BrianMejía
Healthcare ops and data professional with a background in health plan operations, ACA enrollment, and compliance — building tools and insights that improve how people access and navigate care.
About Me
If you stumbled upon my website — hello, welcome, and thank you for taking the time to view it.
I work at the intersection of healthcare operations, patient access, and digital health. My experience includes supporting patients through prescription assistance programs and ACA enrollment while helping improve internal workflows, compliance processes, and digital tools.
My first exposure to data came through baseball, where I worked with sabermetrics for player development and scouting with the Dominican Prospect League during my senior year of high school and freshman year of college. That experience introduced me to how data can guide better decisions and reveal patterns in complex systems.
Today, I find myself back in data — this time in healthcare, exploring how analytics, technology, and operational design can make healthcare systems more accessible, efficient, and patient-centered.
Academic Background
Currently focusing on digital health transformation, AI-driven analytics, health information systems, and data-driven care models — with applied work on scaling mHealth solutions at Hospital de la Santa Creu i Sant Pau.
Served as Class Representative. Focused on innovation strategy, design thinking, lean startup methodology, and strategic foresight — building the commercial foundation to lead data-driven initiatives across complex organizations.
Focused on operations, risk management, and entrepreneurial strategy. Relevant coursework: HR Management, Sales & Marketing, Digital Marketing for Entrepreneurs, and Capstone Experience (Grade: A) — developing the management and analytical foundation applied throughout a healthcare career.
Employment History
Advised clients on ACA health plan selection and led digital operations initiatives — streamlined enrollment workflows, built reporting tools, and applied data analysis to optimize coverage outcomes and retention.
Managed agent licensing pipelines, carrier contracting, and compliance documentation across 25+ states — maintained data integrity across CRM systems and supported the team's recognition on the 2025 Inc. 5000 (#24 overall, #1 in Insurance).
Enrolled 4,000+ individuals into ACA-compliant health plans. Awarded the 2023–2024 Connecting Consumers with Coverage Award and 2024 Elite Plus Circle of Champions Award by HealthCare.gov.
Connected underinsured patients with manufacturer prescription assistance programs — navigated complex eligibility criteria, insurance data, and compliance requirements to reduce out-of-pocket medication costs.
Managed membership sales and guest experience for resort and private club members — developed consultative sales skills and high-touch client relationship management in a luxury hospitality setting.
Managed day-to-day client services for professional MLB players — coordinated logistics, travel, and scheduling while maintaining trust-based relationships with high-profile athletes and their representation.
Supported digital marketing campaigns, social media content creation, and brand communications — built foundational skills in SEO, audience targeting, and creative content production.
Progressed through three roles over four years — started as a Field Operations Intern (2015), advanced to Data Analyst Intern using sabermetrics for player development and scouting (2016), and completed the tenure as a seasonal Operations Specialist (2016–2018) supporting league-wide logistics and field coordination.
Skills
Work & Research
ACA Enrollment Compliance & Reporting Workflow Tool
Built for Top Quality Coverage — an interactive, web-based operational tool that standardized agent workflows across compliance disclosures, objection handling, and plan enrollment steps — improving call consistency and reducing compliance errors across the team.
Medicare Advantage Plan Comparison
An analytical deep-dive into 2024 Medicare Advantage plans across Florida, Texas, California, New York, and Georgia — comparing premiums, CMS star ratings, out-of-pocket maximums, and benefit coverage across major insurers like Humana, UHC, and WellCare. Built a filterable plan overview, value quadrant chart, and side-by-side comparison table to surface the "$0 premium trap" — finding that zero-premium plans consistently carry lower star ratings and higher OOP exposure. Includes analyst-backed recommendations scored across OOP, stars, benefits, and premium.
Not all Medicare Advantage plans are created equal, even when they advertise $0 premiums. This project compares 2024 plans across five major states, looking at what people actually pay out of pocket, how plans are rated by CMS, and what benefits are included or missing. The goal was to build a clear, visual way to see which plans offer real value and which ones just look good on paper. It includes interactive charts, a filterable plan table, and a scoring system that ranks plans based on cost, quality, and coverage. This was also a way for me to demonstrate my ability to work with structured data using SQL and turn it into a functional, interactive dashboard.
ACA Drug Coverage: What's Covered and What's Not
An investigative analysis into how ACA Marketplace formularies treat GLP-1 drugs, antidepressants, and insulin differently based on diagnosis — surfacing a structural coverage gap where the same drug gets covered for diabetes but denied for obesity. Analyzes prior authorization rates, step therapy requirements, tier placements, and out-of-pocket cost consequences using CMS formulary files, KFF data, and ADA research.
The same medication can be covered or denied depending on why a doctor prescribes it. This project looks at how ACA Marketplace insurance plans handle drugs like Ozempic, common antidepressants, and insulin when the diagnosis changes. For example, a GLP-1 drug might be fully covered for diabetes but completely excluded for weight loss. The analysis uses real CMS formulary data, research from KFF, and ADA guidelines to show where these coverage gaps exist, how much they cost patients, and what barriers like prior authorization and step therapy look like in practice. Beyond the research itself, this project was built to showcase my skills in querying data with SQL and presenting findings through clean, interactive dashboards.
mHealth Integration Strategy — Hospital de la Santa Creu i Sant Pau
Exploring how Hospital de la Santa Creu i Sant Pau can move mobile health apps from one-off pilots into standard care for heart-failure patients — making digital tools a routine part of treatment to improve patient outcomes and reduce unplanned hospital readmissions.
Awards
Elite Plus Circle of Champions
Awarded to the top-performing Marketplace agents and brokers in America. Earned by helping at least 500 consumers enroll in ACA Marketplace coverage — placing among an elite tier of agents nationally recognized by HealthCare.gov for exceptional enrollment impact.
Connecting Consumers with Coverage Award
Issued by the Director of CCIIO for helping consumers transition from Medicaid and CHIP coverage to the Health Insurance Marketplace between February 2023 and July 2024 — during the largest insurance unwinding event in U.S. history following the end of continuous Medicaid enrollment.
Let's Connect
Always happy to connect — whether you're working on something or just want to chat.