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30 Nov 2020
Melody Bautista, Director Clinical Data Analytics

Meet the Team – Case Management

From new product launches to partnerships with 2nd.MD and the National Hemophilia Foundation, there’s a lot going on in our Large Claim Solutions vertical. Director of Clinical Data Analytics, Melody Bautista, shares what she’s been working on, and is the perfect example that no two days are the same here at BCS!

Q: Describe your/your team’s role at BCS. 

A: I am the Director of Clinical Data Analytics and work mostly on BCS’s large claim solutions products and services.  My role/responsibility includes data analytics, clinical claims review, risk/cost management, and R&D. We are using an integrated data approach to bring together relevant clinical and claims data in a form that supports a variety of tools and analytics that we can leverage to improve outcomes, quality, and cost for our Blue Plan partners and payers. We identify high cost claimants (HiCCs) using predictive analytics tools and trigger reporting (diagnosis, specialty drugs, Gene Therapy/CAR-T) to identify members that are most likely to incur at least $250,000 in claims spend, then perform clinical claims review and identify BCS Risk Navigator solutions for our customers to contain costs and help their members achieve quality outcomes.

Q: What does a typical day look like for you at BCS?

A: Every day brings plenty of variety.  In a single work day I can work on press release and webinar content with marketing, on development of our HiCC database with Data and IT, conduct clinical claims review from trigger reporting, have meetings with our Blue Plan partners, review a specialty vendor Master Service Agreements with legal, work with account management and sales on an XOL Operations deliverables, assist coordination of SFTP set up with the Data and IT teams, work with our business analyst on clinical data analysis, research Specialty Pharmacies for a limited distribution drug, work on diversity and inclusion initiatives with our Culture Team, and work on process improvement activities with my Six Sigma team. Unlike Phil from Groundhog Day, I can honestly say that I have never had the same day twice and every day is an unknown adventure waiting to unfold.

Q: What trends are you watching in the healthcare industry right now?

A: There are many healthcare trends to watch right now from COVID-19 impact, to changes in healthcare delivery systems, and factors contributing to rising healthcare costs and premiums, but my main focus is always on HiCCs.  That includes paying attention to trends in million-dollar claims, emerging high cost therapies (Gene Therapies, CAR-T, immunotherapy cancer treatments) and specialty drugs, Stop Loss data trends, payment financing models (VBAs/OBAs), and more.  We use the knowledge of these healthcare trends and combine that with our claims/clinical data analytics information to develop highly relevant HiCC solutions to help our customers mitigate risks and improve outcomes.

For example, our actuary department provides us with an annual reports of the highest cost claims conditions and we combine that information with national healthcare information and our data analytics tools, predictive analytics outputs, and clinical claims review reports to identify what conditions we need to target for specialized solutions.  Out of that comprehensive data collection process and analysis, we determined we needed to find the best solutions to address members with oncology conditions like lymphoma and leukemia that persistently sits at the top of the highest cost conditions categories for the healthcare system nationally. That is why we partnered with 2nd.MD to provide top-tier medical navigation, expert consultation, and personalized second opinion services.  With this partnership, BCS can help members get the appropriate care they need, connecting them with board-certified, elite specialists from top medical institutions, and reducing their costs along the way.  In many cases, the second opinion can change the treatment trajectory – 85% of 2nd.MD’s consultations result in improved treatment plans, 35% lead to alternative diagnoses, and nearly 30% of surgery consults result in surgery cancellation.

Using this data, we developed two other customized solutions to support the approximately 20,000 individuals with hemophilia.  With the average annual cost for a patient with hemophilia topping $350,000 – $500,000 a year, we made it our priority to bring to market a solution set for health plans and their members to improve the quality and cost of care for members with hemophilia.  We partnered with the National Hemophilia Foundation (NHF), a trusted advocacy organization aligned with our focus on assisting with quality and cost of care. In addition, we also partnered with Audaire Health to provide hemophilia treatment management that improves patient adherence for high-cost therapies through real time tracking and pharmacy notifications.

We are looking to expand our customized specialty solutions to target more conditions, including Hereditary Angioedema/Defects in the Complement System, Cystic Fibrosis, Multiple Sclerosis, etc.  There is great interest and excitement for these customized solutions and we are currently working with our partners on implementation.  We are also excited to have recently joined our partners at the NHF, who are working on a collaborative with a mission to connect payers and patient advocacy groups to improve access to high quality care and address issues surrounding high-cost claimants through open dialog and shared solutions. I must say, I am truly proud to work for a company that strives to mitigate risks with cost containment solutions and improves quality of care outcomes for members.

