• Drafted or critiqued insurance advertising and statutory disclosure.
• Drafted employer guides and welfare benefit handbooks.
• Drafted procedural methods to implement broad corporate strategies.
• Drafted certificate and policy language and forms for new insurance/HMO products.

  

• Advised/critiqued physician/IPA contracting managers' documents.
• Critiqued and negotiated PPO and network contracts.
• Drafted reinsurance and retrocession treaties of all types.
• SEE THE SPECIAL SECTION ON INSURANCE DRAFTING.

Table of Contents

1. Consult with the vice-president of administration on my proposed new contract wording amendment for provider contracts.
2. Interview Rx card representatives on the coverage and draft benefit rider on the spot for their review before they travel to next appointment.
3. Draft, type, circulate for review, and file Eye Wear Benefits Rider and a Vision Care Services Benefit rider; consult with third party provider about local licensing requirements.
4. Negotiate, draft, type, format and file Prescription Care Rider with corrections and additions; consult with carrier.
5. Edit the 'stems' of a Schedule of Benefits cut sheet regarding family deductible and penalty for failure to obtain precertification.
6. Draft, type and format dummy wallet identification card and carrier sheet for filing, including emergency care instructions.
7. Negotiate with Sr. Contract Analyst at their insurer/paper and with Sr. Underwriter to formulate solution to how to cover out-of-area employees.
8. Research, identify and locate holding company laws for head of accounting in order to respond to DOI auditors.
9. Draft a modification to an existing product to create a two-tiered HMO product with self-referral to specialist.
10. Conduct correspondence with DOI regarding administrative/sales practices.
11. Counseled vice-president of market regarding appearance and correct usage of 'wrapper' type policy form.
12. Advised Allianz re PPO policy form and needed changes to comply with Nevada law.
13. Review advertising copy language/statutory disclosure forms.
14. Organize and document week's work on a computerized data base program; report week's accomplishments and pending projects to upper management.
15. Prepare desk for the following week's work load; make a priority list for Monday morning review with telephone numbers for follow-ups.

EDUCATION:

J.D. Western State University College of Law; Fullerton, Calif.;
M.A. Education, Quantitative and Psychological Foundations (thesis with research grant), University of Iowa, Iowa City, Iowa;
B.Sc. Experimental Psychology, University of Iowa, Iowa City, Iowa.

• Experienced group health underwriter for brand-name carriers.
• Educated in higher order statistical evaluation techniques.
• Experienced in data collection, evaluation and reporting techniques.
• Experienced and familiar with fraud and abuse detection and statutory reporting.
• Knowledgeable of actuarial techniques and opinion letters.
• Evaluated reinsurance needs and retro-cessions.

• Developed a newsletter for college parents to develop funds/programs.
• Increased organization participation four-fold over prior years.
• Solicited funds for community non-profit projects.
• Developed human resources for activities used to raise funds.
• Experienced public speaker.
• Developed program material, advertising and communication.

• Experienced group underwriting and claim analyst.
• Experienced interpreting and implementing complex statutes and regulation into policy, administrative and disclosure forms.
• Draft and filed controlled documents with DOIs, including small employer group health in several states.
• Analyzed, developed and reconciled HMO and indemnity products to create point-of-service products.
• Experienced at work flow analysis and revision.

• Laisoned with medical professions and groups to resolve disputes.
• Team leadership and supervisory experience .
• Experienced public speaker.
• Resolved patient complaints and grievances at an appeal level.
• Developed working relationships with state regulatory agencies.
• Sales experience in retail trades.

• Drafted managed care, provider, hospital, network and TPA contracts.
• Responsive letters to regulatory staff inquiries regarding compliance.
• Coverage opinion for health care cases for General Counsel of insurer.
• Promulgated, responded to and opposed health care discovery.
• Drafted and filed incorporations and partnership documents.
• Supervised and edited bad faith insurance defense pleadings.
• Drafted, filed and plead plaintiff actions in state and federal courts.
• Negotiated and drafted settlement documents for NYX health companies.
• Researched and drafted state and federal service mark filings.

• Analyzed policies, treaties and business contracts for liability for company's General Counsel and recommended a course of action
• Evaluated and selected outside insurance defense litigation counsel
• Visited, inspected, and audited files and business practices of subsidiary out-of-state companies for actual/potential liability
• Audited legal counsel's billings for consistency and accuracy.
• Supervised 240+ lawsuits representing $45 million in liability
• Reviewed pleadings for quality standards and effectiveness.
• Litigated and appeared in Federal, State and Administrative Courts.

• Cognative performance - employee skill set assessment and selection,
• Affective Research - customer service satisfaction, quality control, predictive testing,
• Research - technical analysis requiring review of scientific literature,
• Adult Education - employee training,
• Educationa Design - programmatic, computer assisted and web site design.

• Drafted Medicare supplement plans and brochures.
• Knowledgeable of Medicare and payment methods.
• Rendered coverage opinions re: COB with Medicare.
• Knowledgeable of Medicare marketing/advertising rules.

• Member in good standing; State Bar of California and
• Federal Bar - Central District, California, and
• National Health Lawyers Association.

• Drafted and revised provider contracts - physician, hospital, ancillary provider, and specialist physician contracts, including DRG and incentive compensation clauses.
• Drafted or revised utilization review contracts and licensing.
• Negotiated, researched and reviewed ancillary service contracts such as eye care and prescription drug with outside providers, and drafted and filed appropriate benefit riders.
• Researched, drafted, negotiated and filed point-of service, PPO and EPO revisions to insured policies.
• Drafted provider credentialling criterion and forms.
• Reviewed, critiqued and credentialed PPO networks.
• Analyzed blocks of business for potential managed care savings and recommended actions to implement programs.

