Risk Manager Focus

How a Near-Death Experience Dramatically Changed This Risk Manager’s Career and Life

Janet Sheiner puts focus and creativity into her role as a risk manager and her work as an artist.
By: | June 1, 2018 • 10 min read

In 2000, with a two-week vacation on the horizon, Janet Sheiner decided she wanted to do something different, something “undeniably upbeat and outside of my normal experience.”

Her “normal experience” at least in the professional portion of her life in those days, was doing utilization review (UR) for an HMO.


Sheiner was always drawn to difficult tasks, but the role was starting to wear on her.

“I understood insurance and health care, and I thought I could make a niche for myself in that world by doing the hard stuff,” she said.

“I understood that UR is an important part of keeping health care affordable and protecting members from having unsafe or unnecessary procedures, but it can feel like an antagonistic role by definition, and it wears on you after a while. Essentially, my job was handling denials of coverage — although we didn’t call them denials.”

Seeking a fresh perspective, she found a program offered by UC Davis that aligned willing volunteers with various research projects.

She chose to participate in an expedition in the Sea of Cortez off the coast of Baja, California — a childhood vacation destination she regularly visited with her family growing up in Southern California.

The researchers were studying the impact of El Niño and La Niña on the growth patterns of baby pelicans that populated a series of small, deserted islands.

“We would take these small boats out to the islands, which were protected for the birds, and usually we’d anchor just off the coast and have to swim to shore. Once we got there, the parent pelicans would take off, and we’d have to wrangle the babies, band them and weigh them. Then we’d go back two weeks later to see if they had gained or lost weight,” she said.

“I was speeding toward the edge and I remember thinking, ‘I’m going to die.’”

On one such trip, Sheiner chased after a particularly fleet-footed pelican until she found herself at the top of a gravelly cliff face. She lost her footing and began to slide, grasping at unmoored rocks to no avail, finding nothing to hold on to.

Janet Sheiner, VP of risk management and real estate, AMN Healthcare Services Inc.

“I was speeding toward the edge and I remember thinking, ‘I’m going to die.’”

Finally, she came to a halt just a foot and a half from the edge. Forty feet below her were the rock-encircled, churning tide pools of the Pacific. On that cliff, with a watery death staring her in the face, she made the decision to turn her career around.

“That experience helped me put things into perspective. If you realize you’re doing something with your life you just don’t want to do anymore, it shouldn’t take something that dramatic to make you reassess where you are,” she said.

Fostering Positivity

Once she returned from the expedition, Sheiner followed through on her promises to herself, chucking the TV, quitting her job and moving south to San Diego from Orange County. But her skills and interests still lived in the insurance industry, so she sought ways to capitalize on them in a more positive way.


“I took about six months off, trying to figure out what I wanted to do. I still liked insurance and helping people navigate it. I didn’t want to abandon it; I just had to find a different way in,” she said.

Again, not shying away from hard work, Sheiner eventually found her way by building an insurance company for a chiropractic and acupuncture practice, writing policies to extend coverage to people who otherwise may not have considered the treatment.

“It felt good because I was extending benefits beyond what was normally available, rather than denying them,” she said.

Though the feeling was a welcome change of pace from her previous position, Sheiner learned toughness and perseverance from her days doing utilization review.

And working in UR does give one the opportunity to do tremendous good, as tough a job as it may be.

“A boss once told me that you don’t prove how good you are on your best day. You prove it on your worst day.” — Janet Sheiner, VP, risk management and real estate, AMN Healthcare Services Inc.

In the 1980s, for example, research surfaced supporting the use of bone marrow transplants in conjunction with high-dose chemotherapy for the treatment of stage 4 breast cancer.

Congress considered legislation to force all HMOs to cover the treatment, and according to the New England Journal of Medicine, more than 30,000 breast cancer patients in the U.S. received bone marrow transplants between 1985 and 1998.

But by the late ’90s, the researchers’ findings had been proven false.

“People who had received transplants were dying sooner and with more pain. So that’s where UR helps to protect people — by denying coverage for treatments that aren’t supported by enough evidence and don’t bring benefit over the long run,” Sheiner said.