Q: What are the most important skills you bring to your role?

A: The most important skills for this role are; flexibility/agility, a collaborative spirit, a strong interest in R&D/innovation, analysis, problem solving, and a having very curious mind.  Anyone who knows me knows how much I love solving puzzles and my keen interest in analysis is a great fit for this position because I enjoy recognizing patterns, looking for outliers or anomalies that help identify opportunities, and using data analytics to help guide better business decision making.  It also helps to be resilient and to view setbacks not as “failures” but as challenges or an opportunity for improvement.

Q: You have quite the commute. Pre-pandemic, what are your favorite ways to pass the travel time?

A: I have always had a long commute even when I used to live in the suburbs and took the train to the city but with this reverse commute, I actually use my commute time for prayer. Oddly enough, it is a good way to stay nice and calm during my long commute from the city. It’s tough to get upset with bad drivers when I’m thinking about the people in my life that I am grateful for.

17 Nov 2020
BCS Important News

BCS Financial Announces Partnership with the National Hemophilia Foundation

Emphasis on quality of care, cost containment for members

BCS Financial (BCS), a market leading insurer and reinsurer today announced its partnership with the National Hemophilia Foundation (NHF), bringing to market a solution set for health plans and their members to improve the quality and cost of care.

Founded in 1948, NHF strives to provide better treatments and cures for inheritable bleeding disorders and prevent complications of these disorders through education, advocacy and research.

“The partnership with NHF, a trusted advocacy organization aligned with our focus on assisting with quality and cost of care, is a first-of-its-kind in the industry,” said Peter Costello, President and Chief Executive Officer of BCS, “NHF’s unique ability to advise on optimal care management truly benefits our customers not only with cost but the level of service we strive to provide.”

According to NHF, there are approximately 20,000 individuals with hemophilia, and hemophilia consistently ranks within the top 10 highest catastrophic case spends. Costs range several hundred thousand dollars per year, with more than $1 million in annual costs is not unheard of for patients with the most severe forms of the disease (Source: Optum).

“The partnership between the NHF and BCS and its member plans allow us to establish baseline data on payment claims for people with hemophilia and develop strategies for Blue payers to facilitate the delivery of high-quality care through the network of federally-funded hemophilia treatment centers,” said Leonard A. Valentino, MD, President & CEO of the NHF. “BCS supports our goal to ensure optimal patient outcomes at the lowest possible cost.”

The three major factors affecting hemophilia cost containment include:

  • Site of Care – hemophilia treatment center Gold Standard
  • Assay Management
  • Prescription Management

The partnership addresses all three factors providing customers with increased access to BCS and its broad portfolio of complementary products including Excess of Loss, Stop Loss, International Health, Limited Benefit, and Group Supplemental insurance.

To learn more about BCS and its offerings visit:

About BCS Financial Corporation:

For over 70 years, BCS Financial Corporation has delivered a wide-range of insurance and financial solutions primarily designed for Blue Cross and Blue Shield organizations and their customers nationwide. Through its subsidiaries, BCS Insurance Company and 4 Ever Life Insurance Company, BCS is licensed in all 50 states and is rated A- (Excellent) by A.M. Best. BCS Financial is headquartered in Oakbrook Terrace, Illinois. Learn more at

About the National Hemophilia Foundation

NHF (the National Hemophilia Foundation) is a 501(c)(3) nonprofit organization dedicated to finding better treatments and cures for inheritable bleeding disorders and to preventing the complications of these disorders through education, advocacy and research. NHF’s programs and initiatives are made possible through the generosity of individuals, corporations and foundations, as well as through a cooperative agreement with the Centers for Disease Control and Prevention (CDC). Additional information on hemophilia and NHF can be found at

View the full release on Newswire: 

26 Oct 2020
Susan Lindquist - Chief Human Resources Officer

Meet the Team – Human Resources

There’s perhaps no one better to offer insight into what it takes to succeed at BCS than Chief Human Resource Officer Susan Lindquist. This month, read on for insights from Susan – plus more about her role, her go-to resources for professional development, and the number one thing she’s sharing with employees about benefits enrollment.

Q: Describe your/your team’s role at BCS.

