Mavis Gilman
Ojai,CA
Summary
Professional Summary:
With 29 years as a Health Net/Centene Associate, I have a thorough understanding of systems and processes across a wide range of business areas. Under my direction, Capitation operated effectively with consistent productivity. My prior background in Financial Services contributes to past as well as ongoing improvements in financial controls. In addition, I have had a deep involvement in the project development cycle and deployment of numerous systems and enhancements.
Known for my direct and open communications style, I have forged strong relationships with other Directors as well as VPs across Operations and other business units. Talented Manager with expert team leadership, planning and organizational skills built during successful career.
Overview
5
5
years of professional experience
Work History
Capitation Manager
Health Net
07.2000 - 10.2004
- Managed and motivated a team of 20+ direct reports to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes, working directly with Cap IT in system issues and enhancements.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Cross-trained existing employees to maximize team agility and performance.
- Monitored and analyzed business performance to identify areas of improvement and make necessary adjustments.
- Developed a strong company culture focused on employee engagement, collaboration, and continuous learning opportunities.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
- Streamlined workflows by identifying bottlenecks in existing systems and proactively addressing these challenges through appropriate solutions implementation.
- Championed diversity and inclusion efforts within the workplace, resulting in an inclusive environment that fostered creativity and innovation among employees from various backgrounds.
Capitation Supervisor
Health Net
05.1999 - 07.2002
- Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
- Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
- Monitored workflow to improve employee time management and increase productivity.
- Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
- Maintained compliance with company policies, objectives, and communication goals.
- Achieved results by working with staff to meet established targets.
- Enhanced communication within the team by holding regular meetings and encouraging open dialogue among all members.
- Created successful work schedules for each team member to maintain deadlines and fully staff shifts.
- Collaborated with other departments to achieve organizational goals, fostering teamwork across various functions.
- Reduced employee turnover by fostering a positive work environment and providing ongoing feedback to staff members.
- Established performance metrics for the team, consistently tracking progress towards goals and making adjustments as needed.
Education
High School Diploma -
Lee Academy
Lee, Maine06.1975
Skills
- In depth knowledge of systems, including Membership, Claims Provider and Capitation
- PeopleSoft - HN Accounts payable application
- Sponsor for strategic improvement initiatives and technology projects such as migration of MC400 to ABS (SAP) accounts payable system to PeopleSoft
- Oversee strategic planning and direction for the Provider Database and Configuration Staff
- Rewrote the Cap system in 2005 - moving from the ABS platform to an Oracle platform Resulting in a $5million dollar recoupment/cost saving for the company
- Strong skills in product knowledge, cross-selling and understanding of policies and procedures
- Direct and manage centralized loading of hospital contracts in the HN systems
- Oversee loading of capitation agreements for all lines of business such as HMO, Medicare and Medi-Cal
- Ensure that all relevant Health Net policies and procedures are adhered and followed
Timeline
Capitation Manager
Health Net
07.2000 - 10.2004
Capitation Supervisor
Health Net
05.1999 - 07.2002
High School Diploma -
Lee Academy