LAUREN KAAPA
Pooler
Summary
Operations and Leadership Professional experienced in overseeing team performance and managing workflows within healthcare call center environments. Delivered results through performance monitoring, data analysis, and workforce management, enhancing efficiency and supporting team success. Pursuing a dual degree in Psychology and Operations Management with a 4.0 GPA.
Overview
10
10
years of professional experience
Work History
Operations Supervisor
Results-Cx
Jacksonville
03.2026 - Current
- Oversee daily performance and workflow management for a team of agents within Pharmacy Medicaid operations
- Analyzed real-time performance metrics, adherence, and productivity trends to identify gaps and implement improvement strategies
- Utilize workforce tools and reporting to support RTA monitoring, staffing awareness, and schedule adherence
- Conduct and track coaching sessions, ensuring performance feedback is documented and aligned with KPI expectations
- Managed coaching trackers and performance data to monitor agent development and pinpoint trends for targeted coaching
- Support agents with workflow guidance, policy clarification, and performance expectations
- Collaborated with leadership to resolve operational challenges and enhance team efficiency
- Balance operational responsibilities while maintaining strong availability for agent support and team needs
TRAINER
CPS PHARMACY
Jacksonville
12.2025 - Current
- Serve as real-time Subject Matter Expert via chat support across Medicaid, Medicare Part D, and Marketplace pharmacy workflows
- Guided agents through complex prior authorization requirements, claim rejections, overrides, coordination of benefits, and eligibility scenarios to ensure accurate processing.
- Research and resolve authorization-related issues using MedHOK, UMV, ESI, CoverMyMeds, TruCare Classic/Cloud, Omni, and KeyStarter
- Analyze benefit structures, formulary status, and coverage criteria to determine prior authorization necessity and appropriate routing
- Supported escalated pharmacy cases involving dual-eligible members and high-cost medications, facilitating timely resolutions and comprehensive clinical reviews.
- Reinforced documentation accuracy and compliance with CMS and plan-specific guidelines, enhancing operational integrity.
- Partner with leadership and quality teams to ensure policy alignment and workflow accuracy
TRAINER
Legacy WellCare Duals Medicare Advantage
Jacksonville
08.2025 - 12.2025
- Facilitated new hire training sessions for classes of 20+ trainees supporting Medicare Advantage operations
- Delivered curriculum covering compliance standards, authorization workflows, systems navigation, and Centene policies
- Aligned instruction with CMS guidelines and plan-specific authorization requirements to ensure regulatory compliance
- Coordinated with cross-functional teams to ensure training materials met regulatory compliance standards
- Monitored trainee performance, coached individuals, and documented attendance and corrective actions to enhance training effectiveness
MAIN LINE MEMBER SERVICES AGENT
Fidelis Care
Winter Haven
01.2025 - 08.2025
- Supported Medicaid, Medicare Advantage, Marketplace, and Essential Plan members with authorization, appeal, and grievance workflows
- Processed and documented prior authorization requests in alignment with CMS and state Medicaid guidelines
- Coordinated with providers and internal departments to gather documentation for timely authorization determinations
- Resolved escalated authorization and eligibility cases, ensuring compliance with established turnaround timeframes
- Maintained detailed case documentation, ensuring adherence to HIPAA and PHI compliance standards
OUTBOUND SALES AGENT (Non-Licensed MAPD)
WellCare
Winter Haven
08.2024 - 01.2025
- Conducted outbound calls assisting Medicare members with plan options and eligibility verification
- Documented enrollment interactions in CRM systems to ensure accuracy and compliance
- Cross-trained on inbound workflows, enhancing team adaptability during high-volume periods
OPERATIONS & OFFICE SUPERVISOR
JOSH COLLINS HEATING & AIR
Guyton
02.2016 - 01.2022
- Coordinated daily business operations, including scheduling, billing workflows, and resolving customer escalations to enhance service reliability
- Managed cross-functional communication to facilitate timely service delivery and maintain customer satisfaction
- Oversaw workflow planning and implemented process improvements
- Developed onboarding and training materials to accelerate staff development and ensure consistent knowledge transfer
Education
Bachelor of Arts - Psychology
SOUTHERN NEW HAMPSHIRE UNIVERSITY
Manchester, NH05-2026
Bachelor of Science - Operations Management
SOUTHERN NEW HAMPSHIRE UNIVERSITY
Manchester, NH05-2026
Skills
- Workforce management
- KPI tracking
- Team Performance Management
- Agent Coaching & Development
- Process Improvement
- Escalation resolution
- Operational support
- Data analysis
- Dayforce (Timecards & Attendance Management)
- Compliance regulations
- Cross-Functional Collaboration
- Coaching documentation
Personal Information
Healthcare Operations Supervisor
Technical Systems
Healthcare & Authorization Systems:
MedHOK, TruCare (Classic & Cloud), UMV, ESI, CoverMyMeds, Omni, KeyStarter
Workforce & Operations Tools:
Dayforce (timecards & attendance), IEX Webstation, RTA monitoring tools
CRM & Contact Center Platforms:
Salesforce, CareConnects, Avaya
Productivity & Data Tools:
Microsoft Excel (performance tracking, data analysis, reporting), Microsoft Office Suite
Timeline
Operations Supervisor
Results-Cx
03.2026 - Current
TRAINER
CPS PHARMACY
12.2025 - Current
TRAINER
Legacy WellCare Duals Medicare Advantage
08.2025 - 12.2025
MAIN LINE MEMBER SERVICES AGENT
Fidelis Care
01.2025 - 08.2025
OUTBOUND SALES AGENT (Non-Licensed MAPD)
WellCare
08.2024 - 01.2025
OPERATIONS & OFFICE SUPERVISOR
JOSH COLLINS HEATING & AIR
02.2016 - 01.2022
Bachelor of Arts - Psychology
SOUTHERN NEW HAMPSHIRE UNIVERSITY
Bachelor of Science - Operations Management
SOUTHERN NEW HAMPSHIRE UNIVERSITY