A: Our team’s role is to ensure we have the right talent available to meet our strategic goals.  To that end, we need to create a compelling employee experience that includes highly competitive rewards, opportunities to learn and grow, a vibrant workplace and strong personal connections within our BCS community.  We have almost 40% of our company engaged in culture-building activities including wellness, recognition, diversity and inclusion, community involvement and event planning.

Q: What do you like most about your job? What do you like least?

A: I enjoy the diverse responsibilities of my job.  I can be working on a strategic project in the morning, interviewing a potential new team member at lunch, and then finish my day by approving payroll.  I love that our small company size allows me to know all of our team members!  I least enjoy proofing Summary Plan Documents and Certificates of Insurance for our benefit plans.

Q: What skills does someone need to succeed at BCS?

A: In the last several months, we updated our company Beliefs to reflect both our values and our aspirations.  It’s very important that our current team members continue to embrace these beliefs and we hire new associates who commit to them:  diversity, transparency, simplicity, agility, integrity, and unity.  We can teach most skills!

Q: As we approach annual benefits enrollment, what is the number one thing you’d like to share with employees?

A: Make sure you use our wellness benefits!  Last year, we initiated a Lifestyle Spending Account which reimburses employees for up to $500 annually for expenses related to their wellbeing like gym membership, athletic equipment, financial planning and so much more.  Our Wellness Team also has created some great programs like virtual Cooking Conversations, 1:1 nutrition coaching and meditation.

Q: You are a big advocate for professional development. What are your go-to resources?

A: I am very proud that BCS prioritizes learning with such strategic importance that it is included in our Performance Scorecard.   I love the thought leadership that I find at Gartner and Center for Creative Leadership, and the quick wins I get from Harvard Business Review’s Management Tip of the Day and Daily Alert.  I also enjoy a good read and enjoyed sharing Mindset by Carol Dweck with a small book club last year at BCS.

21 Oct 2020

New Whitepaper from BCS Highlights Healthcare Alternatives for Post-Pandemic Workforce

The U.S. Congressional Budget Office estimates that the economy could take the better part of a decade to fully recover from the coronavirus pandemic and related shutdowns.

Employers may be cautious about returning to business as usual; instead, many are cutting costs and managing expenses, filling vacancies with part-time roles, and/or increasing their intermittent employee population. This post-pandemic workforce brings forward new challenges about how to provide healthcare to part-time and intermittent employees.

Download the whitepaper today to learn about alternatives that may be available for your clients.

20 Oct 2020
Critical Illness Awareness Month

Offer a Solution Your Clients Need This Critical Illness Awareness Month

2020 marks the 10th anniversary of National Critical Illness Awareness Month, recognized annually in October.

This year over 1.8 million Americans will be diagnosed with cancer[1]. Some 790,000 individuals will have a heart attack and almost as many will have a stroke[2]. These critical illnesses can leave many in financial ruin – as high deductibles, copays, and coinsurance add up.

As clients offer benefits enrollment in the Fall, October is an ideal time to highlight the ancillary products like critical illness that can play a pivotal role in a member’s healthcare solution, by offering them financial support when they need it most.

EssentialCare Group Critical Illness[3] pays a lump-sum benefit upon diagnosis of a covered illness or life-changing health event. Employees can use payments to pay for major medical copays and deductibles, or additional expenses like transportation, child care, and more to help fill gaps in their healthcare coverage. EssentialCare Group Critical Illness includes:

  • Coverage for up to 35 adult and 8 childhood illnesses, plus support service coverages including wellness, dependent adult and child care, and more
  • Modular, adaptable plan designs that can be tailored to complement client need and underlying major medical
  • Easy administration with a simple RFQ process, best-in-class administration and claims adjudication
  • Award-winning, first-of-its-kind mental health rider that provides coverage for a severe mental illness event

For more information, contact BCS today, or visit

[1], 2020 Facts

[2] Heart Disease and Stroke Statistical 2020 Update, American Heart Association

[3] Coverage for the Critical Illness plan underwritten by BCS Insurance Company is considered guaranteed issue provided: 1) the employee is actively at work; and2) the employee and all covered dependents are enrolled in a major medical health plan that meets minimum essential coverage requirements as provided under the Affordable Care Act (ACA).



BCS EssentialCare insurance is underwritten by BCS Insurance Company, OH (Administrative Offices: Oakbrook Terrace, IL). See policy documents for a complete description of benefits, exclusions, limitations, and conditions of coverage. Not all benefits available in all states. Features and availability vary by location, and are subject to change. Some products may be pending regulatory approval in certain states.