“Nevertheless, it’s not easy telling a woman with late-stage breast cancer that the treatment she wants isn’t covered by her insurance.”


Her experience in UR engendered the realization that seeing the big picture and maintaining a positive attitude go a long way in getting through difficult days. Doing the right thing can still feel unpleasant, but it’s all about “coming to a difficult situation with as much positivity and as much integrity as you can.”

“A boss once told me that you don’t prove how good you are on your best day. You prove it on your worst day,” she said.

“Say we have a claim against a clinician that involves real, serious damages. Nothing about it will be easy. But I try to bring my best self to the table, so we can do the right thing for all parties involved and that includes defending the clinician if he or she has done nothing wrong.

“Bad things happen, and when they do, it’s critical to hear every side and keep the big picture in mind.”

It’s a message she continually conveys to her team in her current role as vice president of risk management and real estate at AMN Healthcare Services Inc.

Denise Jackson, chief legal officer and corporate secretary, AMN

“One of Janet’s greatest strengths is her commitment to the development of her team,” said Denise Jackson, chief legal officer and corporate secretary, AMN.

“She focuses not just on the functional/technical skill, but really spends time to find a path for her team’s growth and success.”

Some on her team look up to Sheiner as a mentor. Alaina Chapman, supervisor of risk management, AMN, credits Sheiner for inspiring her to pursue risk management as a career.

“Janet is a hardworking and very intelligent individual who is strategic and open-minded in her approach to risk management. She has a genuine passion around supporting others’ growth and seeing them thrive,” Chapman said.

Over the course of Sheiner’s tenure as VP of risk management, she’s been able to transform the department from a transactional unit to a true strategic business partner.

“Now the risk management portfolio touches virtually every aspect of our organization and is considered to be a strategic partner in not just mitigating risk, but leveraging it,” Chapman said.

“I have a lot of fun in risk management, and I try to bring an upbeat feeling to my team and foster a sense of enjoyment and excitement,” Sheiner added.

“And it is an exciting time. Risk managers have a unique opportunity to help enable innovation within our organizations, something we need especially in health care as demand increases.”

Channeling Creativity

Sheiner’s battle against the cloud of negativity hanging over her job at the HMO also served as a catalyst for her pursuit of another passion beyond risk management — art.

“I hit a low point emotionally. My whole life was work, and I didn’t really have any hobbies. I was getting myopic,” she said.

“I thought, ‘I’m just doing this to make money, but what is money really?’ It’s just paper. We’ve all entered this collective agreement that an American dollar that’s really only worth a few cents is actually worth $1. So I started cutting it up to challenge myself to think about it differently.”

Neft Ursa

Folds and fragments of paper bills, coins and even credit cards became raw materials for Sheiner’s sculptures, each with its own geopolitical story behind it.

“Neft Ursa,” or Drunken Bear, is a Russian bear whose clothes are made of rubles, but its eyes, teeth and claws are Soviet coins. It holds a vodka bottle filled with oil.

“Russia is still Soviet at its core in many ways,” Sheiner said. “The oil-filled bottle represents how drunk the ‘bear’ is on its income from oil.”

“Lung Xing” is a Chinese dragon made of Renminbi, whose tail is held up by little men made of American dollars, representing how the American consumer bolsters the Chinese economy.

“The goal is to get people to think more critically about how different parts of the world interact,” she said.

Keeping with that theme, Sheiner and her husband became partners in a cross-border art gallery called The Kitchen Project.

Based in Tijuana, the studio hosts pop-up dinners centered around food, wine and art, bringing in chefs from the San Diego area, Mexico City and Arizona to host exhibitions featuring a new artist at each event.

Sheiner has helped to organize these events for the past eight years and has had her own artwork featured several times.

Josue Castro, a co-partner at The Kitchen Project, said “her sculptures attract a lot of attention. Her work has been very successful. It’s based on a theme we all know — money makes the world go ‘round.”

That creativity comes in handy in Sheiner’s professional life as well. Risk managers are often the gatekeepers between new, innovative ideas and the internal support needed to bring them to life.

