Call Center Inventory Management

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Summary

Results-driven Claims Director with over 20 years of experience managing multi-million dollar claims portfolios and optimizing claims processes. Proven expertise in implementing effective claims resolution strategies and data-driven solutions to enhance accuracy and operational efficiency. Skilled at leading high-performing international teams to exceed client expectations, drive customer satisfaction, and ensure regulatory compliance. Adept at streamlining workflows and fostering a culture of continuous improvement to achieve strategic business goals.

Skills

Experience

CLAIMS DIRECTOR 11/2021 - 07/2024

Citizens Inc - Austin, TX

Claim Category: Life and Health claims, Annuity, Accelerated Benefits, Accidental Death, Property and Casualty.

• Streamlined Claims Processing: Reduced life claims processing time from 66 days to 23 days by implementing a unified inventory management system, enhancing tracking efficiency, and expediting turnaround times.

• Enhanced Departmental Performance: Achieved a 27% increase in departmental performance by strategically overseeing four distinct areas, driving targeted initiatives, and aligning team goals with organizational objectives.

• Pioneered Internal Auditing: Established the company's first internal audit team, developed comprehensive auditing criteria, and integrated findings into performance scorecards, significantly boosting audit efficiency and accountability.

• Optimized Call Center Operations: Built and optimized a high-performing call center team from existing staff, adhering to budget constraints while introducing performance metrics and service level agreements to improve customer experience.

• Standardized Training Excellence: Introduced the Claims Trainer role, designed and maintained consistent training materials, and provided teams with essential resources to ensure high-quality and uniform training delivery. Lynette Cabrera

Austin TX 512-***-**** **********@***.***

• Strategic Planning & Problem Solving

• Astute Communication

• Stakeholder Engagement

• Team Leadership & Development

• Customer-Centric Approach

• Stop loss coordination

• Claims Portfolio Oversight

• Workflow Optimization

• Regulatory Compliance

• Technology Integration

• Financial Analysis & Budget Management

• Establishing and maintaining KPI’s

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CLAIMS SENIOR SUPERVISOR 01/2016 - 10/2021

Cigna Health - Austin, TX

Claim Category: Supplemental Benefits, Medicare, Long term care, Cancer claims and Dental

• Digitized Inventory Management: Successfully transitioned inventory operations to digital platforms, enabling efficient remote work and ensuring seamless business continuity.

• Implemented Data Warehouse Systems: Directed the launch of a new data warehouse, streamlining inventory processes and enhancing reportability through close collaboration with IT teams.

• Accelerated Turnaround Time: Partnered with business analysts to refine auto adjudication workflows, achieving a 4% reduction in processing time and improving performance metrics.

• Unified Auditing Standards: Developed and enforced standardized auditing procedures across departments, ensuring accuracy, compliance, and operational consistency.

• Enhanced Workflow Efficiency: Spearheaded the creation of comprehensive procedural guidelines, improving process efficiency and driving operational excellence.

CLAIMS MANAGER 12/2010 - 01/2016

United Healthcare UMR -Austin, TX

Claim Category: Major Medical, Long term care, and Dental

• Directed Workforce Operations: Led a diverse team of over 300 employees, including onsite, remote, and global staff, achieving exceptional operational efficiency and performance optimization.

• Enhanced Team Development: Designed and implemented development plans for direct reports, equipping them with essential tools and support to drive individual and team success.

• Streamlined Workflow Processes: Revamped departmental workflows to improve coordination and operational synergy, resulting in more streamlined and effective processes.

• Executed System Conversion: Managed system transition by overseeing detailed testing, delivering tailored training programs, and optimizing resources for seamless implementation and inventory control.

• Strengthened Client Relationships: Maintained and enhanced partnerships with high-profile clients by providing superior service and ensuring project goals were consistently met or exceeded.

• Established and reinforced the TPA relationship upon which the organization was founded. Enhanced communications between the two organizations by establishing defined reporting capabilities to include quarterly board meeting presentations. CLAIMS MANAGER 05/2008 - 12/2010

FirstCare HealthPlans -Austin, TX

Claim Category: Major Medical, Complex Claim, Transplant and Cancer Claims

• Optimized Claims Processing: Reduced claims turnaround time from 35 days to 28 days by implementing streamlined workflows, boosting efficiency and customer satisfaction.

• Enhanced Inventory Management: Modernized legacy inventory tools, improving data accuracy and operational control across the claims department.

• Streamlined Assignment Structures: Redefined assignment protocols to align with service level agreements, resulting in higher customer satisfaction and measurable impact.

• Integrated Automation Solutions: Spearheaded the adoption of advanced automation tools, modernizing claims processes and increasing operational efficiency.

• Optimized Staffing Structures: Conducted comprehensive 360 reviews to execute a 15% staffing adjustment, ensuring a balanced team structure while maintaining productivity.

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CLAIMS DIRECTOR 05/2006 - 05/2008

IBO Managed Services - Austin, TX

Claim Category: Medical Claims

• Strategic Claims Transformation: Revolutionized claims operations by implementing advanced data analytics, reducing processing times by 40% while improving accuracy and customer satisfaction.

• Cross-Functional Leadership: Directed cross-departmental initiatives to align claims processes with organizational goals, enhancing efficiency and fostering collaborative innovation.

• High-Impact Team Development: Mentored and developed high-performing teams through tailored training programs and leadership opportunities, driving a 30% increase in team productivity.

• Policy and Compliance Oversight: Established and enforced robust compliance frameworks, ensuring adherence to industry standards and mitigating regulatory risks across all claims processes.

• Technology Integration Leadership: Pioneered the integration of cutting-edge technology, including AI-driven automation, streamlining workflows and delivering measurable cost savings. Websites, Portfolios, Profiles

• https://www.linkedin.com/in/lynette-cabrera-62a2833/ Key value offerings

Highly skilled in enhancing claims processes to achieve rapid, precise, and cost-effective resolutions, significantly boosting operational efficiency and effectiveness., Proficient in applying advanced data analytics to proactively mitigate risks, supporting strategic decision-making and strengthening organizational stability., Well-versed in managing extensive claims portfolios, ensuring financial accuracy, regulatory compliance, and alignment with overarching strategic goals. Experience with the following insurance types: Major Medical-complex claims, catastrophic illness (including PPO, HMO, EPO,POS), Dental, Supplemental Benefits, Medicare & Medicaid, Long term care, Transplant, Cancer, Life & Health, Accidental death benefit, Property and Casualty, Annuity, Accidental death and dismemberment, Accelerated Death Benefit

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