Account Executive - Health Benefits and Self Funding

Kevin P. Ortiz-Roberts

**** ****** ***** ****, ** 89503 775-***-**** *****.*****.*******@*****.***

Seasoned health benefits consultant with over ten years of client satisfaction and administrative expertise. Extensive experience in Mid to Large Group management, with the last 3 years focused specifically on administration of Self Funded employer groups on the TPA side. Medical, HDHP, Dental, Vision, FSA, HRA, and Cobra administration for all clients. I'm seeking a position where I can apply my expertise and continue to advance into a leadership role with an agency as invested in our mutual success as I am. I am currently working on my Masters in Business Administration with a concentration in Health Systems Administration through Grand Canyon University, with an expectation to Graduate by the end of 2018.

- Core Competencies -

Self Funding Account Management Territory Management Prospecting Needs Assessment Sales

Issue Resolution Negotiations Product Presentations Quote Generation Underwriting Marketing

Team Building Reporting Proposals Cross-Selling Microsoft Office Scheduling Excel/PowerPoint

FSA HSA HRA Medical HDHP Forecasting Dental Vision Cobra

- Professional Experience –

CDS Group Health / Prominence 2/17-10/17

Reno, NV

TPA Self Funding Account Manager

Implementation and management of self-funded large group clients. This was a brand new position within the company (CDS had never had an account manager), so main focus was on structuring the role within the various departments I deal with on a daily basis and restructuring process and procedure. Core book of business involved Medical, Dental, Vision, Cobra, FSA, and HSA administration of 24 separate employer groups, with over 5,000 employee lives. Book of business included Casino chains, Municipalities, Hospital Networks, Professional and Manufacturing clients. I worked extensively with a local Business Coalition, the Nevada Business Group on Health, which allowed for specialty pricing and partnerships with PBMs, Surgical Facilities, and other specialty providers. During the first 6 months, CDS had a the entire Eligibility Team replaced, including the Manager and Supervisor. As I worked closely with this team, and since there was no written Process and Procedure manuals for either department, I worked closely with the new Supervisor to create standard practices based off my experience. Additionally, I worked closely with the Eligibility Manager to solidify and train on COBRA process and procedure for both the Self Funded side and the Commercial side.

Hometown Health 5/15 – 2/17

Reno, NV

TPA Self Funding Account Manager

Implementation and management of self-funded large group clients with over 8,000 member count total. Tailoring a unique and strategic management plan to meet the needs of the individual client and member population. One of my biggest accomplishments during my tenure with Hometown was the Implementation of a new group structure with 3 local casinos. 2 properties were already clients, and a 3rd was a new acquisition. During the renewal period, the client obtained new broker representation, and finalizing the renewal plan for all 3 properties wasn't completed until 2 months prior to the January 1st renewal date. Since the new broker was out of state, I worked with the HR Director to finalize a series of 36 varied shift educational meetings, finalized the presentation and education materials, and led the education and Q and A meetings over the course of 4 weeks. I coordinated with the Plan Build team to finalize the benefits in our system so that benefits would be available day 1 (a process that normally takes 2 months). With weekly internal implementation meetings, I was able to make implement 4 completely new plans, run a month long employee education campaign, and train customer service on the new benefits with little to no assistance from the brokerage house.

Woodruff Sawyer & Co 10/13 – 5/15

Novato, CA

Account Manager

Responsible for development and management of client relationships in the Northern Bay Area. This includes managing the RFP (request for proposal) for all lines of coverage, benefit analysis, 5500 Filing, Medicare Part D Notices, Wrap Document processing, and claims management to ensure the clients needs and goals are met throughout the year. Responsible for the assessment and strategic planning to ensure best scenario outcome for annual renewal. Book of business included 25 seperate clients with over 8,000 member lives. Upon employment, I was tasked with bringing 4 separate groups back in line with client and agency standards within 3 months. I'm proud to say I was able to meet with each client, assess their pain points and where our team had failed in the past and built a plan of action with the group and executive management to address their needs and get them back on track in record time. I was given a bonus in my 3rd month of employment based on these results.

Crystal and Company, San Francisco, CA 7/11 – 10/13

Account Executive

Responsible for business development and management of client relationships in northern and southern California, Oregon, Washington, and Texas. This includes managing the RFP (request for proposal) for all lines of coverage and benefit analysis, 5500 Filing, Medicare Part D Notices, Wrap Document processing, and claims management to ensure the clients needs and goals are met throughout the year. Responsible for the assessment and strategic planning to ensure that the best option is presented at renewal time. My largest client, Forever21, implemented 3 new plans during the 2013 open enrollment, and I was responsible for building the educational platform via web portal, PPT presentation, email blasts, and hard copy communications for over 600 separate stores across the nation.

Benelect, Visalia, CA (Third Party Administrator) 7/09 – 7/11

Regional Sales Manager, Sacramento and North Bay Territories

Responsible for new business sales and client relationships throughout the Sacramento and North Bay territories. Worked strategically with clients to identify their needs and goals, and presented group health options to clients based on in-depth assessments. Acquired and retained new accounts, and was successful selling additional lines of coverage to existing accounts. Marketed to both insurance brokers and employer groups by presenting a third-party administrator option that gave employers greater control of healthcare and detailing the benefits of a non-traditional model as well as presenting group health options to clients that would enable clients to reduce healthcare costs by as much as 50%.

Mission Benefits, Sunnyvale, CA 5/07 – 7/09

Account Manager/Sales

Responsible for new business sales and retention of existing business by providing quality customer service and strategic analysis of existing plans, assessing needs, and meeting those needs. Managed the renewal process, enrollments and quotes.

Judy’s Window Coverings, Gardnerville, NV 9/04 – 3/07

Sales Associate

Managed the sale and installation of Hunter Douglas window fashions. Sold products in-person and via telephone, worked trade shows, responded to referrals, and conducted open houses. Provided product training and in-person product presentations/demos. Conducted in-depth assessments of client needs to match appropriate products with needs. Promptly followed up with clients to address all issues/concerns.

Increased sales by 25% in first year, enabling dealership for first time to move to gallery dealer program

- Licenses and Education -

CA Health and Life Insurance License, # 0F65906

Associate’s in Business, Kaplan College – Graduated Magna Cum Laude

Currently attending University of San Francisco in pursuit of my Bachelors of Science in Business Administration

GDBS (Group Disability Benefits Specialist) Certification 2012

- Professional Affiliations -

2011 Board Treasurer, SPI, Incorporated, 501(c)(3) Corporation

2012 Grants Committee Lead, SPI, Incorporated, 501(c)(3) Corporation

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