As she describes it, the risk management team is often viewed as the “Department of No.” But an open mind and a little ingenuity can help find ways to implement even high-risk propositions.

Lung Xing

“Janet has an artist’s mind that provides a different frame of reference that leads to novel approaches. She is incredibly resourceful, which allows her to couple original ideas with practical solutions,” Jackson said.

“What is truly amazing is that Janet’s passion and unique approach gets everyone, including our executive team and board of directors, interested and excited about risk management as a key element integral to AMN’s success. A monumental feat indeed.”

Since joining AMN about six years ago, Sheiner has been able to blend various risk financing alternatives to reduce the company’s total cost of risk and make a tangible impact on its financial results.

Maintaining Perspective

Over roughly two decades in various insurance and risk management functions, Sheiner said one of the most important lessons she’s learned is that both life and work are made successful by balancing the difficult and unappealing tasks with those that are uplifting and positive.


And there’s always a way to “shimmy your way back” from the proverbial cliff.

Just ask the pelicans Sheiner studied back in 2000.

The researchers leading that expedition were the same scientists who proved the effect of DDT on birds of prey during the 1970s — it killed a large portion of the pelican population and made them an endangered species — and helped to make the insecticide illegal.

By the time Sheiner made it to the islands years later, the species had recovered.

“It felt good to be a part of something bigger, and it just drove home for me how it’s all about the big picture,” she said. “That helps me keep perspective even today.”

She did, however, eventually give way on the television.

“My husband came with a TV … but I don’t watch it much!” &

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Exclusive | Hank Greenberg on China Trade, Starr’s Rapid Growth and 100th, Spitzer, Schneiderman and More

In a robust and frank conversation, the insurance legend provides unique insights into global trade, his past battles and what the future holds for the industry and his company.
By: | October 12, 2018 • 12 min read

In 1960, Maurice “Hank” Greenberg was hired as a vice president of C.V. Starr & Co. At age 35, he had already accomplished a great deal.

He served his country as part of the Allied Forces that stormed the beaches at Normandy and liberated the Nazi death camps. He fought again during the Korean War, earning a Bronze Star. He held a law degree from New York Law School.


Now he was ready to make his mark on the business world.

Even C.V. Starr himself — who hired Mr. Greenberg and later hand-picked him as the successor to the company he founded in Shanghai in 1919 — could not have imagined what a mark it would be.

Mr. Greenberg began to build AIG as a Starr subsidiary, then in 1969, he took it public. The company would, at its peak, achieve a market cap of some $180 billion and cement its place as the largest insurance and financial services company in history.

This month, Mr. Greenberg travels to China to celebrate the 100th anniversary of C.V. Starr & Co. That visit occurs at a prickly time in U.S.-Sino relations, as the Trump administration levies tariffs on hundreds of billions of dollars in Chinese goods and China retaliates.

In September, Risk & Insurance® sat down with Mr. Greenberg in his Park Avenue office to hear his thoughts on the centennial of C.V. Starr, the dynamics of U.S. trade relationships with China and the future of the U.S. insurance industry as it faces the challenges of technology development and talent recruitment and retention, among many others. What follows is an edited transcript of that discussion.

R&I: One hundred years is quite an impressive milestone for any company. Celebrating the anniversary in China signifies the importance and longevity of that relationship. Can you tell us more about C.V. Starr’s history with China?

Hank Greenberg: We have a long history in China. I first went there in 1975. There was little there, but I had business throughout Asia, and I stopped there all the time. I’d stop there a couple of times a year and build relationships.

When I first started visiting China, there was only one state-owned insurance company there, PICC (the People’s Insurance Company of China); it was tiny at the time. We helped them to grow.

I also received the first foreign life insurance license in China, for AIA (The American International Assurance Co.). To date, there has been no other foreign life insurance company in China. It took me 20 years of hard work to get that license.

We also introduced an agency system in China. They had none. Their life company employees would get a salary whether they sold something or not. With the agency system of course you get paid a commission if you sell something. Once that agency system was installed, it went on to create more than a million jobs.

