Maxibel Silverio
Hollywood,FL
Summary
Results-driven healthcare operations leader with over a decade of experience in claims management, provider services, and customer experience. Proven ability to lead high-performing teams, optimize workflows, and drive measurable improvements in service delivery and cost containment. Adept at managing cross-functional projects, resolving escalations, and aligning operational strategies with CVS/Aetna’s enterprise goals. Passionate about continuous improvement and delivering exceptional outcomes for members and providers.
Overview
29
29
years of professional experience
Work History
Supervisor
CVS/Aetna
06.2023 - Current
- Supervise daily operations to ensure compliance with company policies and procedures.
- Implemented process improvements that enhanced workflow and reduced errors in service delivery.
- Monitored team performance metrics to identify areas for development and training opportunities.
- Lead daily operations of the MSO claims department, ensuring timely and accurate processing aligned with CVS/Aetna’s compliance and service standards.
- Manage a targeted initiative to reduce late claim interest payments (LCIP) across six cancer facilities. Reduced LCIP from $16M in 2024 to $120,957 YTD in 2025 — saving over $574,000.
- Built and mentored a team of 14 claims processors, 98% of whom were new to CVS/Aetna; successfully ramped the team into full production with high quality standards and strong behavioral performance.
- Manage daily inventory to ensure alignment with enterprise goals of >30 claims processed per day and >7 claims per hour per processor.
- Collaborate with internal departments and external providers to resolve escalations and ensure regulatory compliance.
- Analyze claims data to identify trends and drive strategic improvements supporting CVS/Aetna’s cost containment goals.
Supervisor, Provider Services
Evolent Health
02.2022 - Current
- Manage the customer care management (CMC) and supports services to ensure compliance with policies, procedures and customer requirements.
- Measures performance and productivity against the standards.
- Ensures the care center meets telephone access standards for Magellan.
- Provides routine staff supervision activities regarding staffing, disciplinary actions and performance appraisals.
- Interviews and screens applicants for positions within the department.
- Monitors and evaluates data from the call tracking and call management telephone system for accuracy, completeness, inquiry response time and performance issues.
- Ensures associates are given their QI scores, monthly report cards, and their productivity statistics individually.
- Ensures motivational programs are being utilized.
- Manage the department`s customer/support services quality improvement programs to ensure member and provider satisfaction.
- Identifies training needs for the Customer Service Unit in developing specific training programs for the Service Center.
- Responsible for the training and development of entry level staff and maintaining a teamwork environment.
- Manages the complaint and grievance process.
- Coordinates with sales account management and regional staff to provide smooth implementation of new business within the Care Center and Support Services.
Operations, Supervisor
Centene/WellCare Health Plans.
06.2014 - 09.2022
- Provided direct management of exempt and non-exempt associates responsible for accurate and timely maintenance of provider network, related automated pricing methodologies, daily workflow of team, and configuration liaison between the Market and Shared Services.
- Assign workload, monitor quality, associate coaching/development, and career pathing.
- Managed key performance metrics and implemented improvement plans for individuals or collective level.
- Perform root cause and trending analysis of data from operational units to improve quality and efficiency of our team.
- Build and foster relationships with stakeholders across the business to better align company goals and identify opportunities to increase provider satisfaction.
- Maintain department desk level procedures, track compliance to contractual standards and performs quality assurance audits for telephone inquiry functions.
Operations Auditor/Enrollment
WellCare Health Plans
10.2016 - 02.2019
- Performed quality reviews of data through desk audits/reviews of all applicable employees.
- Establish, perform and track audit projects within production and contractual agreements.
- Analyze, interpret and develop, audit results on a departmental level to help define operational metrics.
- Analyze data submitted by several Market entities to identify discrepancies, determine root cause and provide solutions.
- Effectively communicate and collaborate with other departmental audit teams across the organization.
Executive Response Specialist
WellCare Health Plans, Inc.
06.2014 - 10.2016
- Researched complex issues across multiple databases and worked with support resources to own resolution of all member issues and anticipate their future healthcare needs or potential opportunities to improve the experience.
- Own escalations through resolution on behalf of the member/provider in real time or through comprehensive and timely follow-up.
- Logged, tracked, resolved, and responded to all assigned inquiries and complaints directed to CEO, members, providers, governing bodies, regulatory agencies, BBB, social media, Well Care Legal Dept, Corporate Compliance TRUST department, CMS, AHCA, in writing and/or telephone, while meeting all regulatory requirements in a metric driven environment.
- Analyzed and root caused escalated issues, grievances, and Complaint Tracking Module (CTM) complaints received from the Centers for Medicare and Medicaid Services (CMS), Agency of Healthcare Administration (AHCA) and the Department of Insurance.
- Ability to effectively handle escalated callers and resolve issues quickly seeking a positive outcome for all parties concerned.
- Act as a liaison between internal departments on data gathering and problem solving while investigating complaints and grievances for specific scenarios. Presents proposed solutions in a clear and concise manner.
Sr. Customer Service Representative
UnitedHealth Group, Medicare & Retirement
01.2012 - 06.2014
- Consistent Top Performer with above goal scores in call productivity, quality standards, customer satisfaction surveys, call time and schedule adherence as well as driving first call resolution in a metric driven environment.
- Effectively resolved escalated calls professionally and accurately to ensure caller satisfaction.
- Aided providers regarding plan benefits, physician and hospital claims, appeals, reconsiderations, credentialing, and demographics.
- Coached and mentored new hire training class on all aspects of responding to benefit, eligibility and claims inquires to ensure they achieved high quality and customer satisfaction.
- Agents listen to their own recorded calls to self-evaluate and my recorded calls for example of what they should be doing.
- Research, audit, evaluate and interpret team quality, customer satisfaction scores and adherence.
Esthetician – Self-employed
01.1997 - 12.2012
Education
Associates - Cardiovascular Technology
Central Florida Institute
Skills
- Microsoft Office (Word, Excel, Outlook, PowerPoint)
- Team leadership
- Process optimization
- Compliance management
- Performance metrics analysis
- Claims processing efficiency
- Data trend analysis
- Inventory management
- Cross-department communication
- Regulatory adherence
- Attention to detail
- Complex Problem-solving
Timeline
Supervisor
CVS/Aetna
06.2023 - Current
Supervisor, Provider Services
Evolent Health
02.2022 - Current
Operations Auditor/Enrollment
WellCare Health Plans
10.2016 - 02.2019
Operations, Supervisor
Centene/WellCare Health Plans.
06.2014 - 09.2022
Executive Response Specialist
WellCare Health Plans, Inc.
06.2014 - 10.2016
Sr. Customer Service Representative
UnitedHealth Group, Medicare & Retirement
01.2012 - 06.2014
Esthetician – Self-employed
01.1997 - 12.2012
Associates - Cardiovascular Technology
Central Florida Institute