Robert J Gilmer

Robert is a Director in KPMG's Advisory Risk and Compliance practice in New York City. He is a Certified Public Accountant and has over thirteen years of experience in business and client service. He has extensive experience in the management and execution of Internal Audit plans and financial and operational risk assessments. He has gained this background in the insurance industry, with a primary focus on P&C, Life and Health.

Professional and Industry Experience

• Leading internal audit teams conducting operational and financial audits for various Insurance clients. Responsibilities included: assessing risk, developing audit plans, planning and managing audits, reporting to Audit Committees, and working with client project sponsors to oversee engagements.
• Managing and conducting internal audits focused on processes outsourced to TPA's, including both Management's vendor oversight function and performance by the TPA against agreed-upon operating guidelines and services level agreements.
• Managing and conducting internal audits in both corporate processes and operational areas at Insurance companies and Health Plans, including: claims processing, premiums and billings, enrollment and underwriting, actuarial, model risk, accounts payable, reinsurance, care management, pharmacy (i.e. formulary administration), network management, health benefit exchanges, vendor management, partnership reviews, and new product implementation reviews, amongst others.
• Managing multiple co-sourcing relationships with global Insurance companies. Activities have included assisting Internal Audit Departments with the execution of Internal Audit plans and SOX/MAR program, with a focus on both domestic and international operations. Collaborating with management to design and help implement Sox and MAR compliant internal control frameworks and testing/monitoring programs.
• Leading controls rationalization and optimization reviews for MAR and Sox programs at both Payors and P&C Insurance clients.
• Performing and managing the execution of SOX/MAR monitoring and testing programs for multiple P&C and Reinsurance clients.

Representative Clients

Prudential Financial Inc., Root Insurance, Sompo, Resolution Life, TIAA CREF, Assurant, Swiss Re, Root Insurance, Arch Capital Group Ltd, Oscar Health, BNP Paribas, AIG EmblemHealth, Carefirst (Blue Cross of MD), Independence Blue Cross, Blue Cross Blue Shield of Michigan, HealthFirst Mgmt. Services, LLC, Care Management Organization (Montefiore Hospital), CareConnect (Northwell Health), IU Health Plan, Community Care of Oklahoma, Metlife, & Plymouth Rock Insurance Co.