R&I: So Starr’s success has meant success for the Chinese insurance industry as well.

Hank Greenberg: That’s partly why we’re going to be celebrating that anniversary there next month. That celebration will occur alongside that of IBLAC (International Business Leaders’ Advisory Council), an international business advisory group that was put together when Zhu Rongji was the mayor of Shanghai [Zhu is since retired from public life]. He asked me to start that to attract foreign companies to invest in Shanghai.

“It turns out that it is harder [for China] to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

Shanghai and China in general were just coming out of the doldrums then; there was a lack of foreign investment. Zhu asked me to chair IBLAC and to help get it started, which I did. I served as chairman of that group for a couple of terms. I am still a part of that board, and it will be celebrating its 30th anniversary along with our 100th anniversary.


We have a good relationship with China, and we’re candid as you can tell from the op-ed I published in the Wall Street Journal. I’m told that my op-ed was received quite well in China, by both Chinese companies and foreign companies doing business there.

On August 29, Mr. Greenberg published an opinion piece in the WSJ reminding Chinese leaders of the productive history of U.S.-Sino relations and suggesting that Chinese leaders take pragmatic steps to ease trade tensions with the U.S.

R&I: What’s your outlook on current trade relations between the U.S. and China?

Hank Greenberg: As to the current environment, when you are in negotiations, every leader negotiates differently.

President Trump is negotiating based on his well-known approach. What’s different now is that President Xi (Jinping, General Secretary of the Communist Party of China) made himself the emperor. All the past presidents in China before the revolution had two terms. He’s there for life, which makes things much more difficult.

R&I: Sure does. You’ve got a one- or two-term president talking to somebody who can wait it out. It’s definitely unique.

Hank Greenberg: So, clearly a lot of change is going on in China. Some of it is good. But as I said in the op-ed, China needs to be treated like the second largest economy in the world, which it is. And it will be the number one economy in the world in not too many years. That means that you can’t use the same terms of trade that you did 25 or 30 years ago.

They want to have access to our market and other markets. Fine, but you have to have reciprocity, and they have not been very good at that.

R&I: What stands in the way of that happening?

Hank Greenberg: I think there are several substantial challenges. One, their structure makes it very difficult. They have a senior official, a regulator, who runs a division within the government for insurance. He keeps that job as long as he does what leadership wants him to do. He may not be sure what they want him to do.

For example, the president made a speech many months ago saying they are going to open up banking, insurance and a couple of additional sectors to foreign investment; nothing happened.

The reason was that the head of that division got changed. A new administrator came in who was not sure what the president wanted so he did nothing. Time went on and the international community said, “Wait a minute, you promised that you were going to do that and you didn’t do that.”

So the structure is such that it is very difficult. China can’t react as fast as it should. That will change, but it is going to take time.

R&I: That’s interesting, because during the financial crisis in 2008 there was talk that China, given their more centralized authority, could react more quickly, not less quickly.

Hank Greenberg: It turns out that it is harder to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.

R&I: Obviously, you have a very unique perspective and experience in China. For American companies coming to China, what are some of the current challenges?


Hank Greenberg: Well, they very much want to do business in China. That’s due to the sheer size of the country, at 1.4 billion people. It’s a very big market and not just for insurance companies. It’s a whole range of companies that would like to have access to China as easily as Chinese companies have access to the United States. As I said previously, that has to be resolved.

It’s not going to be easy, because China has a history of not being treated well by other countries. The U.S. has been pretty good in that way. We haven’t taken advantage of China.

R&I: Your op-ed was very enlightening on that topic.

Hank Greenberg: President Xi wants to rebuild the “middle kingdom,” to what China was, a great country. Part of that was his takeover of the South China Sea rock islands during the Obama Administration; we did nothing. It’s a little late now to try and do something. They promised they would never militarize those islands. Then they did. That’s a real problem in Southern Asia. The other countries in that region are not happy about that.

R&I: One thing that has differentiated your company is that it is not a public company, and it is not a mutual company. We think you’re the only large insurance company with that structure at that scale. What advantages does that give you?

