Charles W. Simons
Greater Los Angeles,CA
Summary
Results-oriented Executive Leader with 25+ years in Medicare Advantage and Commercial Health Plans. Expertise in strategic sales growth, client management, and product development, combined with a track record of building high-performing teams and fostering partnerships with health plans and market stakeholders. Proven ability to drive innovative healthcare programs and lead cross-functional teams to achieve exceptional results.
Overview
21
21
years of professional experience
Work History
National Head of Medicare & Medicaid Health Plan Sales & Business Development
Inspira Financial (formerly PayFlex / CVS Aetna)
01.2023 - 01.2024
- Key member of national Health Benefits Sales Leadership team
- Led prospect development / cultivation, RFP / Bid / Pricing Strategy and /execution across largest Medicare / Medicaid payors
- Led business development strategies with strategic partners and built executive relationships, resulting in increased sales for Inspira’s health plans
- Led development and execution of market opportunity assessment and go-to-market strategies with marketing leadership, enhancing market positioning for health plans
- Championed and mentored internal business partners on requirements for promoting focus and knowledge, fostering growth and market expansion within health plan payor marketplace
National Vice President Employer Medicare Sales | Account Management | Strategy | P&L
Highmark Blue Cross Blue Shield
Pittsburgh PA
01.2020 - 01.2023
- Recruited to Highmark to drive strategic end-to-end rebuild of Medicare Group Retiree business and Individual Medicare Sales
- Led team win Medicare Advantage contact award for State of Delaware’s 28k retirees+ hot for 1/23 (beating Aetna for this win)
- In 2021 - 23 led team to achieve >200% of margin, 95 - 99%+ Group membership persistency & 90-120% of new growth goals
- Built new multi-year strategic plan that locked in membership in multi-year contracts addressing competitive pressures
- Championed and mentored internal business partners to enhance focus, knowledge, and rigor for driving growth and market expansion in Medicare Individual and Group Retiree marketplaces
- Led strategic analysis of Highmark’s Medicare capabilities and developed a plan to define requirements for market competitiveness and achieve market-leading position
- Developed and executed a multi-phase staffing model to align resources with membership growth objectives from 2021-2023
National Vice President Head of Medicare Retiree Account Management
Elevance (Anthem Blue Cross Blue Shield)
Costa Mesa CA
01.2017 - 01.2020
- Recruited to Anthem to drive strategic end-to-end rebuild of Group Medicare business moving Anthem from 22nd to 6th nationally
- Managed strategic business operations across a rapidly growing membership base from $200m to $1.8b in annual revenue.
- In 2019 & 2020 led team to achieve 99%+ Account persistency and 133% of membership growth goal
- Led and mentored internal business partners to enhance focus, knowledge, and rigor, driving success within Medicare retiree marketplace
- Conducted strategic analysis of Anthem’s Medicare retiree capabilities and developed a plan to achieve market competitiveness
- Developed multi-phase account management staffing model to support membership growth from 18k to 180k members in 30 months
Director (Segment Leader) Medicare Employer Retiree Programs
Blue Shield of California
Costa Mesa CA
01.2015 - 01.2017
- Executive leader responsible to lead strategic redesign and execution of Blue Shield’s Group Medicare Retiree programs
- Conducted strategic analysis of Blue Shield’s Group Medicare capabilities, reviewing pricing and underwriting/risk assumptions, and developed a plan to optimize retention and margin
- Developed strategies for growth for growth opportunities (new business and in force) to innovate traditional approaches
- Engaged with Commercial leaders to cultivate partnerships that enhanced collaboration in the group retiree market
Senior Director National Head of Employer Medicare Retiree Strategy & Business Development
AETNA (CT) (National Corporate roles - remote office in CA)
01.2008 - 01.2015
- Key driver for exceptional Group Medicare business growth of +98%+ over 3 years increasing revenues by ~$3b /yr
- Strategies executed vaulted Aetna from #3 market share to #1 market share nationally of all Group Medicare health plans
- Led development and execution of Group Medicare Retiree strategy for corporate, government, and labor & trust markets
- Developed and executed strategic initiatives driving growth, including multiyear prospect identification, growth strategy, targeted cost improvement strategies, product enhancements, and addressing regulatory issues
- SME on ACA development that pioneered key elements of Aetna’s Group Medicare Private Exchange strategies and offerings
Western Regional Head of Sales & Account Management Employer Medicare Markets
01.2010 - 01.2011
- Hand selected to assume sales leadership role for Western US region to increase results sales and build market presence in region
- Partnered with Public Sector and Labor and National Accounts commercial leaders to develop new focused sales and marketing strategies to increase visibility and success of Aetna Group Medicare Retiree programs across region and business teams
- Recognized 2010/11 Aetna “Winners Circle” Regional Head of Sales & Account Management at 112% of plan
National Head of Employer Medicare Strategy Public Sector and Labor Segment
01.2008 - 01.2010
- Recruited to Aetna to lead Public Sector & Labor Group Medicare strategy development and execution nationally
- Led strategic development and roll out of an innovative joint venture with ING (now Voya Financial) for Government plan sponsors to calculate and execute strategies to minimize their unfunded retiree healthcare (OPEB) liabilities
- Developed and launched new comprehensive Pre / Post 65 Retiree healthcare model allowing plan sponsors to limit financial risks of retiree benefits as well as outsource retiree health benefit administration via Accenture partnership
Senior Client Executive – United Medicare Retiree Solutions (URS)
UNITEDHEALTH GROUP (Formerly PacifiCare acquired by UHG)
Cypress CA
01.2007 - 01.2008
- Oversaw largest book of business among URS Client Executives nationally, achieving over 100% member retention.
