Tay Gaines
Goodyear,Arizona
Summary
Results-driven professional with 14 years of experience in executive support, team leadership, and operations management. Proven track record of optimizing operational resources, reducing costs, and enhancing team efficiency. In-depth understanding of SaaS technologies and deployment methodologies. Seeking a Senior management role to leverage expertise in driving operational excellence and delivering exceptional customer service.
Overview
15
15
years of professional experience
Work History
Senior Operations Manager
Cigna
Scottsdale, AZ
07.2024 - Current
- Developed and implemented comprehensive strategies to improve operational processes and organizational efficiency.
- Collaborated with senior leadership to set long-term objectives for the company.
- Building relationships with vendors/partners/stakeholders.
- Establishing and tracking key performance indicators (KPIs).
- Maintained Claim Administration for Evernorth Network Solutions.
- Forecasting and managing operating (and other project-related) costs.
- Driving creative problem solving to address operational issues and opportunities
- Managing outside vendors and contractors.
- Evaluated provider payments for accuracy and adherence to applicable state laws.
- Prepared reports outlining the progress, performance, and results of claim processing activities.
- Collaborated with other departments on projects that involved the review or analysis of claims data.
- Negotiated contracts with suppliers and vendors to secure favorable terms.
- Designed and analyzed internal reporting systems and procedures for company.
Director
Mphasis
Goodyear, AZ
06.2022 - 07.2024
- Set and communicated performance targets, resulting in a 15% improvement in team productivity
- Managed Short-term and Long-term disability, call center, claims, credentialing, and Provider Data/ Network departments, overseeing 12 direct reports and 260 employees
- Prepared and delivered metrics based on each client’s goals in a consumable client format that delivered actionable insights (regular meetings, business reviews, ROI)
- Developed, recommended, and implemented policies and procedures to optimize operational resources, resulting in a 20% reduction in operating costs
- Completed thorough data audits for the health plan, ensuring 95% compliance with HEDIS measurements
- Collaborated closely with senior management on long-term strategic planning initiatives related to projects in development or execution stages.
- Utilized Six Sigma methodology to identify compliance risks and quality improvement opportunities, leading to a 25% reduction in operational errors
- oversight over all aspects of the existing business with health plans, including but not limited to utilization growth, daily operations, reporting, and billing.
Operations Manager
Oscar Health Insurance
Tempe, AZ
07.2020 - 07.2022
- Led a team of 100+ processors across 5 departments to optimize Medicare and Medicaid operational processes, resulting in increased efficiency
- Implemented dashboard systems to oversee productivity and streamline issue resolution processes, leading to a 30% decrease in resolution times
- Managed multiple projects with competing deadlines simultaneously.
- Identified and lead team projects to develop intellectual process/tools to support efforts of teams
- Improved decision-making processes by analyzing diverse data sources to produce insightful reports, tools, KPI’s, and metrics
- Coordinated resources across multiple departments and teams as needed for successful completion of projects.
Senior Manager
Cigna
Phoenix, AZ
11.2015 - 08.2020
- Boosted client loyalty and satisfaction by expertly managing the insurance claims process and building strong, trusting relationships to provide support during challenging times
- energized, communicate and built rapport at all levels within the organization
- Investigated customer grievances and recommended actions aligning with collective bargaining terms, enhancing dispute resolution
- Managed claim processing for medical, behavioral health, and professional services
- Diligently investigated, evaluated, and adjusted multi-line claims in compliance with regulations and best practices
- Assisted in developing strategies to improve client and customers satisfaction levels.
- Collaborated with cross-functional teams to develop strategies for driving customer success.
- Maintained up-to-date knowledge of industry trends related to customer success management.
Property Manager
MEB Management
Phoenix, AZ
10.2010 - 10.2015
- Led the development, review, and submission of property operating and capital budgets resulting in a 10% increase in budget accuracy
- Achieved 100% tenant occupancy by optimizing marketing strategies and enhancing tenant engagement through tailored outreach programs
- Managed write-offs, payments, and recoveries processes, resulting in a 15% increase in revenue recovery efficiency
- Implemented targeted marketing strategies that led to a 30% increase in customer acquisition
- Monitored competitor activities in order to stay ahead of the curve in terms of customer service offerings.
- Coached team members on best practices for delivering exceptional customer experiences.
- Prepared documentation, reports and logs to identify and manage sales metrics and support process driven activities.
- Supervised success team, operations and resources to deliver profitable growth.
Education
Completed Courses - Health Information Technology
Maricopa Community Colleges - Glendale Community College
Glendale, AZ12-2013
High School Diploma -
Liberty High School
Peoria, AZ05.2010
Skills
- Operation Excellence
- Compliance/ Regulatory Oversight
- Employee Information Systems(HCM, Workday, ADP)
- SAS,SQL, and SSAS Knowledge
- Medical Record System
- 7 years of Medicare/medicaid knowledge
- Policy and Procedure Management
- Business Excellence
- 13 years of Customer Service Management
- Data Management
- Root cause analysis expertise
- Lean Six Sigma
- Configuration Management
- Project Management
Certificates
- Lean Six Sigma
- Six Sigma Green Belt
- Operational Excellence
Timeline
Senior Operations Manager
Cigna
07.2024 - Current
Director
Mphasis
06.2022 - 07.2024
Operations Manager
Oscar Health Insurance
07.2020 - 07.2022
Senior Manager
Cigna
11.2015 - 08.2020
Property Manager
MEB Management
10.2010 - 10.2015
Completed Courses - Health Information Technology
Maricopa Community Colleges - Glendale Community College
High School Diploma -
Liberty High School