Our executive team has cumulative experience running risk adjustment, quality, and claims operations across more than $90 billion in U.S. medical spend.
Twenty years across two top-ten national plans. Previously SVP Risk Adjustment Operations at a Blue Cross licensee. MD-trained; AAPC CRC.
Built and ran HEDIS engines for three regional plans. Former Optum Enterprise VP. Holds MBA from Wharton.
Spent seven years at a hyperscale AI lab applying LLMs to regulated workflows. Engineering lead on three production agent deployments.
Board-certified internist. Twelve years in clinical documentation improvement leadership at a top-five IDN. AHIMA CDIP, CCS.
Stood up coding operations for two large U.S. payer BPOs. Based in Hyderabad. AAPC CPC, COC, CRC.
Twelve years running U.S. claims operations from Manila. Former BPO P&L owner serving four U.S. TPAs.
Our advisory board includes a former CMS deputy administrator, two retired plan CFOs, the former chief medical officer of a national IPA, and a HEDIS audit principal from a Big Four firm. They meet quarterly with our executive team and are available to client leadership on standing matters of regulatory and operational risk.
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