15 Oct 2020
Cybersecurity Awareness Month

Are You Protected? National Cybersecurity Awareness Month

For the past 17 years, National Cybersecurity Awareness Month (NCSAM) has been informing Americans on the best ways to protect themselves from cyber attacks. This year’s theme, “Do Your Part. #BeCyberSmart.” comes at a time when millions of people are working from home and may be more susceptible to an online threat. Now is a great time to secure your home and work devices from attack.

Over the next few weeks, NCSAM and the Cybersecurity & Infrastructure Security Agency (CISA) will have different themes you can follow along with (week 3 is Securing Internet-Connected Devices in Healthcare), or you can see their resources all at one time. Here is a sample from their Tip Sheet on “5 Ways to be Cyber Secure at Work”:

  1. Treat business information as personal information. Business information typically includes a mix of personal and proprietary data. While you may think of trade secrets and company credit accounts, it also includes employee personally identifiable information (PII) through tax forms and payroll accounts. Do not share PII with unknown parties or over unsecured networks.
  2. Be up to date. Keep your software updated to the latest version available. Maintain your security settings to keeping your information safe by turning on automatic updates so you don’t have to think about it and set your security software to run regular scans.
  3. It only takes one time. Data breaches do not typically happen when a cybercriminal has hacked into an organization’s infrastructure. Many data breaches can be traced back to a single security vulnerability, phishing attempt, or instance of accidental exposure. Be wary of unusual sources, do not click on unknown links, and delete suspicious messages immediately. For more information about email and phishing scams see the Phishing Tip Sheet.

To see all the tips and additional resources, please visit

13 Oct 2020
BCS Important News

BCS Financial Outlook Upgraded to Positive by AM Best

BCS Financial Corporation’s outlook was upgraded to Positive by AM Best, a nationally recognized statistical rating organization overseen by the Securities Exchange Commission. 

CHICAGO Oct. 13, 2020 – BCS Financial (BCS), delivering a wide range of insurance and financial solutions for Blue Cross and Blue Shield organizations nationwide, has earned an upgraded outlook of Positive by AM Best. Several factors that influenced the revision include BCS’s sustained growth and long-term strategy, its strengthening business profile, and expanded portfolio, including its EssentialCare line featuring the first-of-its-kind mental health insurance coverage.

“Insurance is all about a guarantee and a promise,” says Peter Costello, President and CEO of BCS Financial Corporation. “Our plan is to continue to adapt with the changing marketplace while continuing to provide product solutions that customers expect from us.”

Over the past year, BCS has launched new group voluntary accident, critical illness, and hospital indemnity products to capture emerging opportunities driven by growing deductibles and out-of-pocket costs. The EssentialCare Critical Illness policy provides coverage to 35 of the most pervasive critical illnesses, plus eight childhood conditions. Additionally, it features a first-of-its-kind optional rider to provide coverage for four severe mental health crises: severe major depressive disorder, severe bipolar I disorder, obsessive-compulsive disorder and schizophrenia. In 2019, BCS’s progressive EssentialCare Group Critical Illness product was awarded both the 2019 Insurance Nexus New Product of the Year Award, as well as the North American Contribution to Society Award.

“Our EssentialCare Critical Illness product, with its mental health rider, is just one example of how BCS lives its mission to protect customers with innovative and easy-to-use insurance and financial solutions,” said Costello.

Owned by all 36 Blue Cross Blue Shield Plans and the Blue Cross Blue Shield Association, BCS continues to see momentum following the appointment of its new Chief Executive Officer in 2019, Peter Costello, who served as VP at both Blue Cross and Blue Shield of Massachusetts and Excellus Health Plan, bringing a wealth of experience and leadership to continue taking BCS forward and move the company towards its next stage of development.

About BCS Financial Corporation

BCS Financial Corporation has more than 70 years of experience delivering a wide range of insurance and financial solutions for Blue Cross and Blue Shield organizations nationwide. Through its subsidiaries, BCS Insurance Company and 4 Ever Life Insurance Company, BCS is licensed in all 50 states and is rated A- (Excellent) by AM Best. BCS Financial is headquartered in Oakbrook Terrace, Illinois. Learn more at

07 Oct 2020
Camp One Step

BCS Raises Nearly $12K for Camp One Step via Power of One Challenge

BCS is proud to support Camp One Step through the Power of One Challenge. The BCS team achieved incredible results this year:

  • Distance Completed: 4,763 miles
  • Money Raised: $11,891

This donation helps provide virtual programming for one week for 18 campers!