- Directed account retention strategy and client management activities, encompassing proposal generation, new product sales, implementation, ongoing management, renewals, and expansion strategies.
- Led cross-functional teams to implement strategic initiatives enhancing operational efficiencies.
- Developed and executed comprehensive plans aligning with organizational goals and priorities.
- Facilitated collaboration between departments to optimize workflow and resource allocation.
Vice President Employer Medicare Retiree Account
UnitedHealthcare
Cypress, CA
01.2006 - 2007
- Managed P&L, sales strategy, and client management for 600+ Group Medicare sponsored clients, driving $1b in annual revenue through proposal generation, new product sales, and implementation.
- Led team achieving 97%+ account renewal persistency during PacifiCare integration into UnitedHealth Group, ensuring client retention and satisfaction.
National Sales Director Employer Medicare Retiree Sales (PacifiCare)
01.2003 - 01.2005
- Responsible for driving significant growth in PacifiCare’s Group Medicare retiree market share nationally
- Top 10 Nationally for Commercial Sales – Recognized for 2005 / 2006 PacifiCare Sales “Leadership Circle Award.”
- Led 2-year Business / Program Development for a completely new and innovative national retirement saving and health benefits model (in partnership with Fidelity Investments) for Higher Ed institutions nationally (Emeriti Retirement Health Solutions)
Education
Master of Business Administration (MBA) -
California State University Long Beach
Bachelor of Arts - Business Administration (Management)
California State University Fullerton
Skills
- Proven Enterprise Strategy Go to Market Leadership
- 25 yrs Health Benefits Thought Leadership SME
- Proven B2B Sales & Revenue Growth Leader
- Extensive Health Plan & BCBS Executive Relationships
- Medicare Sales
- Market Opportunity Analysis & Strategy
- Robust P&L, Pricing, Margin & Solutions Experience
- Skillful Cross Functional Partner & Mentor
- Passionate Voice of the Customer(s) & Market(s)
Timeline
National Head of Medicare & Medicaid Health Plan Sales & Business Development
Inspira Financial (formerly PayFlex / CVS Aetna)
01.2023 - 01.2024
National Vice President Employer Medicare Sales | Account Management | Strategy | P&L
Highmark Blue Cross Blue Shield
01.2020 - 01.2023
National Vice President Head of Medicare Retiree Account Management
Elevance (Anthem Blue Cross Blue Shield)
01.2017 - 01.2020
Director (Segment Leader) Medicare Employer Retiree Programs
Blue Shield of California
01.2015 - 01.2017
Western Regional Head of Sales & Account Management Employer Medicare Markets
01.2010 - 01.2011
Senior Director National Head of Employer Medicare Retiree Strategy & Business Development
AETNA (CT) (National Corporate roles - remote office in CA)
01.2008 - 01.2015
National Head of Employer Medicare Strategy Public Sector and Labor Segment
01.2008 - 01.2010
Senior Client Executive – United Medicare Retiree Solutions (URS)
UNITEDHEALTH GROUP (Formerly PacifiCare acquired by UHG)
01.2007 - 01.2008
Vice President Employer Medicare Retiree Account
UnitedHealthcare
01.2006 - 2007
National Sales Director Employer Medicare Retiree Sales (PacifiCare)
01.2003 - 01.2005
Bachelor of Arts - Business Administration (Management)
California State University Fullerton
Master of Business Administration (MBA) -
California State University Long Beach