As part of an overhaul of its organizational structure, St. Louis-based health insurer Centene has named Cynthia Brinkley its new president and chief operating officer and filled several leadership roles below chairman and CEO Michael Neidorff.

Brinkley’s promotion comes three years after joining the company as executive vice president of international operations and business integration. Her most recent title was executive vice president of global corporate development, which included overseeing Centene’s “corporate development, specialized and international markets, and government relations.” She previously held

The other appointments include:

• Jesse Hunter being named executive vice president of mergers and acquisitions and chief strategy officer.
• Mark Brooks being named executive vice president while retaining his title as chief information officer.
• Kevin Counihan, the former CEO of Healthcare.gov under President Barack Obama, being named senior vice president of products.

Brinkley, Hunter and Brooks will report to Neidorff, while Counihan will report to Brinkley.

“These well-deserved appointments are a testament to the strong caliber of our team and reflect our commitment to building strong leaders from within our organization,” Neidorff said in a press release. “Over the past two years, Centene has more than doubled its market capitalization following landmark transactions and growth initiatives. This enhanced leadership structure is an appropriate step as we continue to grow Centene and achieve even higher levels of performance in driving value for members, partners and shareholders.”

Centene was ranked as the sixth-largest insurer in the U.S. by Forbes, with a market value of $8.6 billion. Unlike the five major insurers ahead of it—UnitedHealthcare, Anthem, Aetna, Cigna and Humana—Centene has been expanding its presence in the Affordable Care Act’s exchanges, covering many of the counties which had been at risk of having no exchange insurer for 2018. It’s also been expanding through M&A activity, such as its $3.75 billion purchase of Fidelis Care, the leading Medicaid managed care insurer in New York.