CASE STUDIES
Results That Speak for Themselves
Three confidential client engagements — each representing a different dimension of the work Claudia does best. Names withheld by agreement; outcomes verified.
01 — Benefits Strategy · Self-Funding
From Fully Insured to Self-Funded: A $4 Million Transformation
Financial Services
3,000+ employees
$4M+ annual savings
02 — Workers' Compensation · Claims Strategy
Closing the Book: $500K+ in Reserve Reductions Through Strategic Claims Management
Financial Services
500+ employees
$500K+ reserve reduction
03 — Pharmacy Benefits · PBM Reform
Eliminating Spread Pricing: A Pass-Through PBM Transition
Healthcare-Adjacent Services
1,200+ employees
40% pharmacy cost reduction
1 - The Challenge
A major California-based financial institution with over 3,000 employees had been fully insured for decades. Year after year, premiums climbed 8–12% — not because claims were unusually high, but because the carrier was pricing for risk it could not see. The HR leadership team had no visibility into actual claims utilization, no leverage in renewal negotiations, and no mechanism to reward healthy behaviors or penalize waste.
The CFO had flagged benefits costs as one of the top three line items threatening operating margin. The CHRO needed a solution that would satisfy the finance team without degrading the employee experience or triggering turnover in a competitive labor market. The status quo was no longer defensible.
2 - The Approach
Claims Audit & Actuarial Modeling
Claudia commissioned a three-year retrospective claims analysis to establish the organization's true risk profile. The data revealed that 80% of costs were driven by 12% of claimants — a concentration that made self-funding actuarially viable.
Stop-Loss Architecture
A specific stop-loss threshold was set at $150,000 per member per year, with aggregate protection at 125% of expected claims. This structure capped catastrophic exposure while preserving the savings opportunity in the 88% of routine utilization.
TPA Selection & PBM Carve-Out
A competitive RFP process identified a best-in-class third-party administrator with real-time claims reporting. The pharmacy benefit was carved out to a transparent pass-through PBM, eliminating spread pricing and rebate opacity — a move that alone delivered seven figures in year one.
Employee Communication Strategy
A phased communication campaign — anchored in transparency and framed around expanded benefits rather than cost-cutting — ensured employee confidence in the transition. Open enrollment participation increased 18% year-over-year.
3 - The Result
$4M+
Annual savings in year two
18%
Increase in open enrollment participation
0%
Increase in employee premium contribution
100%
Real-time claims visibility achieved
The organization achieved over $4 million in annual savings by year two — without increasing employee premium contributions. For the first time, the HR and finance teams could see exactly where every dollar was going, enabling data-driven decisions about wellness investments, vendor performance, and plan design. The CHRO presented the results to the board as a model for responsible self-insurance.
Client name withheld per confidentiality agreement. Financial figures are accurate and verified.
02 — Workers' Compensation · Claims Strategy
Closing the Book: $500K+ in Reserve Reductions Through Strategic Claims Management
How disciplined case closure strategy protected an employer from a half-million-dollar premium increase.
03 — Pharmacy Benefits · PBM Reform
Eliminating Spread Pricing: A Pass-Through PBM Transition
How one employer discovered it was paying 40% more for drugs than it needed to — and what happened next.
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