Thanks to all who participated to make a difference in the lives of children with cancer.

06 Oct 2020
BCS Important News

BCS Announces Expansion of Risk Navigator Solution Set With Acquisition of Medical Risk Managers, Inc.

Acquisition joins two specialized Stop Loss Insurance and Excess of Loss Reinsurance underwriters

BCS Financial Corporation (BCS) announced today it has acquired Medical Risk Managers, Inc. (MRM), a market-leading provider of Stop Loss pricing and underwriting services.

As a market-leading insurer and reinsurer, BCS protects more than six million medical, supplemental, and travel customers. With this acquisition, MRM’s comprehensive managing general underwriting service model becomes an additional feature included in BCS’s Risk Navigator solution set, a highly predictive and actionable approach to managing carrier and employer large claim risks.

“For three decades, BCS has provided our customers with a portfolio of products and services designed to help flatten the growth of large claim risks,” said Peter Costello, president and chief executive officer of BCS Financial. “BCS’s acquisition of MRM advances our efforts to provide a comprehensive solution-set for our customers.”

In conjunction with MRM, BCS and its customers immediately gain access to market-leading Stop Loss pricing, underwriting, and case management capabilities. MRM and its customers, meanwhile, benefit by gaining increased access to BCS and its broad portfolio of complementary products, including Excess of Loss, Stop Loss, International Health, Limited Benefit, and Group Supplemental insurance.

“It’s undeniable that the volume and severity of High Cost Claimants is a growing problem for self-funded employers,” said Mehb Khoja, president of MRM. “Our new alignment enables both BCS and MRM to grow by sharing strengths, capabilities, and market access.”

Under BCS’s ownership, Khoja will continue as president of MRM, which will remain headquartered in South Windsor, Connecticut.

About BCS Financial Corporation (BCS)

For over 70 years, BCS Financial Corporation has delivered a wide-range of insurance and financial solutions primarily designed for Blue Cross and Blue Shield organizations and their customers nationwide. Through its subsidiaries, BCS Insurance Company and 4 Ever Life Insurance Company, BCS is licensed in all 50 states and is rated A- (Excellent) by A.M. Best. BCS Financial is headquartered in Oakbrook Terrace, Illinois. Learn more at

About Medical Risk Managers, Inc. (MRM)

For over 35 years, Medical Risk Managers, Inc. has underwritten Stop Loss insurance on behalf of its insurance carrier partners. As a managing general underwriter, MRM has underwritten over $4 billion in Stop Loss premium since its inception. Among its capabilities, MRM is able to price Stop Loss coverage at any deductible level, over any network, and in any zip code nationwide. MRM is headquartered in South Windsor, Connecticut. Learn more at

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28 Sep 2020
Christopher Halsey

Meet the Team – Service and Operations

This month, Chris Halsey, director, Service Partner Management (and resident “Top Gun” enthusiast), shares some of the projects he’s been working on, and how he’s adapted to virtual vendor and relationship management.

Q: Tell us about a project you are working on.   

A: I continue to work on refining our new administrative platform, and configuring it to support our EssentialCare products.  This includes creating and adding customer communication pieces, customizing the portal technology, and automating the information feeds to downstream systems.

I have really enjoyed working on this project as it allows me to work with many different areas and individuals in BCS.  It was a great honor to be entrusted with the responsibility of implementing this platform during my first year and a half at BCS.

Q: What is the number one skill someone in your role needs to succeed?

A: Negotiation skills.  I consider myself more of a “generalist” and need the support and knowledge of the experts in the different areas of BCS to help me.  Negotiation skills are critical when trying to convince someone to put aside their day job and help me with my project or initiative.

Q: What do you like most about your job?

A: Working with just about all areas in the company and multiple individuals.

Q: You work with vendors all over the country. What tips do you have for managing virtual partnerships?

A: Develop a sense of humor, of which I am still working on.  I always feel laughter is a good way to build partnerships, in the right moment. The key is knowing when it is the appropriate time.

Q: What’s your favorite way to relax? 

A: Ever since I started using my Fitbit, I enjoy walking and biking to see how many steps and miles I can accumulate in a day.  When not competing in my imaginary Olympics, I enjoy watching movies and several different streaming series.  And in case you did not know it, I’m a closet Top Gun fan!   Well, maybe an open-door closet that has an F14 flying out of it.