Work · Brief · 2 minutes
The decisions behind the work.
Explore claims reconciliation, pharmacy operations and procurement adoption through the decisions and evidence. Cases omit internal names and confidential details. Outcome figures are real and stated in headline form. Retrospective analysis is labeled.
Focused work account · Cigna Pharmacy
Delivered product
One drug catalog, many pharmacy workflows
Departments maintained their own drug lists. I helped turn those separate lists into a centralized catalog with shared source data, a consistent model and a workflow for creating and approving lists.
Business and functional requirements; product roadmap and workflow design
My contribution
I led business-process and requirements sessions, analyzed First Databank and Medi-Span feeds, and worked with an analyst on the data model, user interface and roles. The first milestone used GPI and GCN criteria to retrieve the matching NDCs.
What the work delivered
The team delivered a transaction store, a master drug-data model and a librarian interface for creating and approving drug lists for consumers.
01
The fragmented starting point
Individual departments managed and maintained their own drug lists. I worked with pharmacy business groups to capture the current process, define the future process and identify the requirements for a shared drug-list repository.
02
The work I owned
I facilitated business-process modeling and requirements sessions, translated business needs into functional specifications, and reviewed the requirements with business, development and QA. The work included data mapping, GUI use cases, report specifications, API service specifications and calculation rules.
03
A focused first milestone
I shaped a roadmap that began with an MVP: select GPI and GCN criteria and retrieve the available NDCs. With an analyst, I divided the delivery into source-data ingestion, the supporting data model and the user interface with workflow roles.
04
The delivered workflow
The resulting product combined a raw-data transaction store, a master drug-data model and a librarian interface to create and approve lists. The later use of this catalog by another Cigna business was a separate reuse decision, rather than the original catalog launch.
Focused work account · Cigna Pharmacy
Workflow requirements
Make the rebate billing lifecycle visible
Rebate billing connects drug-level calculations to manufacturer invoices and payments. I defined the requirements and business-process models that made those connections explicit.
Business analysis, process models and requirements
My contribution
I worked on billing packages and manufacturer invoices, rebate calculations and projections, price-protection calculations, receivables and the reports needed to support the process.
What the work delivered
The work translated a connected financial workflow into application requirements and reporting specifications for pharmacy teams.
01
The connected business process
I created business requirements and process models for the pharmacy rebate application. The scope covered manufacturer billing packages and invoices, prescription rebate calculations, projections, payment receivables, sharing and related reports.
02
My contribution
I made the business logic and reporting needs explicit so development and QA could work from agreed requirements. My work included rebate-detail reporting, price-protection calculations, invoices and reporting.
03
Connected to sharing
Rebate sharing is a related part of the same application family. The incoming billing and payment workflow connects to the downstream sharing process and its reports.
Focused work account · Cigna Pharmacy
Workflow requirements
Connect rebate payments to sharing and reporting
Billing is only part of the rebate story. I also worked on the rebate-sharing process and its reports, keeping that downstream work connected to calculations and payment receivables.
Business requirements and process modeling
My contribution
I captured the sharing requirements and related reports within the pharmacy rebate application, alongside the business models for billing, calculations and incoming payments.
What the work delivered
The requirements described both the incoming rebate workflow and the sharing process that followed it.
01
A distinct part of the same application
The Cigna rebate application included sharing processes and related reports alongside billing and receivables. I worked on those connected requirements so the downstream sharing workflow remained visible.
02
What I contributed
I created business requirements and business-process models spanning rebate calculations, manufacturer invoices, receivables, sharing and reporting. I also worked on rebate-detail reports and invoice reporting across the billing and sharing systems.
03
Following the full process
Looking across billing and sharing helped connect the calculation, incoming payment and downstream reporting work. The requirements needed to describe those handoffs in terms that business, development and QA could review together.
Focused work account · WellPoint / Anthem
Clinical decision-support workflow
Help oncologists explore treatment options
The oncology workflow brought patient notes, history and reports together so clinicians could review three treatment options with IBM Watson support.
Business Systems Analyst; reporting, workflows and application requirements
My contribution
I worked on reporting use cases, report mockups and process flows, and helped define the application’s access and security requirements with business, information-security and legal partners.
What the work delivered
My contribution connected clinical users’ needs to reviewable workflows, reporting and application requirements.
01
The clinical workflow
The work supported oncology treatment exploration using patient notes, history and reports. The workflow presented three options for clinical review.
