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Angela M. Lloyd, MPH, CHC Director, Medicare Audit & Corrective Action

Health Partners Plans

Angela Lloyd, MPH is the director of Medicare audit and corrective action at Health Partners Plans of Philadelphia (HPP). Angela is responsible for the oversight of Medicare audit program, which includes operations and processes, analyzing data, reviewing Policies and Procedures, documenting work and drafting audit reports. She also works collaboratively with leadership of operational units, and partners with vendors to ensure corrective action plans are developed and manages them through implementation.

Angela has worked at HPP for 13 years and has over twenty years of product, compliance and operations experience in Medicaid and Medicare programs.  Angela’s creative and result focused program has proven successful in driving compliance throughout the organization.  Her expertise in the execution of regulatory contractual requirements with the understanding of policy in various channels has improved the companies understanding and awareness of the products offered under the Centers of Medicare and Medicaid Services especially the Special Needs product.   Angela truly strives for excellence in everything she does keeping the HPP communities and membership in mind.  Angela received a bachelor’s degree in business law, graduate degree in public health from Drexel University and is Certified in HealthCare Compliance.

Deborah Marine Compliance Officer

SummaCare

Deborah Marine – Chief Compliance Officer Deborah joined SummaCare as the Medicare Compliance Officer in January 2015, and became the Chief Compliance Officer for the insurance arm of Summa Health (SummaCare and Summa Insurance Company) later that year. She is responsible for the health plan compliance program, encompassing all lines of business with an emphasis on Medicare Advantage, Part D, and Marketplace products. Deborah became the health plan Privacy Officer in 2017. Prior to joining SummaCare, Deborah served as the Compliance & Privacy Officer for Health Alliance Plan in Detroit, Michigan for 12 years. She was in-house counsel, focusing on regulatory compliance, for Univera Healthcare in Buffalo, NY from 1996 to July 2002. Qualifications and Credentials Deborah earned a law degree from Case Western Reserve University in Cleveland Ohio in 1995 and is licensed to practice in Ohio (inactive status), New York (retired status), and Michigan (active status). She received her certification in healthcare compliance (CHC) in 2009.

David Reid Senior Director, Operational Performance & Regulatory Support

Florida Blue

David Reid is the Senior Director of Operational Performance at Florida Blue with over 17 years of experience in the insurance industry.  A Certified Information

David Reid is the Senior Director of Operational Performance at Florida Blue with over 17 years of experience in the insurance industry.  A Certified Information Systems Auditor (CISA), he is accountable for ensuring business processes across multiple divisions are operationally effective and adhere to regulatory and industry requirements for Commercial and Government market segments at Florida Blue as well as other entities under the GuideWell Mutual Insurance Holding Company.  David’s background is in internal auditing, process improvement, operations management, regulatory/accreditation compliance, systems development and database administration. 

Systems Auditor (CISA), he is accountable for ensuring business processes across multiple divisions are operationally effective and adhere to regulatory and industry requirements for Commercial and Government market segments at Florida Blue as well as other entities under the GuideWell Mutual Insurance Holding Company.  David’s background is in internal auditing, process improvement, operations management, regulatory/accreditation compliance, systems development and database administration. 

Melissa Rusk Director Claims & BPO Operations

SummaCare

Melissa Rusk is the Director Claims and BPO Operations at SummaCare in Akron Ohio. In this role, Melissa is responsible for leading Claims, Claims Recovery, and Document Management Services.  She leads and oversees multiple internal efforts to ensure compliance with federal and state regulatory requirements and plan performance guarantees. This includes: Fraud Waste and Abuse, FDR management, payment integrity, implementation of new plans and plan changes, weekly and monthly performance monitoring, system upgrades and new system implementation, encounter submissions, and plan audits.  She oversees business decisions associated with coverage and payment policies.

Melissa has over 30 years’ experience working within the insurance industry in customer service, compliance and operations.

She is a Lean Six Sigma Black Belt and is certified in Lean by the University of Akron.

Sarah Simmerson, CIA, CRMA FBM Optimization

Florida Blue

Sarah is a Consultant at Florida Blue with the Florida Blue Medicare Optimization team. She has worked with internal and external business partners to monitor and evaluate delegated entities' adherence to CMS and State regulations.

She is a graduate of Clemson University, a Certified Internal Auditor (CIA) and has a Certification in Risk Management Assurance (CRMA). Sarah's background is in internal auditing, regulatory compliance, process improvement, and risk management.

Jessica Vander Zanden, CHC Vice President, Compliance and Audit

Network Health Insurance Corporation

Jessica Vander Zanden leads Network Health’s efforts in compliance and member privacy, internal audit, human resources and appeals and grievances. She has over a decade of leadership experience in the areas of compliance, privacy, corporate integrity, human resources and organization development.

Jessica is a graduate of the University of Wisconsin – Oshkosh and holds a Masters of Social Work from the University of Wisconsin – Milwaukee and a Masters in Organizational Business and Business Leadership from Silver Lake College in Manitowoc, WI. She holds certifications in Health Care Compliance from the Health Care Compliance Association, Strategic Decision and Risk Management from Stanford University and Gerontology from the University of Wisconsin – Milwaukee. She holds a current Wisconsin license as an Advance Practice Social Worker and is also a Six Sigma Green Belt and a certified Gallup Strengths Coach.

Todd Boyer Mr

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Wilmington

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