Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
System Applications
Generic

Edgar Sepulveda

Buda,TX

Summary

Operations leader with 13+ years of experience in Healthcare with proven track record of managing multi-functional teams for health plans. Skilled in leading large scale initiatives and demonstrates innovation for problem solving. Adept at creating a strong company culture focused on accountability, employee engagement, collaboration, and continuous learning opportunities to achieve operational excellence.


Overview

13
13
years of professional experience

Work History

Manager of Intake Operations

Centene Corporation
04.2017 - 07.2025
  • Led teams for call center operations, overseeing prior authorization, correspondence, and referral services for multiple states, including Texas, for Medicaid, Medicare and Marketplace
  • Delivered executive-level presentations to senior leadership to showcase project status, performance reporting or KPI (Key Performance Indicators) trends, and progress toward strategic objectives. Executed remediation plans for KPI improvement opportunities.
  • Managed full project lifecycle, including resource planning, business analysis, system integration, and implementation for process improvement by leveraging Lean Six Sigma methods.
  • Developed supervisory staff by creating succession plans and leadership development programs.
  • Collaborated with key stakeholders and leadership across all levels to implement new product or departmental initiatives, ensure policy adherence, follow regulatory compliance, procedures, and promote organizational change to align with business goals.
  • Achieved departmental goals by developing and executing strategic plans to meet performance metrics.

Supervisor of Referral Services

Superior Health Plan
09.2015 - 04.2017
  • Directly managed up to 45 individual contributors to ensure performance metrics and company expectations were met.
  • Supervised daily operations for Prior Authorization department, ensuring operational efficiency and timely completion of tasks to meet required turnaround times.
  • Conducted performance evaluations, identifying areas of opportunity to provide professional development plans
  • Developed staff skills through targeted training programs, resulting in improved performance and career growth opportunities.
  • Led staffing efforts including interviewing, hiring, onboarding, and training.
  • Optimized customer experience by delivering first call resolution services and effectively troubleshooting issues.
  • Increased team productivity by implementing efficient workflows, providing job aid support, and communicating clear expectations for all team members.
  • Enhanced communication within the team by holding regular weekly/monthly meetings and encouraging open dialogue among all members.
  • Collaborated with other departments to achieve organizational goals, fostering teamwork across various functions.

Referral Specialist II

Superior Health Plan
06.2012 - 09.2015
  • Provided Team Lead and subject matter expert support by assisting with work process related questions, de-escalate difficult calls, delegating work tasks, tracking and reporting work volumes or trends.
  • Served as a preceptor for new hires supporting onboarding, initial training, and delivering refresher training to reinforce performance and knowledge retention.
  • Provided research and solutions for complex prior authorization cases.
  • Performed internal quality audits for prior authorizations completed by team members to provide feedback and meet quality goal.
  • Facilitated high-volume inbound calls from requesting or servicing providers for prior authorization for outpatient and inpatient services.
  • Verified member and provider eligibility for active members an in-network providers to meet HIPPA compliance.
  • Met performance metrics by reviewing and processing fax requests for prior authorization services in accordance with Superior Health Plan prior authorization guidelines.

Education

High School Diploma -

J.W. Nixon High School
Laredo, TX
05-2004

No Degree - Psychology

The University of Texas
Austin, TX

Skills

  • Experience Leading In-Office and Remote Teams
  • Organizational Change Management
  • 5 years Project Management
  • 6 years Call Center Operations Management
  • Workforce Planning and Scheduling
  • 5 years Process Improvement and Optimization
  • Conflict Resolution and Mitigation
  • Public Speaking and Presentation
  • Critical and Innovative Thinking
  • Detail-Oriented and Highly Organized
  • Adaptable in Fast-Paced Environments
  • Bilingual: Fluent in English and Spanish (spoken and written)

Accomplishments

  • Participated in a Green Belt project to improve new hire onboarding, leading to the development of a structured learning journey that enhanced retention and reduced 90-day attrition rates.
  • Developed and launched an internal mentorship program to enhance new hire onboarding, providing structured support during the first 2–4 weeks post-training.
  • Led the creation of an internal system application to streamline member and provider lookup processes, reducing authorization errors tied to incorrect provider affiliations and improving claims accuracy.
  • Contributed to the rebranding of Superior HealthPlan’s core values as part of the Employee Inclusion Group. Co-developed and launched the “I Got Pinned” campaign to promote employee engagement and recognition that evolved into "Employee of the Quarter/Year" recognition program.
  • Completed inaugural Mentorship Program through the Employee Inclusive Group. Mentored a Centene colleague, focusing on professional growth and leadership development.
  • Developed and launched an automation project with senior leaders and consulting group, Ernst & Young, by programming a bot to automate provider and member notification letters. Leveraged virtual machines to boost processing efficiency, volume capabilities, and reallocate staffing to higher-priority areas.
  • Lean Six Sigma White and Yellow Belt Certified

Timeline

Manager of Intake Operations

Centene Corporation
04.2017 - 07.2025

Supervisor of Referral Services

Superior Health Plan
09.2015 - 04.2017

Referral Specialist II

Superior Health Plan
06.2012 - 09.2015

High School Diploma -

J.W. Nixon High School

No Degree - Psychology

The University of Texas

System Applications

MS Outlook, MS Word, MS PowerPoint, MS Excel, MS Teams, MS One Note, MS Smartsheet, Skype, Zoom, FaxCom, EmpCenter, Omni, IEX Webstation, Avaya CMS Supervisor 19, SharePoint, MicroStrategy, BisCom, NICE Engage, Taleo, Beeline, WorkDay, MyPay/DayForce, FileNet, Avaya One-X, Amisys, Vizio, Power-Bi, Power Apps, AWS (Amazon Web Service), Calabrio, Care Central, RightFax, ServiceNow, OneDrive

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