GREGORY SHORTZ
Gettysburg
Summary
Senior underwriting consultant with solid expertise in risk assessment, policy evaluation, and client management. Proven ability to drive collaborative efforts within teams, adapting to evolving requirements to achieve optimal results. Skilled in financial analysis, regulatory compliance, and strategic decision-making. Respected for reliability, integrity, and results-driven approach.
Overview
11
11
years of professional experience
Work History
Senior Underwriting Consultant
Kaiser Permanente Mid-Atlantic States
07.2012 - 03.2013
- Rated prospective fully insured business with 50+ eligible employees.
- Reviewed claims projections, ASO fees, and specific and aggregate stop loss quotes for formerly self-funded prospects.
- Used the in-house predicative analysis tool (Pharmacy (Rx) scripts + medical encounters) to forecast claims.
- Analyzed utilization to negotiate appropriate rate actions for existing exclusive and slice accounts with 50-5,000 members.
- Coached Underwriter I & Underwriter II team members about basic underwriting fundamentals.
- 2012 Marketing, Sales, and Business Development Achievement Award winner.
Large Group Underwriter
Optima Health Plan
08.2010 - 06.2012
- Rated prospective business with 100+ eligible employees.
- Analyzed utilization to negotiate appropriate rate actions for existing exclusive and slice accounts with 25-1,500 members.
- Developed rates on both the standard twelve (12) month billing schedule, coupled with equivalent ten (10) month rates, for school districts.
- Developed and reviewed ASO fees.
- Used Impact Pro as a predicative analysis tool for commercial large claimants and to determine the Specific Deductible for Self-Funded groups.
- Teamed with CFO to negotiate discounted access to HCA's Richmond monopoly for smaller sized groups with less than (<) two hundred (200) members.
- Project managed the design, development, and implementation of new Actuarial & Underwriting rating models by coordinating a three (3) team effort between the Underwriting, Actuarial, & Sales Departments. As a result, thru put efficiency was increased by 95%, utilizing the advantages inherent in Visual Basic for Applications (VBA), which programs Macros in Excel. Automation scheduled to run for ten (10) years thru 3rd Qtr. 2022.
- Reduced the development timeline for annual Sales reporting by 99.96% for the Director of Underwriting.
- Created Standard Operating Procedures and Large Group Underwriting training manuals (Prospects & Renewals) for new and existing employees.
Intermediate Underwriter
Geisinger Health Plan (GHP)
05.2007 - 07.2010
- Calculated premium rate proposals and product portfolios for Community and Experience Rated groups ranging from 100-1000+ insured members.
- Assessed group risk, the expected cost to deliver services, marketability, and competitiveness of health care services in order to ensure profitability.
- Used actuarial data to formulate baseline PMPMs for comparing and analyzing new and existing groups.
- Developed new departmental reports, including the MedAI (Medical Artificial Intelligence) predicative analysis tool, to assess risk and profitability.
- Department lead for high cost utilization Pharmacy (Rx) and Transplant claims.
- Authored documentation for departmental underwriting procedures. Developed strategies and solutions for streamlining departmental processes.
- Conducted weekly training sessions for regional sales management professionals on the foundations and concepts of rating methodologies.
Underwriter
Geisinger Health Plan
06.2006 - 05.2007
- Developed renewal rates for Community Rated groups with 16 – 100 eligible employees.
Small Group Underwriter
Geisinger Health Plan
02.2006 - 06.2006
- Medical underwriting for new client groups with 2 – 15 eligible employees.
DSS, Data Extractor
Geisinger Health Plan
01.2004 - 02.2006
- Developed custom ad-hoc Excel and Access reports for Customer Service Support Team, Medical Claims Research, Marketing and others within GHP for research, error resolution and monitoring.
- Developed custom SQL scripts to manipulate and merge source data for decision making reports.
- Developed weekly audit reports that checked payment accuracy of facility and professional medical claims.
- Worked in conjunction with Medical Claims Research to provide detailed analysis for the identification of fraudulent billing practices.
- Developed quarterly utilization reports, in conjunction with the Sales Team, used to explain renewal increases during conference calls with groups and consultants.
Customer Service Representative II
Geisinger Health Plan
09.2003 - 01.2004
- Resolved customer concerns and problems in a broader, more effective capacity using the comprehensive knowledge gained from GHP's Claims Processor Training (August 2003), which deepened my knowledge of UB-92 (now UB-04) and HCFA-1500 (CMS-1500) for institutional and professional services.
- Used the Multiplan/PHCS network to process Out-of-Network (OON) claims for deeper discounts.
Customer Service Representative I
Geisinger Health Plan
08.2002 - 09.2003
- As a member of the Customer Service Team, effectively communicated and resolved customer concerns and maintained customer satisfaction in a timely fashion.
- Assisted Enrollment Processors by entering new members into Amisys.
Education
B.A. - Economics
Bloomsburg University of Pennsylvania
12.2001
Skills
- GHP Claims Processor Training
- Professional, Academy For Healthcare Management
- Underwriting and Pricing, S M Snow & Associates
- Proficient in VBA & SQL
- Proficient in MS Office, Windows OS, including the Analysis Tool Pak
Timeline
Senior Underwriting Consultant
Kaiser Permanente Mid-Atlantic States
07.2012 - 03.2013
Large Group Underwriter
Optima Health Plan
08.2010 - 06.2012
Intermediate Underwriter
Geisinger Health Plan (GHP)
05.2007 - 07.2010
Underwriter
Geisinger Health Plan
06.2006 - 05.2007
Small Group Underwriter
Geisinger Health Plan
02.2006 - 06.2006
DSS, Data Extractor
Geisinger Health Plan
01.2004 - 02.2006
Customer Service Representative II
Geisinger Health Plan
09.2003 - 01.2004
Customer Service Representative I
Geisinger Health Plan
08.2002 - 09.2003
B.A. - Economics
Bloomsburg University of Pennsylvania
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