Amy Giese

With over 30 years of experience in the industry, Amy Giese has established herself as a seasoned expert in individual, small, and large group health insurance, including the ACA market, MEWA (Multiple Employer Welfare Arrangements), and level-funded plans. Her extensive background encompasses Medicare Part D bid development and support, pharmacy benefit management, provider benchmarking, and group dental insurance.

Amy has collaborated with commercial carriers on pricing strategies, projecting the impact of healthcare reform legislation, and managing financial and strategic risks. She has been instrumental in underwriting, product development, provider contract negotiations, and various actuarial projections. Her expertise extends to risk adjustment optimization, reserve valuation, claims auditing, rate filing assistance, and annual actuarial certifications.

In the Medicare market, Amy has supported Part D plans with strategic planning, formulary analysis, bid preparation, partnership analysis, and fraud, waste, and abuse monitoring. Her pharmacy-related projects include working with pharmacy benefit managers and retail pharmacies, formulary design, medication adherence outcome evaluations, and competitive analysis.

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

As an appointed actuary for various clients, Amy has demonstrated her ability to distill complex information into understandable insights for diverse audiences. She is known for challenging the status quo and introducing innovative methods to enhance actuarial processes. Amy is also a good listener, adept at understanding and addressing clients' needs effectively.