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My responsibility
As a business systems analyst on WellPoint Care Assistant, I developed reporting use cases, report mockups, process flows and use-case diagrams. I worked directly with business stakeholders, including physicians, through requirements and design reviews.
03
Access and application requirements
I also contributed to application security requirements and worked with information-security and legal partners on access, terms of use and service disclaimers. Requirements, mockups and workflows made the intended behavior reviewable by the teams building and using the application.
Focused work account · Cigna Supplemental Benefits / Evernorth
API reuse
Reuse the drug data already in the business
A sales application needed drug data. I recognized that a prior Cigna Pharmacy catalog already had the source feeds and worked with both teams to reuse its interfaces.
Cross-team product discovery and integration alignment
My contribution
I checked with my former pharmacy team that the catalog and feeds were still in production, established that consumer APIs existed, and brought the catalog and sales-application teams together to assess the integration.
What the work delivered
The sales-application team used the existing API instead of establishing a separate drug-data subscription for the same need.
01
A separate chapter from catalog creation
This decision happened later, during work for Cigna Supplemental Benefits. I had previously worked on the pharmacy catalog and knew there might already be a useful capability inside the company.
02
What I did
I contacted the former team and confirmed that the First Databank and Medi-Span feeds remained in production and that APIs were available to consumers. I arranged the discussion between the sales-application team and catalog team to check whether those APIs met the need.
03
The result
The consuming team agreed to use the existing API. The original catalog could support another business workflow through an established enterprise interface.
Focused work account · Cigna Supplemental Benefits / Evernorth
Launched product
Launch a benefit across the whole member journey
A dental, vision and hearing product needed to work beyond enrollment. I organized the launch across product configuration, member experience and the claims-administration handoff.
Technical product management; roadmap and integration delivery
My contribution
I built the roadmap, converted milestones into epics, defined acceptance criteria and coordinated the product, enrollment, policy, digital, claims, ID-card, EOB and reporting work.
What the work delivered
The product launched for Medicare supplemental customers with the enrollment and claims-administration integration in place.
01
The complete launch
My responsibility was to launch the dental, vision and hearing product for Medicare supplemental customers, including enrollment installation at Cigna and integration with the claims-administration partner.
02
The roadmap I owned
I divided the roadmap into product configuration, enrollment application changes, policy configuration, digital integration, claims management, ID cards and EOBs, and reporting. I turned milestones into epics, set priorities and clear acceptance criteria, and worked with the teams against the launch plan.
03
A second path for enrollment
The enrollment integration also needed a fallback when the partner API was unavailable. I proposed and coordinated a file-based backup with the partner. The enrollment-resilience account explains that decision and its production use.
Focused work account · Cigna Supplemental Benefits / Evernorth
Production fallback
Give enrollment a fallback before it fails
The new benefit used an API to publish enrollment to a claims-administration partner. Testing made me question how that path would behave during an outage, so I proposed a second way to deliver the same enrollment.
Technical product management; partner integration and resilience
My contribution
I worked with the partner on an existing file-processing capability and coordinated SFTP connectivity and enrollment-file generation as a fallback.
What the work delivered
Production support used the backup to publish memberships when the API was unavailable.
01
The risk I noticed
During testing for the new benefit, I saw enough integration issues to question the reliability of a new API spanning two organizations. The customer needed enrollment to reach the claims-administration partner even when that service was unavailable.
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A practical second path
I discussed fallback options with the partner and learned it already supported traditional file processing. I proposed using that capability during API failure, and the teams set up SFTP connectivity and enrollment-file generation.
03
Used in production
Production support used the fallback during subsequent outages to publish memberships. The second delivery path gave the team a practical way to continue enrollment when the API was unavailable.
Focused work account · Cigna Supplemental Benefits / Evernorth
Launched member self-service
Put the deductible answer in the member’s hands
Members had to call customer service to learn how much of their deductible they had met. I helped put that answer into the digital experience using the same underlying calculation.
Technical product management; accumulator logic and digital delivery
My contribution
I reverse-engineered the Medicare Part A, Part B and Plan K accumulator logic, worked with engineering to reproduce the required behavior, and kept the API tied to the core calculator.
What the work delivered
Members could view their accumulator information through the digital platform instead of relying solely on a service call.
