About Gigi Carrabbia · Founder & CEO · GGenesis Strategic Solutions

My Story

How I got here.

I started in claims operations in the mid-1990s with Humana, then moved to Arizona with United Healthcare, HealthChoice, and Schaller Anderson. I learned the trade by doing the trade. Every claims platform I know, I learned by touching it, breaking it, fixing it, then training someone else to do the same.

In New York, I joined the Tri-State managed-care ecosystem. Elderplan at Metropolitan Jewish Health System, Healthfirst, Zelis Healthcare, Affinity Health Plan. I led claims operations through an $18M HealthRules migration with zero critical defects at go-live. I reduced 73,000 aged claims to 13,000 in six months. I designed the first full appeals and call-center structure at a payment integrity vendor. I generated $2.5M in COB savings at 6.1 ROI inside a New York Medicaid and Medicare regulated environment.

Claims has been the through-line for 25 years. Not a specialty, the entire operation. In New York I designed the full claims operation from the ground up, with distinct subdivisions each staffed, trained, and measured:

Appeals · first-level and second-level appeals with regulatory turnaround SLAs
Cost containment · payment integrity, coding review, overpayment recovery
Call center structure · member and provider service scripting, escalation trees, quality assurance
Reconciliations · daily, monthly, and year-end financial and claim-level reconciliations
Reconsiderations · pre-appeal review workflow and provider dispute resolution
Auditing · internal claim audit cycles, regulator-facing audit prep, root cause reporting
DHS regulatory case handling · designed the intake, tracking, and response process for New York Department of Health regulatory cases and member grievances, including regulator-facing SLAs and executive escalation paths
Training · onboarding curriculum, upskilling, and cross-training for the entire claims workforce
Special Projects Unit · dedicated team for platform migrations, regulatory change, and executive mandates
Robotic Process Automation · designed and deployed software automation for repetitive claim tasks including adjustments, status queries, and letter generation
Corrected claims and Coordination of Benefits (COB) processing · introduced structured routing and processing workflows for corrected claims and coordination of benefits
Executive reporting and KPI framework · architected the operational KPI framework and C-suite reporting cadence, translating claims-floor performance (throughput, aging inventory, appeal cycle times, first-pass adjudication rate, provider network compliance, financial recovery) into board-ready dashboards reviewed monthly by executive leadership and quarterly by regulators

Then Minnesota. Six years with UCare Health Plans through the NTT DATA partnership. I designed and delivered the Claims Workforce Onboarding Academy from scratch. I built 20+ eLearning modules covering Technical Configuration and Complex Claims Processing across 1,000+ hours of instructional content in Cornerstone LMS. I led the GuidingCare eligibility transformation from legacy LOB and Plan structures to a modernized six-level hierarchy. I architected enterprise digital hubs: Learning and Development Communications Site, Change in Motion, Provider Network Management ServiceNow Center.

In December 2025 I founded GGenesis Strategic Solutions LLC in Broussard, Louisiana. GGenesis is where all of it comes together: over 25 years of operational depth, named methodologies (Cost-to-Revenue Method™, Operational Translation Sprint™, Change Impact Crosswalk™), and original products in market. CaliberSuite™ filed with USPTO. Talvori™ in active development.

"I don't do consulting theater. I do the work. Then I build the platform so the client can keep doing the work after I leave."

I serve clients nationally, virtually first. Health plans, small business owners across service industries, coaches and consultants ready to scale. Louisiana boutique consulting. Founder-led every engagement.

Current Engagement

The GGenesis AI Capability Maturity Diagnostic.

A six-week productized advisory engagement for companies who have been asked to define AI strategy and need a defensible framework fast. Delivered personally by Gigi. Fixed price. Board-ready output.

SCOPE

6 weeks · fixed price

Kickoff, six to ten stakeholder interviews, CMM scoring across five pillars and thirty sub-capabilities, written diagnostic report, executive presentation deck, twelve-month strategic roadmap, and a 90-day activation plan.

DELIVERABLES

Board-ready output

Written diagnostic report with rationale and prioritized recommendations for every sub-capability. Fifteen-slide executive summary deck suitable for board review. Twelve-month roadmap with quarterly OKRs and revenue-triggered hiring plan.

ENGAGEMENT TERMS

Scoped after diagnostic conversation

Every engagement is scoped to firm size, complexity, and the actual work in front of you. We measure first, then price. Payment structured 50 percent at kickoff, 50 percent at delivery.

CURRENT AVAILABILITY

Accepting three diagnostic engagements this quarter.

First conversations are 30-minute fit calls on Zoom to determine whether GGenesis is the right partner for the work in front of you.

