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Jessica Claire
Montgomery Street, San Francisco, CA 94105
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Summary

Accomplished Executive in operations, P&L oversight, sports marketing & purchasing, corporate benefits, and healthcare law. A lean thinker with proven expertise in business/operations planning and data-centric decision making. Unique personalized approach to managing and engaging people, streamlining processes, and triaging operations.

Health and Welfare Expert Skills
  • Benefit Strategic Planning, Design & Cost Control
  • Plan Design Alignment (Health, Dental, Vision, Life, and Disability)
  • Financial Management, Budgeting & Funding Options
  • Population Health Management
  • Benefit Administration
  • Risk Management
  • Contract Negotiations with Third Parties
  • Contract Preparation (PBM's/Stop Loss/TPA's/Direct Contracts)
  • Claims Management
  • Fraud, Waste, and Abuse Auditing
  • Insurance Billing and Coding Auditing
  • ERISA Compliant H&W Strategies and Policies
  • Ensure Compliance with H&W Legislative Requirements
  • Software Implementation & Management
  • Healthcare Cost Control & Measurable Savings
  • Effective Leadership Through Relationship Building
Experience
10/2017 to Current
VP of Healthcare Division Grady Legal, PA City, STATE,

Responsible for establishing corporate responsibility within benefits to show extensive ROI. Assists in collaboration with key stakeholders in complex organizational environments to develop and maintain strategic ERISA plans and contracts. Provides strategic vision, compliance, and operational excellence in oversight of all client's health and welfare benefits. Provides plan document oversight and summary plan description formation to protect the interest of the employer and employee. Manages contract negotiations between the employer and Carrier, ASO, Accountable Care Organizations, Direct Primary Care Physicians, PBM's, TPA's and other third parties. Prevention and investigation of healthcare fraud in both private and government sectors. Provides expert opinions on Labor & Employment and ERISA cases regarding benefits.

10/2008 to 10/2017
Director of Health & Wellness Nutranext (A Clorox Company) City, STATE,

Managed health and welfare plans and developed employee wellness programs while managing various vendors. Drafted program financials and policies. Ensured compliance with all benefit programs in accordance with location specific regulatory and legislative requirements; specifically PPACA, ERISA, HIPAA, COBRA, ACA, EEOC. Created the most recognized wellness program in the United States, which was awarded the Healthiest Employer in the US by Fitbit and Springbuk in 2017. The program showed a true ROI reflected in claims, and a cultural shift that aided in the sale of Nutranext to Clorox.

07/1999 to 05/2008
Vice President of Field Services Franklin Retail Solutions City, STATE,

Responsible for building and maintaining relationships with national outdoor retailers to acquire the best products for our client brands, as well as manage and lead a national team of 250 reps.

  • Build and manage relationships with key brands by helping them achieve their objective and develop a long-term business development strategy for consistent campaigns.
  • Identify new brands and trending products including acquiring exclusive products and pitch internally for future campaign inclusion.
  • Negotiate best in market cost and product offering to support overall growth strategy.
  • Act as the brand ambassador internally to help define the vision, goals and positioning of the brand in their respective campaigns.
  • Identify common callouts from brands during the curation process to assist in the development of future initiatives.
  • Create custom sales presentations and proposals, write P.O.'s and coordinate with internal teams to ensure quality and receipt of products.
  • Participate in industry and company events along with marketing production, as needed.
  • Inventory control through analytical and business minded approach to meet financial targets.
Education and Training
Expected in 05/2012
Master of Science: Exercise Science And Sport Psychology
California University of Pennsylvania - California, PA
GPA:
Expected in 05/1998
Bachelor of Arts: Psychology
Holy Family University - Philadelphia, PA
GPA:
Certifications

HIPAA Compliance for Covered Entities

Security Awareness

Florida Pre-License Certification (License 2-40)

Certified Outcomes Report Analysis (CORA)

Certified Health Value Professional (Validation Institute)

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Resume Overview

School Attended

  • California University of Pennsylvania
  • Holy Family University

Job Titles Held:

  • VP of Healthcare Division
  • Director of Health & Wellness
  • Vice President of Field Services

Degrees

  • Master of Science
  • Bachelor of Arts

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