01
The service problem
The existing path required a member to call customer service, where a representative looked up the deductible-met amount in the policy system and explained it. I proposed making that information available directly in the digital platform.
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The product and technical work
I developed the roadmap and worked through the existing accumulator rules so the new experience would use the same calculation logic. With engineering, I built the application behavior around the core calculator and its API.
03
The delivered experience
The application was deployed to the digital platform, and members used it to track their accumulators. This is a distinct member self-service outcome within the broader digital migration.
Focused work account · Cigna / Evernorth
Deployed identity service
Give membership a reusable identity
Different insurance products had their own enrollment systems and could create duplicate identifiers. I proposed a common identifier service and a way to connect it to the enrollment program.
Customer MDM product management; proof of concept and integration proposal
My contribution
I asked the team to test the approach, identified an existing identifier algorithm we could reuse, and presented the service and integration plan for funding.
What the work delivered
The service was deployed and integrated with enrollment, producing identifiers designed for use across ID cards, IVR, digital and customer service.
01
Why identity mattered
Customer MDM was responsible for maintaining identity while insurance products continued to use separate enrollment platforms. I saw the need for a shared identifier service rather than treating each product’s identifier as an isolated concern.
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My decision and proposal
I asked the team for a proof of concept, explored reuse of an existing identifier algorithm and prepared the proposed service and integration steps for program leadership.
03
A funded, integrated service
Leadership funded the work, and the service was deployed and connected to enrollment. It supplied IDs usable as card numbers and compatible with IVR, digital and customer-service requirements.
Focused work account · Cigna Supplemental Benefits / Evernorth
Implemented workflow
Move product approval into a usable launch workflow
Product approval did not mean a benefit was ready to sell. Commission structures still moved through manual approvals and loading steps, so I designed a connected workflow for that final stretch of launch.
Technical product management; workflow design and funding case
My contribution
I mapped the process with product, commissions, actuarial and marketing teams, identified approval and loading bottlenecks, and proposed a web workflow with notifications, backup approvers and versioned templates.
What the work delivered
The workflow received funding and was implemented, connecting approved commission structures to the enrollment and policy platform.
01
The gap after approval
The product team designed a commission structure, collected approvals from commissions, actuarial and marketing, and then loaded the product into the enrollment platform. This manual process delayed launch after state approval.
02
The work I led
I scheduled working sessions with the business groups to map the process and pain points. I then designed a web-based workflow, notifications, backup approvals and automated loading of an approved commission structure, with a roadmap that leadership could fund.
03
The implemented change
Leadership funded the proposal. The implementation moved commission structures from spreadsheets into versioned templates and connected the approval process to the enrollment and policy platform. This is distinct from earlier BCBS Florida incentive-compensation work.
Production account · Amazon Pharmacy
Three production agent workflows
Three production AI agents
I own three production generative-AI agents across customer assistance, clinical support, and claims and billing.
Senior Product Manager – Technical · Amazon Pharmacy
Three production agents at a national online pharmacy, one standard of accountability.
AI earns a place when it removes meaningful work or improves a decision enough to justify its cost, uncertainty and operating burden. I own three production generative-AI agents, and I hold each to the same standard: define the evidence, evaluate failures, make corrections possible, keep authority with a person for consequential actions, and record the reason for the final decision.
I defined the AI-assisted to AI-primary strategic theme for annual planning, and it was adopted as a planning pillar. The customer assistant resolves 78% of chats without a human. In healthcare, launch is when you have proven safety at scale, not when the code ships.
Production · Customer assistant agent
A customer assistant that resolves 78% of chats without a person
The customer assistant answered common questions using context and retrieval, with a summary for the representative when the issue needed a person. For this illustrative workflow, ordering requires a separate authorized step.
Outcomes: 78% of chats resolved without a human; 18% of voice contacts fully automated; moving from an intent router to ReAct lifted resolution 18%; hot-path optimization cut median inference calls from two to one for 43% P50 and 67% P90 latency improvement and 40–54% lower token cost.
Workflow explanation
- Contact arrives Chat or voice · identity established first
- Reason and act ReAct loop · one inference call on the hot path
- Live data via tools Prescriptions, orders, insurance, pricing
- Bounded actions Illustrative ordering requires separate authorization
- Resolve or hand off Summary to a person · acceptance is illustrative policy
- Measure Illustrative policy · evaluate resolution and handoff
Production · Clinical copilot
A clinical copilot rebuilt when 15-second latency made it unusable
The copilot supported clinical operators with curated procedures, case summaries and next-best actions. The illustrative validation control checks latency and accuracy before expanding the workflow.