Start a Conversation →

What I've Built

Original products. Client platforms. Enterprise digital hubs.

Most consultants either strategize or execute. I do both. Here is what I have actually built and shipped.

AI Products (GGenesis IP)

My own products in market

CaliberSuite™ A personal AI advisor for business leaders. Filed with USPTO June 2026. Founding Member program open. Deploys August 2026.
Talvori™ Multi-tenant SMB operations SaaS platform in active development. Built to replace the SaaS stack, not sit alongside it.

Client Platforms Delivered

What I build for clients

AIDA Pro Services Full luxury website plus custom Estimate Generator with client sign/decline flow and Invoice Generator with multi-payer routing.
AIDA Pro Client 360 Database Pipeline dashboard, AR aging, services playbook, and CRM integration.

Learning Platforms & Training Simulators

Proprietary training environments I designed and built

Healthcare Revenue Cycle Training Platform (proprietary, in build) Proprietary end-to-end training simulator covering BOTH the provider and payer sides of the same medical claim. Three integrated modules: RevCycleSim (provider revenue cycle), ClaimsLab Pro (payer adjudication), PayerSim Pro (payer navigation). HCFA-1500 and UB-04 form rendering with field-level error highlighting. Institutional pricing engine (APC, APG, DRG, SNF case rates). Instructor coaching view with real-time student progress. The only training course in the market with a hands-on simulator covering both sides of the same claim.
Clinical Systems & Utilization Management Enablement Led the CBH eligibility transformation from legacy LOB and Plan structures to a modernized six-level eligibility hierarchy. End-user readiness across the full clinical workflow: Authorizations, Pharmacy, Care Plans, Programs, Compliance, Letters, Reporting. Redesigned enterprise care-management onboarding using SAM methodology. Modular Articulate Storyline eLearning with system simulations. Standardized mock member data environments. Payer platform integration UAT for supplier records, services, levels of care, and UM notes.
20+ eLearning Modules covering Technical Configuration AND Complex Claims Processing · 1,000+ hours Authored SCORM-packaged content in Cornerstone LMS covering COB, DRG, PCA, LTC, IHS, MN Medicaid DRG, Modifier GA Review, High Dollar Claims, HRP Upgrade. Produced 40 to 60 percent reduction in SME-led repeat sessions.
Leadership, Change Management & Professional Development Library (proprietary) 30 interactive HTML eLearning modules with quizzes and certification. Leadership (20 courses across Foundation, Intermediate, Advanced, and Cohort tiers), Change Management (5 courses), Professional Development (5 courses).

Enterprise Digital Hubs (UCare and Elderplan)

Enterprise-scale operational infrastructure

Change in Motion Financial-turnaround support framework built at UCare to guide employees and leaders through major organizational realignment. Integrated learning, engagement, communication, and readiness.
Provider Network Management ServiceNow Center Structured processes, routing logic, and documentation tools to streamline provider contract updates and operational requests. Cross-department collaboration workflow implementation.
Learning & Development Communications Site Enterprise digital enablement hub at UCare centralizing learning content, change communication, and operational guidance.
SharePoint Claims Documentation Repository Built at Elderplan / Metropolitan Jewish Health System during the HealthRules migration. Centralized project documentation, workflows, and cross-team knowledge sharing.

The rare combination

Executive strategist AND builder. Most consultants can talk about transformation. Fewer can architect and ship the platforms that make transformation stick. GGenesis is founder-led every engagement because the founder has actually done the work at both scales: managing 60+ FTE at a regional health plan, AND shipping her own SaaS products under her own trademark.

Notable Engagements

Twenty-five years of operational depth. Documented, measurable results.

A short list of the wins that shaped how I work today. Full engagement history available on LinkedIn.

$18M

HealthRules Payer migration · zero critical defects at go-live

UAT Lead for a full operational transition covering Medicaid, Medicare, and the FIDA duals program. Claims inventory sustained under 30 days through go-live.

73K → 13K

Aged claims cleared in six months

Directed 60+ staff across Claims, Appeals, Correspondence, Account Management, Coding, and Quality. Reduced aging by 82% and stabilized under 30 days.

$2.5M

COB recovery · 6.1 ROI

Coordination of Benefits recovery in a NY Medicaid and Medicare regulated environment. Six-figure quarterly savings on top of the recovery.

96%

Client savings rate on payment integrity audits

CCI/NCCI audits and reimbursement optimization. Built the first full appeals and call-center SOP structure at a payment integrity vendor.

1,000+ hrs

SCORM eLearning content in production

20+ modules covering Technical Configuration and Complex Claims Processing. 40 to 60 percent reduction in SME-led repeat sessions.

