Adam Wesselink

Senior Manager - IT Delivery @Health Care Service Corporation

Chicago, IL, US

Responsible for end-to-end delivery of multi-year, multi-million dollar transformational IT programs within the Health Care Management Technology Portfolio. Delivered solutions for key initiatives such as:• AI-based systems used to review and approve (but never deny) authorizations through clinical policy codification and artificial intelligence (AI)• Data Science-based initiatives designed for early identification of health risks with stratification modeling to deliver preemptive care management programs designed to lower said risks. Risk scores are updated monthly to ensure that members with evolving medical conditions are captured and stratified for engagement. • Advanced Approval programs for:o Interoperability – streamlining access to Utilization Management (UM) services and providing real-time prior-authorization checks for subscribers and providers by integrating all access channels for 27x messaging, Coverage Requirements Discovery, Prior Authorization Support, and Documentations Templates and Rules.o Alacura – designated UM services for medical transportation, with a gross medical cost reduction of $65M.o Gene Therapy Protection – designed to improve access to advanced medication for cancer therapy.o Modify Out of Service Area Coverage – designed to reduce barriers to care for members. Providers who are out of state but in contiguous counties to the member’s state no longer require waivers for non-emergency care.o Care Management Outreach – designed to identify members who frequently visit emergent care facilities and enable proactive outreach. This works to ensure members are following post-care guidelines, deliver appropriate care programs, and reduce emergent care visits.

Hope College

Bachelor of Science (B.S.), Computer Science