Outcomes: P90 15 s to 1.6 s; a model change to a higher per-token cost model with fewer turns lowered net cost; a storage-key change cut memory cost 95%.
Workflow explanation
- Case or call Operator opens a case or takes a call
- Retrieve Curated procedures and knowledge with citations
- Summarize Issue, history and next best action
- Stream Illustrative response delivery · validate latency and accuracy
- Operator decides Clinical authority stays with the person
- Validate Illustrative policy · check latency and accuracy
Production · Claims and billing agent
A claims and billing agent that explains 800+ rejection codes
The billing workflows are in production after pilot and ramp-up. The agent interprets rejection knowledge and can correct a 30-day supply to the allowed 28 days, update insurance and resubmit, or refile an approved 30-day quantity when a 90-day request exceeds the insurance limit. Clinical/DUR edits go to a pharmacist for manual verification and approval; brand/generic prescription and DAW edits go to a technician. Prior authorization goes to a PA bot for Cover My Meds filing, follow-up after four unresolved days and customer notification after approval. Other paths compare coupon and insurance pricing or communicate the next available refill date. I integrated the billing agent into the Amazon Pharmacy platform after prescription typing and launched the prescription flow: a technician or pharmacist refiles after making the required edit, and the agent suggests further changes. The work affected more than 100,000 prescriptions per month at Amazon Pharmacy.
Workflow explanation
- Claim rejects One of 800+ codes · representative asks
- Retrieve Rejection-code knowledge base
- Look up Authorized billing context and rule limits
- Interpret and route Allowed billing actions · clinical edits to pharmacist; prescription edits to technician
- Guardrails Illustrative policy · record and review breaches
- Experiment Illustrative policy · review candidate changes
Illustrative review controls
This illustrative breach-review control records safety exceptions and routes them for review. Candidate prompt, model and guardrail changes are evaluated before reuse. Action permissions remain specific to the authorized workflow.
Explore the engineering practice
Amazon Business · Integrated Quoting
From a quote request
to an order.
Volume pricing becomes an orderable commitment after the quote is won.
After the quote is won ↓
Commercial workflow. Local eligibility and unit conversion examples are illustrative, not measured results. Select a labeled step for an overview and process details.
Read the complete process
Quote request
Enterprise buyers request quotes from Amazon Business and third-party providers inside their sourcing platform. The response path makes product match, available inventory and the requested unit explicit.
Process note: The request form is simplified. It contains no buyer identifier, historical conversion rate or recorded quote.
Volume pricing
Catalog match and availability inform a suitable response. A pack price and an each price cannot be compared without conversion factors. Illustrative arithmetic: $4.25 × 12 ÷ 6 = $8.50 per case of 12.
Process note: Illustrative eligibility: more than 1,000 units OR more than $10,000. Exactly 1,000 units and $10,000 does not meet either strict threshold. The existing local calculator remains the place to try inputs.
Quote won
After a quote is won, the workflow locks price and reserves inventory while the customer orders. This is the commercial transition between quote response and the order path.
Process note: No win rate, completed pilot, lock duration or reservation duration is asserted.
Lock price + reserve
Price lock and inventory reservation follow quote win and support the customer while they order. The two objects in the illustration are parallel commitments in this same state.
Process note: The lock and stock specimens show function. They do not imply a specific time limit or inventory quantity.
Submit the order
The customer submits the order through Ordering API/XML. This order-submission role follows the won quote and its price lock and inventory reservation.
Process note: The XML page is a conceptual artifact; it is not an actual API schema or customer payload.
Post-order follow-through
Reconciliation/Invoice API supports the post-order workflow. Its role is distinct from Ordering API/XML, which handles the submission of the order.
Process note: The invoice specimen is illustrative. No invoice amount, fulfillment rate or reconciliation outcome is added.
- What
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The missing claims: 300,000 claims and about $10M found by asking what never reached the report
Healthcare projects · From my experience
Three projects. Three different decisions.
Supporting healthcare documents →
400,000+ paper claims converted to EDI 837; an 80-person team redeployed; about $1M a year saved.
From scanned CMS-1500 and UB-04 forms to validated EDI transactions and auto-adjudication.
A match the next system can trust.
