Shelley Segal is a Medicare industry veteran whose experience in Medicare program leadership and day to day operations provides Gorman Health Group clients an expert resource for strategic planning, program development, compliance management and business process engineering.
Prior to joining GHG, Shelley was most recently Compliance Director for SCAN Health Plan, an HMO serving over 70,000 seniors in the greater Los Angeles market. Before SCAN, Shelley served as National Director, Medicare Compliance and Associate Vice President, Medicare Operations at Health Net as well as holding numerous other positions with Medicare programs at Foundation Health and FHP.
As a compliance and regulation expert, Shelley is often called upon to translate the regulatory requirements of Medicare Part C and Part D in to concrete operational procedures and work processes in the managed care and insurance industry.
Her expertise includes:
Project management and facilitation of interdisciplinary project teams
Medicare functional areas day-to-day operational management (Medicare call center, appeals, grievances, enrollment, sales/marketing and claims, etc.)
Interpretation and implementation of Medicare regulations
Development of automated internal audit tools
Development of organization wide compliance training programs including intranet development and desktop based training tools
Review and creation of policies and procedures related to Medicare programs
Development and implementation of enrollment reconciliation and programs
Determining operational best practices and implementing those procedures across multi-site organizations
Medicare sales and marketing
Maintaining compliance plans in the ever changing Medicare regulatory environment
Shelley’s expertise extends to Medicare regulatory compliance, enrollment and reconciliation, customer service along with sales and marketing to Medicare beneficiaries. In addition to her day-to-day operations experience, she has served as project manager for numerous start-up, product development and business process re-engineering initiatives.
She resides in Southern California.
