Health Strategies for You
Transform your health insurance experience through expert guidance and valuable resources tailored to your needs.
Hi! I'm Nurse Lauren,
I'm the Founder of Actuate Insights, a nurse-led benefits advisory and cost-containment partner for self-funded employers, brokers, and MGUs. As a registered nurse with 16 years of experience, including 12 years in care management, utilization review, patient advocacy, and revenue cycle management, I specialize in transforming clinical details into tangible results while preserving the member experience.
I'm known for building trusted relationships, leading high-dollar claim negotiations, and vetting or managing vendor and SaaS programs with clear SLAs and compliance. Before joining Actuate Insights, I served as Vice President at Point C Health, where I led clinical services and cost containment efforts.
Today, I deliver clinical claim reviews, specialty medication pathways, and stop-loss alignment services, available on retainer or as project-based engagements, backed by a proven track record and a transparent approach. Driven by a belief in accountability and access, my mission is straightforward: to make healthcare work clinically sound, financially responsible, and compassionate.
What we offer
A nurse-led, outcomes-driven partner for brokers, employer groups, MGUs/stop‑loss, and health tech teams. We blend bedside-level clinical judgment with payer/TPA operations, underwriting discipline, and product savvy to deliver savings you can audit and member experiences you can stand behind.
MGU / Stop‑Loss Cost Containment
Bill Review & Pre-Service Negotiation
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Technical + clinical review aligned to CMS/NCCI/DRG rules and payer policy
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Pre-service intercepts to secure closure terms and prevent downstream appeals
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Out-of-network negotiation, implant/vendor pass-through validation, multi-procedure reductions, and revenue code integrity
Specialty Medication Management
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High-dollar drug case audits (medical vs. pharmacy benefit), dose to need validation, and alternative therapies
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Site of care optimization and compliant sourcing pathways
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Manufacturer programs and continuity of care safeguards
Risk Review & Lasers
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Individual risk file development (clinical story + expected value, trend, and mitigation plan)
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Laser recommendations with removal/reduction strategies tied to utilization controls
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Contract nuances: aggregating deductibles, specific/agg corridor, exceptions, disclosures
Deliverables
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Audit packets with line item analyses, rules cited, and provider rebuttal templates
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Pre-service negotiation memos with closure language
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Monthly performance roll-ups: identified vs. realized savings, hit rate, aged inventory, and projected impact to loss ratio
Great For
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New blocks, renewal season, or portfolios with rising specific hits and volatile specialty spend.
Clinical SaaS & Application Build‑Out
Turn clinical know-how into scalable, code-ready workflows and rules that pass client diligence and drive adoption.
What We Build
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Clinical Rules & Content: ICD/CPT/HCPCS/NCCI logic, DRG bundling, prior‑auth/UM criteria, and document templates.
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Workflow Architecture: Intake triage, tasking/queues, case lifecycle, and cross-team handoffs (UR ↔ case mgmt ↔ cost containment).
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Data & Reporting: Event models, savings measurement, audit trails, and CFO/underwriter views.
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Compliance & Security: Policy libraries, role-based permissions, PHI handling patterns, and quality management.
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Change Management: UAT scripts, go-live playbooks, training, and adoption KPIs.
Deliverables
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Product requirement docs, rule books, and decision trees.
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Click‑through prototypes and acceptance criteria.
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Implementation runbooks and success metrics.
Great For
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Health tech teams, TPAs, and MGUs turning manual programs into scalable products—or fixing underadopted modules.
Additional Services
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High‑Dollar Claim Intercepts: Rapid clinical review before the service date to set terms, alternatives, or site‑of‑care changes.
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Case Management Program Design: Model selection (episodic, longitudinal), staffing ratios, scripting, and documentation standards.
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Pharmacy Benefit Carve‑Out & PBM Oversight: Contract language, pass-through validation, rebate transparency, and audit cadence.
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Vendor Portfolio Rationalization: Reduce overlap, consolidate reporting, and renegotiate SLAs.
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Appeals & Arbitration Strategy (Commercial): Medical necessity narratives, coding rebuttals, and settlement frameworks.
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Reference-Based Pricing Readiness: Member navigation, provider relations, escalation ladders, and balance‑bill protocols.
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Population Health & Gap Closure: Stratification, outreach journeys, and ROI tracking tied to stop‑loss exposure.
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Education & Training: Broker/HR clinics on specialty meds, billing integrity, and member communication.
Your Expert Team
Our skilled professionals bring a unique blend of clinical expertise and healthcare industry knowledge to drive innovative solutions for your organization.
Lauren F. R.N.
Benefits Consultant | Medical Management | Cost Containment | Bill Review | Vendor Placement
Rex
The Dynamic Thinker
Our energetic German Shorthaired Pointer is the spark of curiosity behind our name. Analytical and full of personality, he’s always one step ahead—whether it’s chasing a new scent or solving a problem before it’s even named.
Robert R.
Claims & Business Strategy | Leadership & Management | Veteran | M.S.M.L.
Benedict
The Gentle Strategist
Our dignified Vizsla brings calm confidence and sharp instincts to the Two Pointers pack. He thrives on structure, is always alert, and has a nose for guiding any project with poise—usually while lounging in his favorite sunspot.
Our Insights
Our Amazing Partners
We haven't worked with everyone, but we have collaborated with some outstanding partners and would like to recognize them. These vendors have consistently demonstrated reliability, innovation, and a commitment to service that aligns with our values.
By highlighting them here, we hope to share resources our clients can trust, while also showing appreciation for the teams who go above and beyond. From technology providers to healthcare cost-containment experts, these partnerships have helped us deliver measurable results and positive experiences. We’ll continue to update this list as we discover and collaborate with more organizations that share our standards of excellence.
