Why this former corporate ‘intrepreneur’ decided to finally start her own company

Nicole Semeraro’s career as a founder started while she was still working for one of the largest companies in the world.

But Semeraro wasn’t building a side hustle while working her day job. Instead, she founded Specialist Management Solutions, which launched as a subsidiary of healthcare services provider Optum, as an “intrepeneur.”

The experience gave her an inside look at the industry—and prepared her to eventually build a company of her own.

In 2023, Semeraro founded Karias Health, which she calls a “guided care intelligence platform” designed to help consumers make better healthcare decisions. Karias’s products include Faith AI, a virtual companion that helps patients keep track of information discussed during medical visits.

In a conversation with Founder Brew, Semeraro shares what she underestimated about building in health tech, why she’s focused on building an operationally strong company over chasing growth, and how her passion for helping people propelled her to leave the comfort of the corporate world and run her own venture.

This interview has been edited for length and clarity.

When you decided to leave healthcare leadership and become a founder, what would you say was the biggest risk you were taking?

My first company I actually built as an “intrepreneur.” My company was a subsidiary of Optum, which was safe in many ways.

It’s funny because I always tell people the story: There are not many founders out there like me that are 43 years old, that have kids that are young and a husband and a mortgage and all those things to just completely leave my high-paying corporate job to take an 80% pay cut to go after a calling to make change in the world. It’s very uncomfortable. Most people don’t do it.

I felt very much called to solving the problem and very equipped to do so, and wanted to bet on myself because I knew that there was no one out there more passionate about wanting to help people actually make these decisions in a different way.

It took me two years to muster the courage to just leave what was so comfortable and so easy to actually do this, and it’s been literally the joy of my life.

Healthcare is notoriously difficult to disrupt, with complex regulations and many companies trying to solve similar problems. What did you underestimate about building in this space?

When we entered the market, we actually started with small to midsized businesses as our target market, and most companies don’t do that. They go for the big dollars, the big accounts.

I felt the call to actually serve the small to midsize market because that market is hit so hard with rising healthcare costs. I underestimated just how much education was needed around self-funded health plans and these companies owning their healthcare.

How do you balance staying committed to Karias’s mission while making the tough business decisions required to grow the company?

Building a company inside of the fourth largest company in the world made me a really strong fiduciary operator and a strong fiduciary founder, because sometimes getting capital inside of big companies is harder than raising external capital. I knew I wanted to raise the right amount of capital to be responsible to our investors and to how I wanted to tackle.

Because of how we raised, we were in a unique position that allowed us to really iterate and put forth something solid versus having to rush around growth targets and not build an operationally strong company.

My goal is always to build a really strong operational business, serve our clients well, execute, and then have the right balance of scale at the right time. A part of that is we are very selective about who we partner with. We want people that are values aligned to solving the problem in a different way, and we’ve been very fortunate to find those partners with consultants and brokers throughout the country.

Was there an early hire or department you knew you needed to invest in that ended up having a major impact on the company’s growth?

I always tell people I’m completely unequipped to be leading this company because I am not a technology person. But then I also feel like that makes me completely equipped because what the world needs is simplicity.

One of the early hires I knew I needed to make was our chief product and technology officer that was going to take my vision for Faith AI, the “K Card,” and really wrap it in a bow and bring it to the world.

If you were advising another founder entering health tech, what’s something you wish you knew at the beginning that you’d tell them now?

The newest part of this has been understanding all the different ways that you can obtain capital for your business. My biggest piece of advice would be to really find the right advisors around you. I had amazing advisors around me to help discern the best way to raise the right amount of capital and the timing of raising that capital based on milestones.

You have to start with conviction and passion because if you don’t have that, then you’re never going to be able to make it. Building a company from nothing is so hard. Even when you have 20 years of healthcare experience, it’s still hard.