John first joined Milliman in 2011. His experience includes:
- Advanced analysis of claims data, including storyboarding pathways of care and cohorting clinical conditions
- Rate filings for marketplace products
- Pricing and reserving for insurance carriers and self-funded large employer health plans
- Reimbursement auditing of PBM arrangements
- Modeling of reimbursements under prospective PBM contracts
- Review of pharmacy benefit agreements and outpatient pharmacy agreements
- Analysis of Medicaid and Medi-Cal experience to support innovative risk sharing arrangements and care delivery models
Prior to rejoining Milliman in 2020, John worked for a rapidly growing Medicare Advantage plan. He focused on business intelligence and financial management. Projects included drawing insights from raw application data such as online HRAs, prior authorizations, claims data, and call logs. He focused on both quality improvement and medical cost savings initiatives, including evaluation of claim operations, medical audit, utilization management, and clinical interventions. John managed the budget (FP&A) for human resources, office expense and rent, communications, sales, and marketing.
Previously, John also worked for KPMG UK, including a project for a major international life insurer calculating EV for the first time, financial reporting and due diligence at major financial institutions, and strategic growth analysis.
Prior to joining Milliman in 2011, John served as the Executive Officer of USS Chinook and Patrol Coastal Crew INDIA. His responsibilities included security sweeps of vessels in the Northern Arabian Gulf, navigation, and communications. During his military career, he received three navy achievement medals.
