Amy Giese

Amy’s areas of expertise are individual, small, and large group health insurance; Medicare Part D bid development and support; pharmacy; provider managed care contracting; and group dental.

Amy has worked with commercial carriers in performing pricing and projecting the impact of health care reform legislation for financial and strategic risk management, underwriting, product development, provider contract negotiations, and other actuarial projections. Her insurer experience also includes risk adjustment optimization, valuation of reserves, claims auditing, rate filing assistance, and annual actuarial certifications.

Specific to the Medicare market, Amy has assisted Part D plans with strategic planning, formulary analysis, Medicare bid preparation, partnership analysis, and fraud waste and abuse monitoring.

Related to pharmacy, Amy has worked with pharmacy benefit managers and retail pharmacies. Examples of projects include pricing for specialty medication programs, formulary design, evaluation of medication adherence outcomes, and design of competitive analyses.

Amy’s provider contracting experience involves working with national provider management vendors to achieve overall corporate strategic planning and profitability objectives. The vendors include PBMs, specialty pharmacies, primary and passive rental PPO networks, radiology, laboratory, and Centers of Excellence.