6-Level

GuidingCare eligibility hierarchy transformation

Led CBH eligibility transformation from legacy LOB and Plan structures to a modernized six-level hierarchy across Authorizations, Pharmacy, Care Plans, Compliance.

What I Do

Where I bring the most value.

Claims Operations Turnaround

Aged claims resolution, adjudication tuning, auto-adjudication improvement, payment cycle KPI recovery, appeals and correspondence flow rebuild.

Payer Platform Configuration

HealthRules, GuidingCare, QNXT, FACETS, Amisys, EXP Macess. Configuration audit, defect triage, UAT design, cross-platform integration testing.

AI Strategies for Business Transformation: Generative and Agentic Intelligence

Certified in AI Strategies for Business Transformation: Generative and Agentic Intelligence. Applied AI in operational contexts. CaliberSuite™ (USPTO registered) and Talvori™ (in development). Cost-to-Revenue Method™ analytical framework.

Utilization Management Systems

GuidingCare eligibility hierarchy design, care plan configuration, UM workflow, compliance and letters operations, legacy structure migration.

Learning & Workforce Enablement

Blended learning program design, role-based operational curriculum, modular Articulate Storyline eLearning, standardized mock member data environments.

Provider Network Enablement

ServiceNow provider network center architecture, contract and reimbursement documentation, provider portal and directory data governance, credentialing workflow.

Data Analysis & Reporting

Oracle DB SQL, SQL Server, Tableau (Developer Level Certified), PowerBI. KPI engineering, defect triage, regression testing, executive reporting.

Change Management

Change Impact Crosswalk™. Change communication, stakeholder guides, readiness plans, supportive learning materials that reduce confusion and increase adoption.

Instructional Design

Articulate 360, Storyline, Cornerstone LMS, Visme, Synthesia, Camtasia, FS Pro, Adobe Captivate. eLearning, workflows, job aids, curricula, knowledge bases.

What Colleagues and Clients Say

Named voices. Real feedback.

Testimonials from professionals I worked directly with at UCare Health Plans, Elderplan, and other engagements. Each name is real. Each quote is from documented feedback.

"Thank you for your consistent support during this year's HealthRules Major Upgrade. This year's upgrade was filled with opportunities for us to come together and share our wisdom and lean onto one another for support."

Mason Smith, MBA

HealthRules Major Upgrade collaboration

"I want to recognize Gigi for her tremendous trainings, particularly with development month. Gigi is a wealth of knowledge, and her presentation of content is so well done. You know she is more than prepared and engages well with staff. Thank you, Gigi."

Reed Tenhoff

Enterprise Training and Development

"Thank you, Gigi, for leading the PNM project this year. Your continued willingness to go the extra mile, assign task and align our project's phase one and two completions doesn't go unnoticed. Your efforts exemplify what it means to be a true team player, and they directly contribute to our success as a group. Thank you for all you do."

Jess Clarke

Provider Network Management ServiceNow Project

"Thank you, Gigi, for helping me figure out how to run SQL reporting for lower environments. This will cut down my research by 50% or more. I can't tell you how much this is appreciated."

Jobi Berry

SQL Reporting Environment Enablement

FAQ

Questions people ask before we start.

How do you define your work?

I bring operational discipline to businesses that need it. That means claims turnaround for health plans, AI advisory for business leaders, workforce enablement platforms for enterprise learning teams, and named methodologies that make consulting outcomes documented, not vague.

What sets you apart from other consultants?

I do the work and I build the platforms. Most consultants either strategize or execute. I do both. Over 25 years of operational leadership plus original products in market: CaliberSuite™ USPTO filed, Talvori™ in development, and enterprise digital hubs at UCare.

What is the Cost-to-Revenue Method™?

My signature analytical framework. Maps every operating dollar spent to the revenue behavior it produces so leaders can make pricing, staffing, and workflow decisions with real data. Used inside CaliberSuite™ and every consulting engagement.

Do you work with clients outside healthcare?

Yes. Healthcare is my operational depth, but the Cost-to-Revenue Method™ and the AI transformation work apply across SMB service industries: hair and beauty salons, home services, medical and dental practices, boutique agencies, real estate teams, coaches and consultants, and multi-location franchises.

Where are you based?

Broussard, Louisiana. Lafayette Parish. Serve clients nationally and locally.

How do we start working together?

Book a Discovery Call. 30 minutes. I use the call to understand your operation, your bottleneck, and whether GGenesis is the right fit for the work in front of you.

Hi, I'm Gigi Carrabbia.