COMPLIANCE CONSULTANT
Med One Health Plan

The position was made available to me by the former head underwriter of Sierra Health Services (Pat Sherer) who moved to Med One when there was a major and unanticipated cut-back at Sierra that affected us both. Med One was an alliance of Dr. Elias Ghanam's TPA operation of captive medical clinics and Columbia, H.C.A.. It was started when Sierra would not enter in to provider contracts with Columbia's local provider hospital, Sunrise Hospital, and the Doctor's TPA was for sale. Eventually, Med One was sold out to Sierra Health Services disposing of Ghanam's TPA and saddling Sierra with a Columbia contract. This position lasted until a few weeks in advance of the sale to Sierra, at which time the entire staff was terminated. I reported to the President, Lowell Foster.

Job Duties:

• Programmed automated "fill-in-the-blank" policy issuance system
• Developed a Point-of Service product, negotiated and filed it with the Nevada DOI
• Abated a 'Cease and Desist' order from the Nevada Department of Insurance
• New policy plan development
• Drafted and filed with DOI policy, discolosure copy, and benefit riders, i.e. prescription drug and eyecare/eyewear.
• Researched, drafted and filed new point-of-service product
• Revised provider contracts and benefit exclusionary lists
• Negotiated policy terms with reinsurer
• Advise/consult with staff and management regarding legal standards, and state and federal regulatory compliance
• Drafted employer and employee benefit guidlines pages
• Drafted marketing, disclosure and advertising forms in compliance with local state laws
• Visited with Nevada DOI personnel and researched DOI files for competitive analysis purposes
• Commercial insurance analysis of the TPA/HMO's coverages and needs

WRITING SAMPLES: Grievance Resolution / Marketing Piece / Rx Policy Rider

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