Hank Greenberg: Two things. First of all, we’re more than an insurance company. We have the traditional investment unit with the insurance company. Then we have a separate investment unit that we started, which is very successful. So we have a source of income that is diverse. We don’t have to underwrite business that is going to lose a lot of money. Not knowingly anyway.

R&I: And that’s because you are a private company?

Hank Greenberg: Yes. We attract a different type of person in a private company.

R&I: Do you think that enables you to react more quickly?

Hank Greenberg: Absolutely. When we left AIG there were three of us. Myself, Howie Smith and Ed Matthews. Howie used to run the internal financials and Ed Matthews was the investment guy coming out of Morgan Stanley when I was putting AIG together. We started with three people and now we have 3,500 and growing.

“I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

R&I:  You being forced to leave AIG in 2005 really was an injustice, by the way. AIG wouldn’t have been in the position it was in 2008 if you had still been there.


Hank Greenberg: Absolutely not. We had all the right things in place. We met with the financial services division once a day every day to make sure they stuck to what they were supposed to do. Even Hank Paulson, the Secretary of Treasury, sat on the stand during my trial and said that if I’d been at the company, it would not have imploded the way it did.

R&I: And that fateful decision the AIG board made really affected the course of the country.

Hank Greenberg: So many people lost all of their net worth. The new management was taking on billions of dollars’ worth of risk with no collateral. They had decimated the internal risk management controls. And the government takeover of the company when the financial crisis blew up was grossly unfair.

From the time it went public, AIG’s value had increased from $300 million to $180 billion. Thanks to Eliot Spitzer, it’s now worth a fraction of that. His was a gross misuse of the Martin Act. It gives the Attorney General the power to investigate without probable cause and bring fraud charges without having to prove intent. Only in New York does the law grant the AG that much power.

R&I: It’s especially frustrating when you consider the quality of his own character, and the scandal he was involved in.

In early 2008, Spitzer was caught on a federal wiretap arranging a meeting with a prostitute at a Washington Hotel and resigned shortly thereafter.

Hank Greenberg: Yes. And it’s been successive. Look at Eric Schneiderman. He resigned earlier this year when it came out that he had abused several women. And this was after he came out so strongly against other men accused of the same thing. To me it demonstrates hypocrisy and abuse of power.

Schneiderman followed in Spitzer’s footsteps in leveraging the Martin Act against numerous corporations to generate multi-billion dollar settlements.

R&I: Starr, however, continues to thrive. You said you’re at 3,500 people and still growing. As you continue to expand, how do you deal with the challenge of attracting talent?

Hank Greenberg: We did something last week.

On September 16th, St. John’s University announced the largest gift in its 148-year history. The Starr Foundation donated $15 million to the school, establishing the Maurice R. Greenberg Leadership Initiative at St. John’s School of Risk Management, Insurance and Actuarial Science.

Hank Greenberg: We have recruited from St. John’s for many, many years. These are young people who want to be in the insurance industry. They don’t get into it by accident. They study to become proficient in this and we have recruited some very qualified individuals from that school. But we also recruit from many other universities. On the investment side, outside of the insurance industry, we also recruit from Wall Street.

R&I: We’re very interested in how you and other leaders in this industry view technology and how they’re going to use it.

Hank Greenberg: I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.

R&I: So as the pre-eminent leader of the insurance industry, what do you see in terms of where insurance is now an where it’s going?

Hank Greenberg: The country and the world will always need insurance. That doesn’t mean that what we have today is what we’re going to have 25 years from now.

How quickly the change comes and how far it will go will depend on individual companies and individual countries. Some will be more brave than others. But change will take place, there is no doubt about it.


More will go on in space, there is no question about that. We’re involved in it right now as an insurance company, and it will get broader.

One of the things you have to worry about is it’s now a nuclear world. It’s a more dangerous world. And again, we have to find some way to deal with that.

So, change is inevitable. You need people who can deal with change.

R&I:  Is there anything else, Mr. Greenberg, you want to comment on?

Hank Greenberg: I think I’ve covered it. &

The R&I Editorial Team can be reached at [email protected]