James T. O'Connor

Jim has considerable experience consulting in individual health and employer group insurance as well as managed healthcare programs. His product knowledge encompasses PPO and managed comprehensive medical; other hospital, surgical, and medical plans; critical illness and specified disease coverage; and other health insurance plans.

Jim assists a variety of clients with pricing and plan design, marketing and administrative management, financial reporting, and strategic planning and acquisitions. He has assisted clients and others regarding the requirements and impact of healthcare reform. He also has considerable experience with profitability and experience analyses, state insurance department filings, and various product compliance issues. Clients also seek his expertise regarding voluntary worksite insurance programs.

Jim has provided consulting services to the National Association of Insurance Commissioners (NAIC), numerous states including the Massachusetts Connector, insurance carriers, and industry groups and associations regarding small employer and individual health insurance regulation, plan design, reinsurance programs, and pricing issues. He was retained by the NAIC to assist with the development of the credibility adjustment factors to be used in the ACA MLR calculations, as well as researching the use of stop-loss reinsurance for self-funded employers.

Jim has made numerous presentations and written articles and papers regarding ACA and the individual and small group markets.