Wildana Cruz Diaz

I’m an Operations and Customer Service Supervisor with extensive experience leading high-performing teams, ensuring data accuracy, and managing system-driven operations in regulated environments. I audit processes, identify discrepancies, and implement corrective actions to strengthen efficiency and compliance.

I’m recognized for optimizing workflows, maintaining data integrity, and supporting real-time operational decision-making through strong system management, reporting, and cross-functional collaboration. I actively monitor performance metrics, conduct quality reviews, spot trends and errors, and drive continuous improvement through corrective action plans.

In my current service-center leadership, I oversee daily operations across multiple locations, including member eligibility, enrollment transactions, documentation management, PHI protection, grievances and appeals, prior authorizations, and payroll reconciliation. I also ensure accurate and efficient use of operational systems such as QNXT and MyQNXT, while meeting audit and reporting requirements.

Earlier, as a Team Lead and in member services roles, I coached teams to improve first-call resolution (FCR), call documentation, and professional tone, while resolving complex escalations and claims disputes. I’ve achieved strong results (Quality Score of 97.36% and NBA of 94.98%), supported GPT pilot testing, and mentored new hires while improving adherence and compliance.