Jim Cunningham

Jim Cunningham

About

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Chief Operating Officer | Service Operations | Business Transformation | M&A Integration
United States

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Résumé


Jobs verified_user 0% verified
  • ZELIS
    Senior Vice President, Client Services
    ZELIS
    Nov 2022 - Current (2 years 4 months)
    Lead operations supporting all payer and provider client services for the Payments business. Functional service areas include: Clients: Implementation, Client Experience, Communications Operations Providers: Network Implementation, Service Center, Payment Remittance & Compliance Internal: Strategic Enablement, Project Management Office, Workforce Planning
  • McKinsey & Company
    Senior Advisor
    McKinsey & Company
    Jan 2022 - Jan 2023 (1 year 1 month)
    Healthcare practice M&A senior advisor, engaged in: • Buy side diligence • Integration strategy • Asset optimization • Operational scale and readiness • Provider and patient engagement • OPEX and CAPEX recommendations
  • E
    Vice President & General Manager; Chief Operating Officer, PBM
    Evernorth
    Jan 2019 - Jan 2022 (3 years 1 month)
    Transitioned from Express Scripts to Evernorth following Cigna’s $67B acquisition in December 2018. Expanded scope to serve as COO leading all operations supporting $60B pharmacy benefits business unit, and integrate operations to enable enterprise service model. Scope included 10K global resources & $600M budget. Functional service areas included: Clients: Benefit Configuration, Eligibility, Consumer Driven Health (CDH), Client Service Center Patients: Customer Service, Claims, Communications & Distribution Providers: Prior Authorization/Utilization Management, Medical Benefit Drug Management Network Pharmacies: Retail Pharmacy Help Desk Internal: Project Management Office, Analytics, Quality & Continuous Improvement, Workforce Planning,
  • E
    Vice President & General Manager, Service Operations (COO, PBM)
    Express Scripts
    Jan 2017 - Jan 2019 (2 years 1 month)
    Promoted to improve operations supporting $60B pharmacy benefits business unit. Responsible for strategy & service across team of 3.5K global resources & $200M budget. Functional service areas included: Clients: Benefits, Eligibility, Consumer Driven Health Patients: Claims Providers: Coverage Review/Prior Authorization, Medical Benefit Drug Management Internal Partners: Project Management Office, Analytics, Facilities Strategy & Planning, Workforce Planning, Quality & Continuous Improvement, Corporate Real Estate, Business Continuity
  • E
    Vice President, PBM Services
    Express Scripts
    Jan 2015 - Jan 2017 (2 years 1 month)
    Selected to launch new operating models for Benefit Services & divisional Shared Services organizations. Scope included team of 400 people & $40M budget. Functional service areas included: Benefit Configuration, Analytics, Quality & Continuous Improvement, & Program Management
  • E
    Vice President, Consumer Experience & Strategy
    Express Scripts
    Jan 2012 - Jan 2015 (3 years 1 month)
    Transitioned to lead new organization focused on omnichannel contact strategy & >500M annual patient interactions following $29B Medco acquisition. Led 3 functions with >200 resources & $200M operating budget. Service areas included: Member Experience Campaign Management, database marketing operations Communications Fulfillment, with >500M outbound communications through omnichannel delivery
  • E
    Vice President, Client Implementation & Integration
    Express Scripts
    Jan 2010 - Jan 2012 (2 years 1 month)
    Promoted to integrate $4.7B NextRx acquisition & implement Express Scripts’ largest client. Delivered largest client implementation in company history, spanning 12 health plans and >17M patients in only 18 months. Led $120M budget & team of 350. Functional Service Areas included: Implementation, Prior Authorization, & Customer Experience & Strategy
  • E
    Senior Director, Client Services
    Express Scripts
    Jan 2008 - Jan 2010 (2 years 1 month)
    Promoted to lead concurrent turnarounds across 2 operations. Led team of 160 employees across 4 sites responsible for >20K annual plan changes & comprehensive clinical program portfolio. Functional services included: Client Benefit Administration and Campaign Management
  • E
    Senior Director, Account Management Services
    Express Scripts
    Jan 2005 - Jan 2008 (3 years 1 month)
    Promoted to lead operational recovery & profitably grow book of Commercial Division clients with $39M in annual gross margin.
  • E
    Senior Manager, Corporate Quality
    Express Scripts
    Jan 2003 - Jan 2005 (2 years 1 month)
    Selected to establish Medicare Ombudsman office for company’s entry into new regulated Medicare Part-D market, & to transform service resolution & reporting teams for non-regulated business.
  • E
    Project Manager, Clinical Operations
    Express Scripts
    Jan 2001 - Jan 2003 (2 years 1 month)
    Selected to improve internal & external service levels & quality of clinical outreach programs.
  • P
    Senior Consultant, Health Plan Operations
    Practice Patterns Science an Express Scripts subsidiary
    Jan 1999 - Jan 2001 (2 years 1 month)
    Promoted from Consultant to lead divisional turnaround for integrated data products/services supporting all health plan clients.
  • SSM Health
    Outpatient Rehabilitation & Community Wellness
    SSM Health
    Jan 1997 - Jan 1999 (2 years 1 month)
    Responsible for in- & outpatient cardiopulmonary care, and community wellness programs. Promoted to lead wellness programs across three network hospitals.
Education verified_user 0% verified
  • Truman State University
    Bachelor of Science (B.S
    Truman State University
Projects verified_user 0% verified
    This is a community-created genome.