Karen Oluma
Park Rapids,MN
Summary
Accomplished Health Risk and Cost Containment Consultant with a proven track record working with all lines of business for Stop Loss Employer Groups, Captive, and Reinsurance HMO Clients. Ability to quickly establish sound, collaborative client relationships, drive continuous improvement and optimal care while implementing claims cost containment solutions for the mutual benefit of the company and clients.
Overview
25
25
years of professional experience
Work History
Health Risk Management & Const Containment
Berkley Accident & Health
11.2008 - 06.2024
- Evaluated client needs, goals and established clear priorities with clients for cost containment.
- Delivered outstanding service to internal and external clients to support client retention & expansion.
- Liaised with customers, management, and sales team to better understand customer needs and recommend appropriate solutions.
- Collaborated with cross-functional teams to successfully deliver comprehensive solutions for clients.
- Reviewed underwriting renewal and new business claims data for potential catastrophic claims.
- Provided underwriting and sales with estimates for claims going forward and potential cost containment strategies for clients future claims mbased on current claims.
- Consulted directly with brokers and clients for contractual issues specific to transplants contracts for the State and Public Programs clients.
- Created ICD-10 Risk Management Tool for Underwriting, Sales, and Clinical Risk Underwriting Review Nurses.
Underwriting Consultant
HCC Life Aka Tokio Marine
11.2006 - 11.2008
- Developed evidence-based protocols, promoting consistent practices across the department.
- Provided Underwriting support for renewal and new business underwriting claim reviews.
- Implemented Cost Containment Strategies for clients/
- Performed internal claim Reviews for Reinsurance Client Reimbursement requests.
- Supported sales in new client onboarding and ongoing direct client support.
- Consulted with brokers and clients for cost containment strategies on known ongoing claim cost issues and catastrophic claims.
- Managed the Medical Necessity Review outsourcing and process.
Clinical Consultant
Allianz
02.2006 - 11.2006
- Participated in continuous professional development activities, staying current with industry advancements and best practices.
- Performed clinical Underwriting Reviews and Sales Support for ESL clients, and HMO/PEL lines of business.
- Identified catastrophic claims and projected the potential costs for ongoing claims in support of underwriting review of risk for new and renewal business.
- Provided transplant contract analysis and referral support for all lines of business.
- Transitioned to a position with HCC Life (now Tokio Marine) when the business was sold in November 2006.
Manager Utilization Review
UCare Minnesota
06.2001 - 02.2006
- Managed and motivated employees for optimal production and job satisfaction.
- Developed and implemented improved processes to promote department efficiency and accuracy.
- Accomplished multiple tasks within established timeframes.
- Identified, implemented, and maintained NCQA, Medicare, and Medicaid performance standards for intake and prior authorization of services.
- Enhanced customer satisfaction by resolving provider complaints promptly.
- Supervised a team of Intake staff, UR and Case Management Nurses for State and Public Programs, Medicaid, Medicare, Waivered Services, Medicare Special Projects, Dual Eligible, and Delegated Entity Clinics.
Manager Utilization Review and Case Management
Advanced Focus, A Fortis Company
06.1999 - 11.2001
- Managed a MN office team of Intake Representatives and Utilization Review Nurses for Advanced Focus, a Fortis company, with primary office in Florida.
- Managed all operations and employees performing Intake services, Prior Authorizations and Case Management for Employer Stop Loss clients.
- Supervised Case Management Cost Containment of Catastrophic claims for the employer Stop Loss Employee line of business.
- Supervised and participated in the SLE reinsurance reimbursement claim process.
- Managed the transition period for closure of client contracts after the business was sold and all other employees were laid off.
Education
Associate of Applied Science - Nursing Education
Minneapolis General Hospital School of Nursing
Minneapolis, MNSkills
- Integrity & Honesty
- Critical Thinking & Problem Solving
- Customer Focused Client Management & Engagement
- Work Planning and Prioritization
- Implements CPI & Best Practices
- Medicare, Medicaid, Commercial LOB Knowledge
- ICD-10 Proficient
- CPT Coding Proficient
- Medical Necessity Claim Review Process Proficient
- Stop Loss Claim Review Proficient
- Captive Claim Review Proficient
- Reinsurance Claim Review Proficient
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Experience is a hard teacher because she gives the test first, the lesson after.
Vernon Law
Timeline
Health Risk Management & Const Containment
Berkley Accident & Health
11.2008 - 06.2024
Underwriting Consultant
HCC Life Aka Tokio Marine
11.2006 - 11.2008
Clinical Consultant
Allianz
02.2006 - 11.2006
Manager Utilization Review
UCare Minnesota
06.2001 - 02.2006
Manager Utilization Review and Case Management
Advanced Focus, A Fortis Company
06.1999 - 11.2001
Associate of Applied Science - Nursing Education
Minneapolis General Hospital School of Nursing
Accomplishments
Created ICD-10 and CPT coding spreadsheet for use in sales and underwriting to quickly identify disease states, treatments and diagnoses with a potential for catastrophic claims.
Saved over 8 million dollars for clients by analyzing network contracts, LOAs, and providing feedback to clients on the cost performance of each contract.
Developed guide to new and evolving gene and cell therapy for use in underwriting, sales, and the development of underwriting strategies to address these potentially catastrophic costs.
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