Lumeris

Actuary

• Model & Tool Development
• Design, build, and validate actuarial and analytic models from the ground up
• Develop efficient processes to support business operations, financial reporting, and MA PD bids
• Formalize and adhere to team standards for model design and work quality
• Continuously refine and improve models based on emerging data and business needs
• One-Off & Strategic Analytics
• Perform deep-dive, ad hoc analyses to answer complex business questions, displaying high degrees of mathematical rigor and common sense
• Translate ambiguous business problems into structured analytical methodologies
• Present findings clearly to both technical and non-technical stakeholders to influence business decisions
• Own and manage analytic projects from planning to communication of results.

Senior Actuarial Analyst

Financial Planning and Analysis

• Oversee the day-to-day operations of the AP and AR/Premium Billing functions.
• Manage and develop a team, providing guidance, training, and performance feedback to ensure departmental goals are met.
• Oversee all accounts payable processes, including vendor invoice processing, provider claims payment processing, and commission payments, ensuring accuracy and timeliness.
• Drive enhancements to the AP/invoicing platform to increase efficiency and improve the customer experience.
• Own and manage the entire member/group premium billing cycle, including invoicing, collections, cash posting, and reconciliations.
• Oversee the application of payments from various sources (lockbox, EFT, member portal), ensuring accuracy and timeliness.
• Manage the collections process for outstanding receivables, including the relationship with the collection agency.
• Handle correspondence, premium refunds, and adjustments as necessary.
• Partner with third-party print/mail and payment portal vendors to enhance the customer experience and resolve issues.
• Identify opportunities for process improvements and workflow automation within the AP and AR cycles.
• Serve as the business lead for system enhancements, including performing User Acceptance Testing (UAT).
• Ensure compliance with all relevant regulations, including CMS, State DOI, and HIPAA.
• Serve as the subject matter expert and business owner for all audits (Financial, SOX, State, Federal) related to AP and AR/Premium Billing, including managing evidence requests.

Manager, Health Plan Finance Operations

• Oversee the day-to-day operations of the AP and AR/Premium Billing functions.
• Manage and develop a team, providing guidance, training, and performance feedback to ensure departmental goals are met.
• Oversee all accounts payable processes, including vendor invoice processing, provider claims payment processing, and commission payments, ensuring accuracy and timeliness.
• Drive enhancements to the AP/invoicing platform to increase efficiency and improve the customer experience.
• Own and manage the entire member/group premium billing cycle, including invoicing, collections, cash posting, and reconciliations.
• Oversee the application of payments from various sources (lockbox, EFT, member portal), ensuring accuracy and timeliness.
• Manage the collections process for outstanding receivables, including the relationship with the collection agency.
• Identify opportunities for process improvements and workflow automation within the AP and AR cycles.
• Serve as the business lead for system enhancements, including performing User Acceptance Testing (UAT).
• Ensure compliance with all relevant regulations, including CMS, State DOI, and HIPAA.
• Serve as the subject matter expert and business owner for all audits (Financial, SOX, State, Federal) related to AP and AR/Premium Billing, including managing evidence requests.

Customer Support

• Reviews rejected pharmacy claims for appropriateness.
• Becomes a pharmacy claims processing subject matter expert and triages claims issues.
• Becomes subject expert with Medicare Part D policies and procedures.
• Reviews transition claims reports.
• Interacts with the pharmacy benefits manager, pharmacies, prescribers, and members to ensure appropriate and timely member access to prescription drugs.
• Supports medical pharmacy prior authorizations and Medicare Part D drug reconsiderations.
• Supports Medicare Part D call center questions and issues received from members, pharmacies, and providers.
• Supports compliance functions and requests.
• Supports quality programs including STARS.
• Conducts retrospective claims reviews.
• Complies, interprets, documents, and tracks findings from claims monitoring data.

