I run the operations of a health plan administrator and build the tools it runs on.
VP, Better Health Plan, the TPA arm of Bennie. Fourteen people across claims, eligibility, stop loss, member and provider services, underwriting support, renewals, and accounting. Self-funded and level-funded group plans.
I own the P&L, the vendor relationships, and the platform. Most of what I do is turn things that are held together by one person into things that are held together by a process, and lately by software.
The cost base was mostly fixed, so the work was on the revenue side and on cash. Renewals held, receivables got collected, and stop loss got reimbursed on time instead of eventually. No layoffs, and no vendor cuts that would have shown up as service problems six months later.
Inherited a balance that had been carried for years across a dozen groups. Worked it group by group with the account team, set payment schedules where a lump sum wasn't realistic, and got every group but one to zero. The one exception was on an agreed extension.
The incumbent platform had a year-old payment integration that still broke, an eligibility feed that corrupted on special characters, and a two-month window where inbound claims from a major carrier never arrived. Nobody caught it because nothing flagged it. I mapped the claim lifecycle end to end, scoped five vendor integrations, and picked a platform that had already cleared our security review and was live with the carrier feeds we depend on.
Rebuilt claim submission, tracking, and aggregate reporting with one associate. Reimbursements that used to arrive when the carrier got to them now average within 30 days of submission. Wrote a coordination-of-benefits policy that only collects other-insurance forms when a member is actually approaching the deductible, instead of denying everyone by default.
Read our standard client contract and found no limitation of liability, an indemnity carve-out using the wrong negligence standard, and no exclusion for benefit payments themselves. Drafted replacement language and am restating across the book ahead of 1/1 renewals, timed with the platform migration so clients sign once.
Structured a stop loss receivables factoring program with a specialty lender so clients aren't fronting six-figure claims for 60 to 90 days while waiting on reimbursement. True-sale structure, submission owned by our stop loss associate, with a pre-submission coordination-of-benefits screen so nothing gets repurchased.
I build with Claude Code. I write the spec, review every diff that touches money or member data, and keep a test suite that doesn't let me merge something I don't understand. These run in production for a regulated health plan administrator, which is the bar I'd hold anyone else's tools to.
Replaces a rating workbook, four separate email chains to stop loss underwriters, and me as the second set of eyes on the arithmetic. Every parsed value still gets confirmed by a person, on purpose. Per-deal underwriting time went from 7.9 hours to about 5.
FastAPI, Cloud Run, Cloud SQL, identity-aware proxy, ~200 tests. Built with Claude Code.
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Replaces a spreadsheet that took a day to reconcile every month and couldn't answer "what happens if this group leaves." Same architecture as the proposal engine so there's one environment to secure.
FastAPI, Cloud Run, Cloud SQL, identity-aware proxy. Built with Claude Code.
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Checks total paid hours (worked plus PTO, which is the part people get wrong) against each role's baseline. Approves what's in range, emails me what isn't.
Claude scheduled task, browser automation, written SOP.
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Pulled every line item from a contractor's monthly summaries, tied them back to individual deals, and built the case to move from hourly to a scoped flat fee 13% under run rate. The recommendation went to my COO with the actuals attached.
Claude, spreadsheet extraction, a memo.
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When employees started building AI tools that touched member data, I wrote the gate. Anything with PHI runs in the sanctioned cloud environment with access control, or it doesn't run. My own tools were the first ones held to it.
Policy, not code.
Bennie / Better Health Plan
VP, Better Health Plan Oct 2024 to present
Director, Claims Operations May 2024 to Oct 2024
Runs the TPA. Fourteen people, seven functions, P&L, vendors, platform.
Sana Benefits
Director, Claims Operations Oct 2022 to Feb 2024
Director, TPA Operations Mar 2021 to Oct 2022
Manager, TPA Operations Mar 2020 to Mar 2021
Claims and TPA operations for a level-funded health plan. Team of 4, then 7. Auto-adjudication from manual to 70%, accuracy above 97%, No Surprises Act and Transparency in Coverage compliance.
Justworks
Product Operations Manager, Payments Feb 2019 to Mar 2020
Product Operations Analyst, Payments Oct 2017 to Feb 2019
Payments operations for $9B in annual payroll. Team of 3. Built the payments risk function and strengthened SOC 1 controls.
Oscar Health
Claims Processing Analyst Oct 2016 to Oct 2017
Member Operations Nov 2015 to Oct 2016
Claims reporting and member escalations. Found $1M in eligibility leakage, redesigned escalation pathways.