Provider matching moved to the provider master, with a 99% match in the proof of concept.
An integration platform · the legacy claims integration replaced
A legacy claims integration replaced.
I led the replacement of Microsoft BizTalk with homegrown EDI shredding into a normalized datamart before adjudication. Complete claim data reduced enhancement turnaround by 50% and improved received-to-paid mapping and CMS reporting.
- Who
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Applied AI · Featured technical case
Agentic customer care
The technical design: access and authorization before customer context or AI, routing, retrieval, authorized actions, both escalation paths, reconciliation and reviewed learning.
- How
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Automating state controlled-substance reporting: rules for the known, people for the exceptions
Every controlled-substance dispense must be reported to state monitoring programs, and the reporting was manual. I led the automation: 2,250 daily reports to all 50 states and DC, about 5 hours of manual work a day eliminated, and zero compliance gaps.
- So what
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Case studies
Rebuilding the drug-safety check to run in real time
Drug utilization review is a clinical-safety check in the pharmacy workflow. I co-led the product work to replace the asynchronous path with a synchronous service, with historical replay and staged rollout described in the launch account.
A safety check before dispense, launched through a phased rollout
I led the requirements and phased rollout of a safety check closer to dispense, aligning readiness with clinical and operational partners.
Deep dive · 3 minutes
Work: Deep dive
Cutting alert noise without weakening the safeguard
I analyzed alert categories and designed eleven proposed optimizations across three themes: reduce avoidable alerts, surface useful clinical context, and consolidate review. The proposal models reduced workload while preserving clinical coverage. Those modeled benefits are separate from the narrower dose-check fix reported as shipped. The broader program is in progress.
One console for pharmacy customer care: about three minutes saved per contact in the pilot
Amazon Pharmacy customer care worked across a legacy agent tool plus chat and voice systems, while pharmacists and technicians juggled many separate tools. I was the product manager for a unified care console: I flipped the launch sequence to protect continuity of care, piloted it, and then shipped the capabilities that removed the biggest sources of transfers and hold time. The pilot saved about 3 minutes per contact across more than 6,000 contacts a month. AI-assisted routing saved 21 minutes per routed contact and eliminated about 1,000 transfers a month.
Sequencing an MDM migration around the systems that depend on it
Leadership wanted a source-by-source migration from a legacy customer book-of-record to the enterprise master-data platform. I brought the dependency data (500K daily validation calls, 100K+ provider transactions), won approval to integrate critical consumers first, and then led the initiative across both platforms.
Enrollment that completes within an hour
I chose to redesign the enrollment flow on the new streaming infrastructure rather than patch the legacy batch. Nine months later members had digital access, claims and service within an hour of enrolling, and a seven-days-before-go-live performance crisis was fixed at ten times the throughput.
Punchout: a five-lever turnaround across more than 100 e-procurement systems
Punchout lets an enterprise buyer leave their procurement system, shop on Amazon Business and return the cart for approval. I owned Punchout across more than 100 e-procurement systems, but growth had slowed and too few connected users were buying. I wrote and ran the go-to-market turnaround across sales, services, product, marketing and partners. Amazon reported new Punchout adopters up 50% in 2023.
Integrated Quoting: we were optimising the wrong engine
Integrated Quoting lets enterprise buyers request quotes from Amazon Business inside their e-sourcing platform. After basket-level quoting launched in 2023, five months of funnel data showed why it was not converting: most quotes had product matches, but almost all requests failed the quote engine’s eligibility rules, and the prices we did return looked wrong because of a unit-of-measure default. I wrote the version 2 technical strategy: a marketplace offer with a price lock, a unit-of-measure fix and automation of the manual steps.
Hosted Catalog: designing the change, not just the publication
Enterprise buyers wanted Amazon Business’s planned-spend catalog inside their own e-procurement systems next to other suppliers. Keeping a published catalog current took manual refreshes. I took the product from framing through eight requirement versions and a pilot, with change management designed in from the start.
Moving pharmacy point-of-sale off the back-room server: a business-model conversion
At McKesson I led the migration of the retail point-of-sale and pharmacy management systems that process in-store payment and prescription transactions. $25M budget, a seven-person team.
Punch-in: partner readiness is not adoption
Punch-in lets a buyer start on Amazon Business and send the cart into their procurement system as a requisition. Partners went green. Customer adoption came in well below goal. This is the miss, what I changed, and why it reshaped how I set goals.