Erickson Baniaga

Now

VP, Better Health Plan, the TPA arm of Bennie. Fifteen people across claims, eligibility, stop loss, member and provider services, underwriting support, renewals, and accounting. Self-funded and level-funded group plans.

I own the P&L, the vendor relationships, and the platform. Most of what I do is turn things that are held together by one person into things that are held together by a process, and lately by software.

Selected work

2025 01

Turned the P&L.Multi-year losses to breakeven in the first full year.

The cost base was mostly fixed, so the work was on the revenue side and on cash. Renewals held, receivables got collected, and stop loss got reimbursed on time instead of eventually. No layoffs, and no vendor cuts that would have shown up as service problems six months later.

Multi-year losses to breakeven in the first full year.

2024 to 2025 02

Collected the receivable.About $2M outstanding down to $175K.

Inherited a balance that had been carried for years across a dozen groups. Worked it group by group with the account team, set payment schedules where a lump sum wasn't realistic, and got every group but one to zero. The one exception was on an agreed extension.

About $2M outstanding down to $175K.

2025 to 2027 03

Replaced the claims platform.Selected the vendor, built the business case, running the migration to a 1/1/2027 go-live.

The incumbent platform had a year-old payment integration that still broke, an eligibility feed that corrupted on special characters, and a two-month window where inbound claims from a major carrier never arrived. Nobody caught it because nothing flagged it. I mapped the claim lifecycle end to end, scoped five vendor integrations, and picked a platform that had already cleared our security review and was live with the carrier feeds we depend on.

Selected the vendor, built the business case, running the migration to a 1/1/2027 go-live.

2025 04

Cut stop loss recovery to 30 days.

Rebuilt claim submission, tracking, and aggregate reporting with one associate. Reimbursements that used to arrive when the carrier got to them now average within 30 days of submission. Wrote a coordination-of-benefits policy that only collects other-insurance forms when a member is actually approaching the deductible, instead of denying everyone by default.

2026 05

Rewrote the services agreement.

Read our standard client contract and found no limitation of liability, an indemnity carve-out using the wrong negligence standard, and no exclusion for benefit payments themselves. Drafted replacement language and am restating across the book ahead of 1/1 renewals, timed with the platform migration so clients sign once.

2026 06

Stood up receivables financing.

Structured a stop loss receivables factoring program with a specialty lender so clients aren't fronting six-figure claims for 60 to 90 days while waiting on reimbursement. True-sale structure, submission owned by our stop loss associate, with a pre-submission coordination-of-benefits screen so nothing gets repurchased.

Built with AI

I build with Claude Code. I write the spec, review every diff that touches money or member data, and keep a test suite that doesn't let me merge something I don't understand. These run in production for a regulated health plan administrator, which is the bar I'd hold anyone else's tools to.

2026 01

Proposal enginePrices self-funded proposals and generates the deck.

Replaces a rating workbook, four separate email chains to stop loss underwriters, and me as the second set of eyes on the arithmetic. Every parsed value still gets confirmed by a person, on purpose. Per-deal underwriting time went from 7.9 hours to about 5.

FastAPI, Cloud Run, Cloud SQL, identity-aware proxy, ~200 tests. Built with Claude Code.

P&L modelDriver-based revenue by client, monthly close parser, scenario toggles.

Replaces a spreadsheet that took a day to reconcile every month and couldn't answer "what happens if this group leaves." Same architecture as the proposal engine so there's one environment to secure.

FastAPI, Cloud Run, Cloud SQL, identity-aware proxy. Built with Claude Code.

Timecard reviewScheduled agent that approves biweekly timesheets and escalates only the exceptions.

Checks total paid hours (worked plus PTO, which is the part people get wrong) against each role's baseline. Approves what's in range, emails me what isn't.

Claude scheduled task, browser automation, written SOP.

Consultant spend analysisTwelve months of invoices traced deal by deal.

Pulled every line item from a contractor's monthly summaries, tied them back to individual deals, and built the case to move from hourly to a scoped flat fee 13% under run rate. The recommendation went to leadership with the actuals attached.

Claude, spreadsheet extraction, a memo.

GovernanceThe rule for everyone else's tools, including mine.

When employees started building AI tools that touched member data, I wrote the gate. Anything with PHI runs in the sanctioned cloud environment with access control, or it doesn't run. My own tools were the first ones held to it.

Policy, not code.

Scope: any tool touching member data
Gate: sanctioned environment or nothing
First subject: my own tools

Experience

2024 to present

Bennie / Better Health Plan

VP, Better Health Plan Sept 2024 to present

Director, Claims Operations May 2024 to Sept 2024

Runs the TPA. Fifteen people, seven direct reports, seven functions, P&L, vendors, platform.

Sept 2024 to presentMay 2024 to Sept 2024

2020 to 2024

Sana Benefits

Director, Claims Operations Oct 2022 to Feb 2024

Director, TPA Operations Mar 2021 to Oct 2022

Manager, TPA Operations Mar 2020 to Mar 2021

Claims and TPA operations for a level-funded health plan. Team of 4, then 7. Auto-adjudication from manual to 70%, accuracy above 97%, No Surprises Act and Transparency in Coverage compliance.

Oct 2022 to Feb 2024Mar 2021 to Oct 2022Mar 2020 to Mar 2021

2017 to 2020

Justworks

Product Operations Manager, Payments Feb 2019 to Mar 2020

Product Operations Analyst, Payments Oct 2017 to Feb 2019

Payments operations for $9B in annual payroll. Team of 3. Built the payments risk function and strengthened SOC 1 controls.

Feb 2019 to Mar 2020Oct 2017 to Feb 2019

2015 to 2017

Oscar Health

Claims Processing Analyst Oct 2016 to Oct 2017

Member Operations Nov 2015 to Oct 2016

Claims reporting and member escalations. Found $1M in eligibility leakage, redesigned escalation pathways.

Oct 2016 to Oct 2017Nov 2015 to Oct 2016

Georgetown University, BSBA, Finance and Operations & Information Management, 2013
Six Sigma Green Belt

The fun stuff

The same way of working, on my own time and without the compliance constraints. A travel site with a 3D globe, and a camera app for my dog.

2025 to 2026 01

My Jet Set LifeA travel advisory site with a 3D globe of everywhere I have been, an award flight search, and a trip inquiry flow.

Astro on Cloudflare Pages. The globe is globe.gl and three.js in the brand emerald with a gold atmosphere, 205 places across 59 countries and all 7 continents, flight arcs fanning out from New York, and an "Inspire me" button that flicks the globe with real momentum and lands on a story. The photos behind the pins were picked from a library of 82,304 by a pass of parallel agents and then pruned by hand. Award search runs as a Cloudflare Pages Function and emails the options.

Astro, globe.gl, three.js, Cloudflare Pages Functions, Resend, node test. Built with Claude Code.

Chowder camA camera setup and app so I can check on my dog when I am out.

Any spare phone, tablet, or IP camera becomes a station that stays with Chowder, and I watch from my own device from anywhere. Video and audio stream peer to peer over WebRTC; the server only handles sign-in and pairing. Bark and motion detection, two-way talk, recorded voice commands, clips, push alerts with the app closed, and a Raspberry Pi that runs the cameras with no computer left on. Built because I wanted it, not because anyone asked.

Node, WebSockets, WebRTC, Web Push, a Raspberry Pi bridge, installable PWA, 13 test files. Built with Claude Code.