David Fernandez
Chief Claims Officer
About
What I am Passionate About: · Helping organizations and individuals accomplish things they never thought possible · Solving complex problems and doing work that matters · Building a workplace culture that engages and values employees · Hiring, developing, and coaching others so they can do their best work What I Do Now: · Lead Claims and Enrollment Operations for Point32Health, a $9B Health insurer, to drive Quality, Efficiency, Provider and Member experience, and compliance. What I Have Done in the Past: · Lead customer facing operations from 100->1000 employees at industry leading companies. · Taken on the most challenging operational leadership roles because of my ability to quickly understand what’s working, what’s not, and lead the organization to a better future. Key Highlights From My Career: · Reduced Claims inventory by 75% post system implementation through building foundational metrics, developing staffing forecast models, staff augmentation, and automation. · Realized $60M in annual savings and met operational/financial outcomes by driving a robust transformation program. · Decreased annual over payments $25M by taking over, turning around, and executing an IT implementation on-time. · Attained $2M+ in operating efficiencies and 10-pt. increase in service scores by improving operational stability, automating repetitive tasks through technology, and increasing digital self-service offerings. · Generated breakthrough employee engagement, increased Employee Net Promoter Score by 25 points, and decreased turnover 30%. What I Love Doing When I’m Not Working: · Spending time with family and friends, and being outdoors including running, hiking, biking, and water skiing · Raising money for Dana Farber Cancer Institute and riding in the Pan Mass Challenge · Volunteering at Colby College Operational Excellence | Strategic Planning & Execution | Process Improvement | Customer Experience | Digital Enablement | Change Management | Full Cycle Talent Management | Employee Engagement
United States
Greater Boston
Insurance
Leadership, Coaching, Team Building, Property & Casualty Insurance, Employee Benefits, Risk Management, Strategic Planning, Casualty Insurance, Insurance, Liability, Claims Management, General Insurance, Commercial Insurance, Underwriting, Business Process Improvement, Casualty, Analysis, Health Insurance, Disability Insurance, Business Strategy
Experience

Chief Claims Officer
Kingstone Insurance
New York, United States

Vice President
Boston, Massachusetts, United States
Responsible for delivering operational excellence, program management, and post-merger integration. – Reduced inventory by 75% post claim system implementation by developing foundational metrics and KPI’s, building staffing models, process improvement, and automation. – Planned and executed multi-year project to overhaul and automate the Coordination of Benefits process resulting in $8M in annual medical cost savings, $500k in efficiencies, improved compliance, and reduced Provider friction.

Vice President
Greater Boston Area
Led the Transformation and Project Management Office for a rapidly growing 3,500 FTE Claims organization, Unum US Enterprise Lean Management deployments and BPO strategy and implementation. – Redesigned Claims operating model leveraging Customer Journey Mapping and Voice of Customer to drive 10-point improvement in Customer Service results and improved efficiency. – Attained $2M+ in operating efficiencies using Lean-based methods including Value Stream Mapping, process mapping and improvement, management systems, digital self-service, and enabling technology.

Vice President, Senior Field Manager
Greater Boston Area
Selected to transform an underperforming multi-site, 1,200 FTE auto claims organization; Responsible for operational and financial results, customer experience, talent management, and employee engagement. – Developed and implemented a comprehensive transformation and change management program focused on culture, service, quality supported by Lean Management System. – Increased Net Promoter Score from 40% to 50% in 12 months, reduced unit cost 7%, and improved loss results by ~$30M annually through operational execution, creating a service focused culture, and process improvement.

Vice President and Manager
Greater Boston Area
Led 800 employee Casualty claims organization with over 20,000 litigated cases and annual payments of $1.3B. – Led the implementation of a transformation program focused on accuracy, quality, and litigation effectiveness which met or exceeded all financial and operational targets including reduction of overpayments by $60M annually. – Increased productivity 15% over 18 months by instilling and championing a continuous improvement culture; engaged front line teams to promote process improvements and drove the adoption of best practices. – Improved employee engagement results from lagging internal benchmarks to the best in division of 8,000 employees.

Assistant Claim Product Manager
Led the post-acquisition integration of 500 FTE Safeco Casualty Claims organization with Liberty Mutual claims. – Developed comprehensive transformation program focused on aligning Casualty operating models, process, technology, and culture for both legacy organizations – Implemented paperless claims handling for the department resulting in ~$5M of annual savings. – Deployed vendor technology solution and restructured operating units to reduce overpayments by $15M annually.

State Claims Manager
Promoted throughout tenure to lead ~700 employees and $800M+ in annual claim payments. – Consistently recognized for being in top tier nationally for performance across key metrics. – Led claims turnarounds in MI/WI New England, and 1-year special assignment in NY/NJ
David Fernandez's Contact Information
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