Scott Sowell
Health Plan Operations Executive
Summary
Experienced executive skilled in developing enterprise quality strategies, executing tactical plans, and monitoring ongoing operational metrics for optimal process performance and customer satisfaction. Demonstrates a strong track record in all aspects of health plan operations and proficiency in LEAN/Six Sigma methodologies. Skilled in various business transformation roles, offering innovative business engineering solutions and leading successful technical and business implementations. Possesses a deep analytical and intuitive mindset, enabling the identification of data trends and effective problem-solving by pinpointing core issues.
Overview
21
21
years of professional experience
2
2
Certifications
Work History
President
Blackwater Tiger Consulting
Phoenix, Arizona
07.2021 - Current
- Deliver input and guidance on strategies for ensuring a positive consumer experience during early-on phases of projects entailing the use of digital modernization models
- Facilitate deep-dive analyses across a range of problems experienced by client companies
- Provide expertise to business sponsors in planning major initiatives
- Aid clients in exploring options for business architecture and technical design, along with strategies for meeting future-state staffing and technology requirements
- Assimilate vision and strategy to build scalable processes for core health plan operations (enrollment, billing, claim adjudication, benefit configuration, provider data management, and payment integrity)
- Completed a deep consultation to re-engineer broker compensation and experience with the plan significantly
- After operational stability, built a portfolio of data analyses to uncover issues in the process before they affect the commission outcomes to the broker community
- Expertise in advising clients on disruptions in healthcare, addressing revenue opportunity and accounts receivable matters, and strategies for resolving healthcare claim payment issues
Vice President, Customer Growth Solutions
Blue Cross Blue Shield of Arizona
Phoenix, AZ
08.2017 - 07.2021
- Drove the strategy on the organization's planned product portfolio
- Responsible for all core operations (claims, enrollment & billing, customer service, payment integrity, clearinghouse), and all associated technical platforms
- Direct accountability for operation teams of up to 600 staff members in enrollment, claims, EDI analysts, and business analysts
- Direct and matrix responsibility for newly created technical Agile team as the Executive Product Owner overall development in the member and provider experience pillars
- Led and drove modernization of end-to-end technical functions, focusing primarily on claims, benefits, membership, and clinical management processes
- Outfitted Agile teams with high-quality tools and systems to enable the delivery of exceptional services, maintaining a strong focus on business needs and requirements, testing tools, and product validation processes for ensuring seamless migrations
- Delivered key leadership contributions in overseeing provider program portfolio to ensure positive outcomes on downstream processes and corresponding consumer experiences
- Responsible for all financial management of internal resources as well as internal/external resources providing services through a series of BPO arrangements
- Built a team of Vice Presidents and Directors and targeted development programs for each one of them
Vice President, Client Implementation
Blue Cross Blue Shield of Arizona
Phoenix, AZ
01.2012 - 08.2017
- Overhauled Sales and Account Management functions, leading to an 11% uplift in organic growth
- Assembled and led client implementation teams and designed processes for engaging with sales teams and clients for flawless onboarding
- Instrumental in ensuring the company's full preparedness for the Accountable Care Act (ACA) implementations
- Steered comprehensive integration of Lean and Six Sigma methodologies into organizational infrastructure and procedural guidelines
- As my role broadened over the years, my executive team and I began driving other products and process improvements across all areas of the organization to create scale and efficiency in alignment with the organization's vision
- A strong focus was placed on commercial onboarding to ensure a positive experience in transitioning new clients to the organization's products
- Built BPO structure and teams for all member, provider, and medical support outsourcing arrangements, including negotiating contractual and service-level terms
- Led cross-functional leadership team to revamp all web portals enterprise-wide, including the national Blues network, leading to considerable improvements in consumer interactions and self-service options
- Formed strong work bonds by leading development and cross-functional partnering on all core system configurations, particularly benefits, provider pricing, and enrollment
- Established processes to collect customer insights and drive that data to stakeholders so programs can be improved, and focus moved to what customers truly need
Vice President, Operational Excellence
Blue Cross Blue Shield of Arizona
Phoenix, AZ
01.2004 - 12.2012
- Accountable for all facets of corporate quality, particularly those products that included member, provider, and broker experiences with the health plan
- Developed 'out-of-the-box' organizational-wide facilitated work sessions
- Examples of work session deliverables are SIPOCs, Roadmap to Winning, Customer Journey Mapping, Customer Service Blueprints, Role-based Process Maps, Functional Decompositions, and Implementation plans
- As a Lean/Six Sigma Black Belt, drove the production optimization and scaling into each improvement step
- All initiatives contained skill evaluations, organizational structure, and organizational readiness processes to ensure alignment of skills are in place to manage new processes
- Guided and coached business and technical leaders in effective management of key corporate investments, focusing on business case development and planning for implementation of financially viable, employee- / consumer-centric initiatives
- Advised senior leadership and cross-functional teams on strategies for monitoring/evaluating functions with no precedent and inherent tracking challenges
- Re-engineered the front-end of the claims engine bringing the first pass rate from 84% to 91%
- Orchestrated planning and execution of a myriad of large-scale systems migrations and infrastructure-wide process improvements
- Oversaw Medical Underwriting team for Individual line of business, along with Credentialing and Clinical Reporting responsibilities
- Accelerated revenue timing through business process improvements
Education
Master of Arts - Organizational Management
University of Phoenix
Phoenix, AZSkills
Operations Management
Employer Group Servicing
Member Experience
Healthcare Provider Experience
Strategic Organizational Design
Efficiency Enhancement Strategies
Comprehensive Metric Evaluation
Lean Efficiency Strategies
Collaborative Technical Partnerships
Navigating Corporate Culture Changes
Leadership Skills Enhancement
Payment Accuracy
Certification
Six Sigma Black Belt, Aveta Business Solutions
Awards
- Albert Nelson Marquis Lifetime Achievement Award - Marquis Who's Who 2023
- Paloma Award for Financial Leadership - Southwest Center for HIV/AIDS
Accomplishments
- Resolved $38,000,000 in open accounts receivables with Marketplace accounts
- Successfully identified root cause of system migration issues, recast historical data, corrected back-payments to over 1,000 brokers, and assisted management with onboarding of a new leadership team
- Achieved $13,500,000 annual operational cost reductions through effectively outsourcing back-office and middle-office functions
- Achieved 11% organic growth by restructuring Sales, Account Management, and Client Implementation activities
Affiliations
American Society of Quality (ASQ)
MG Rush Systems
Timeline
President
Blackwater Tiger Consulting
07.2021 - Current
Vice President, Customer Growth Solutions
Blue Cross Blue Shield of Arizona
08.2017 - 07.2021
Vice President, Client Implementation
Blue Cross Blue Shield of Arizona
01.2012 - 08.2017
Vice President, Operational Excellence
Blue Cross Blue Shield of Arizona
01.2004 - 12.2012
Master of Arts - Organizational Management
University of Phoenix