Pharmacy Operations Support Specialist

Chief Marketing Officer

• Build the marketing measurement ecosystem from the ground up, defining the tools, data requirements, and processes needed to move beyond platform-reported metrics.
• Lead the selection and implementation of an MMM solution and use it as the primary framework for budget allocation.
• Establish a structured testing program to measure what marketing is actually driving.
• Assess and implement attribution capabilities where they add value.
• Own marketing performance frameworks, ensuring consistent and accurate evaluation across all channels and campaigns.
• Develop marketing-driven forecasts for leads, calls, and enrollments aligned to campaign strategy.
• Translate marketing analytics needs into clear data requirements.
• Define and enforce campaign structures, channel hierarchies, and marketing-specific definitions.

Director of Marketing Analytics – Performance

Marketing

• Own the end-to-end lifecycle marketing strategy across acquisition, onboarding, engagement, retention, and reactivation for members, brokers, and providers.
• Translate business and experience goals into quarterly and annual lifecycle roadmaps for each audience.
• Define key moments in the journey and design strategies to improve engagement, retention, and outcomes.
• Evangelize and enforce the customer journey framework, including best practices for trigger-based vs. batch communications.
• Ensure journeys are scalable, documented, and consistently deliver an exceptional experience for all audiences.
• Define frameworks for audience segmentation and targeting across members, brokers, and providers.
• Enable personalized, relevant communications while maintaining regulatory compliance.
• Own lifecycle performance measurement for all audiences, defining KPIs across engagement, conversion, retention, and satisfaction.
• Establish a structured test-and-learn program to continuously improve journeys and campaigns.
• Own the marketing technology roadmap and associated budget, ensuring it supports the lifecycle marketing strategy.
• Lead, mentor, and develop a high-performing team of lifecycle marketers and marketing operations / martech professionals.

Director, Lifecycle Marketing – Martech

Implementation Specialist

• Has functional ownership, provides strategic direction and influence, and ensures project team success across all implementations.
• Helps coach, mentor, motivate, support, and develop team members across functions.
• Fosters accountability and collaboration to ensure team member and overall team success.
• Guides the creation of implementation models for clients and supports the development of technical solutions.
• Oversees and/or guides implementations to successful conclusion, ensuring timeline, resourcing, and budget parameters are met.
• Anticipates and balances the needs of multiple key partners by adapting in real time to align with demands and different situations.
• Develops and maintains collaborative relationships with internal/external clients, vendors, and partners.
• Effectively establishes priorities, communicates and guides program expectations, and provides program updates as appropriate.
• Coordinates and collaborates cross-functionally on strategic development, operational planning, and implementation planning of the program to align with both Lumeris and client's vision and contractual delivery timelines.
• Ensures continued alignment on initiative and implementation methodologies.
• Oversees cross-functional project teams by providing direction, delegation, and removal of obstacles experienced by cross-functional project teams.
• Coaches, mentors, and motivates program team members and client SMEs to ensure the strategic and operational goals of the implementation are met.
• Reports/communicates deviations to program timeline and/or scope and facilitates discussions to achieve positive resolution.
• Ensures established initiative documentation processes are adhered to.
• Utilizes approved tools and processes to ensure maintenance and versioning of key deliverable templates, including development and maintenance of tracking mechanisms for efficient movement.
• Ensures processes, systems, tools, and organizational resources are in place to initiate, plan, execute, and monitor programs, including guiding a successful transition to support and maintenance teams upon program close.
• Responsible for ensuring Risk mitigation and Impediment resolution processes are being adhered to by project teams and escalates Risks and Impediments internally and with clients when deemed necessary.
• Collaborates cross-functionally to identify and institute program management process improvements.
• Supports team in learning new solutions and continuously improving the approach to implementation and the deliverables used to support implementation.
• Meaningfully contributes to the success and standardization of the approach for transitioning from implementation to ongoing operations.

Senior Actuarial Analyst

Manager, Health Plan Finance Operations

Manager, Health Plan Finance Operations

Pharmacy Operations Support Specialist

Director of Marketing Analytics – Performance

Director, Lifecycle Marketing – Martech

Client Implementation Director