• Advised subsidiary insurers regarding financial services product development, insurance and related agency sales contracts & Federal regulatory obligations.
• Managed a contract negotiation and documentation team to draft, distribute and execute five years of outstanding and undocumented multi- party international multi-layered property/casualty treaties.

1. Analytical technique - Masters degree in qualitative and quantitative analysis (statistics);
2. Group health insurance underwriter - six years (accounting);
3. Undergraduate course work - gerontology and social sciences;
4. J.D. drafting plans, negotiating PPO and provider contracts representing either the insurer or physician;
5. Compliance consultant filing with state and federal regulatory agencies - five years;
6. Corporate counsel to health insurer drafting coverage opinions for contested health claims.

• Negotiated physician contracts with financing hospital system.
• Formulated the contents of business documents for managed care services, third party administration, managing general underwriter, and computer services contracts.
• Negotiated the reconciliation of multi-part international reinsurance treaty documentation for reinsurance intermediary.
• Negotiated life and group health insurance settlements.

• Ability to organize work load to meet changing priorities and deadlines.
  
• Demonstrated experience in developing methods and procedures to track forms and their state statutory variations in more than thirty-five jurisdictions.
  
• Demonstrated ability to develop policies and procedures to organize complex written and financial files for NYX company.

• Knowledgeable of the required form and style of court pleadings.
• Experienced at researching the law, case law, regulations, library research, Shepardizing, Lexus, HiWire, real property title search and using the internet.
• Drafted and filed; Complaints, Law and Motion, Settlements, and Injunctions.
• Legal research; case law regarding casualty liability, real property title and insurance matters.
• Experienced drafting; coverage opinions, correspondence, judicial counsel forms and title reports.
• Filing; set-up filing systems, and form codification systems.
• Proficient using word processing, spread sheets & data base.

• Drafted HMO contract and compensation revisions for Med One.
• Negotiated and revised PPO provider contracts for Boston Mutual.
• Negotiated revisions of physician contract for physician client.
• Drafted and revised managed care review contract for Boston Mutual.

• Experienced negotiating and dealing with public agency personnel.
• Visited and developed working relationships with regulators in several states.
• Stymied, prevented or lifted 'Cease and Desist Order' for carriers.
• Developed market conduct compliance/performance reviews and stipulations

• Tort and Insurance Pleadings & Briefs, Vol. III, No: 3, June 1987, Managing Editor.
• Harvard Law Review, Vol. 100, pp 1788 [note 40], 1795 [note 85], 1987 - writings cited re: insurance risk and placed on file in the law library.
• Compliance Bulletin, Reinsurance Management, Inc. for Boston Mutual Life Ins. Co.; Chief Contributing Editor.

• Office building development: title review; easement review, drafting and negotiation; hydrological assessment and well closing; utilities procurement; re-zone from R1 to C3; architectural coordination.
• Residential: pre-purchase review; title review; comparative cost survey; geological review; sewer easement verification.
• Title assessments: location of lost real property assets as part of estate planning, title drafting and transfer.

As a litigation supervisor for Farmers Insurance Group, Inc., I was responsible for claim litigation from service of process through settlement, including identification, evaluation, selection, appointment, and supervision of outside legal defense counsel.
• Perform task analysis to identify type of expertise required Perform legal analysis to identify the level of expertise required
• Interview prospective company witnesses to determine type of evidence to be produced
• Assess attorney and firm to determine experience with case tasks identified
• Identify firm's physical and time resources available to be devoted to the assignment
• Evaluate affective disposition toward unsympathetic defendant (insurance company)
• Evaluate file building and document content relative to company and legal standards

• Research Methodology - techniques and design of research projects
• Elementary Functions - statistics for research, level I
• Educational Measurement - statistical analysis and methodology
• Contruction & Use of Tests - test design and application
• Experimental Psychology II - research design and methodology
• Cognitive Processes - brain function, micro-anatomy and learning
• Motivation - methods and techniques of classroom motivation
• Small Group Processes - psychology of interpersonal interactions
• Masters Thesis - affective evaluation parallel Likert Scale (grant)

• MS Word,
• WordPerfect for windows and for DOS,
• Ami Pro,
• data bases,
• statistical packages or statistics in Excel
• WordPro for Lotus,
• Excel,
• HiWire,
• HTML mark-up language,
• e-mail, and
• Internet.
• typing tested at 40 wpm.

• life, AD&D, weekly indemnity, long term disability insurance,
• underwriting processes,
• claims review and grievance process,
• marketing and competitive analysis,
• product offerings and alternatives,
• plan design and disclosure requirements,
• welfare benefit plans and laws,
• reinsurance - American, British and French styles, all types of treaties,
• annual reporting,
• various state and Federal laws and regulatory issues, including small employer group reform.

• Design and conduct training sessions regarding changes in company policy, regulatory and legislative changes.
• Draft and design handouts/outlines illustrating complex concepts to laypersons regarding procedural and operational changes in company organization and work flow.
• Taught industry classes in life insurance to staff (LOMA).

• Large account analysis; new and renewal, for multi-milion dollar accounts, including branch accounting and varied plans and funding.
• Experienced rate analyst, including partial and full self-funding.
• Experienced financial analyst of experience reports.
• Familiar with risk analysis and hidden liabilities.
• Trained and experienced in higher order statistical analysis.
• Experienced interacting with and consulted for F.S.A.s.
• Experienced preparing sections for Annual Report to DOI