Operational Performance Director
Current
Mar 2022 - Present
AeroLeads people directory · profile
Keyla E. Negrón Díaz Email & Phone Number
Director, Operational Performance at Abarca
at
Abarca Health
LinkedIn matched
✓ Verified Jul 2026
3 data sources
Profile completeness 100%
Current company
Role
Director, Operational Performance at Abarca
Location
Puerto Rico
Company size
Who is Keyla E. Negrón Díaz? Overview
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Quick answer
Keyla E. Negrón Díaz is listed as Director, Operational Performance at Abarca at Abarca Health, a with 317 employees, based in Puerto Rico. AeroLeads shows a matched LinkedIn profile for Keyla E. Negrón Díaz.
Keyla E. Negrón Díaz previously worked as Operational Performance Director at Abarca Health and Pharmacy Operations Support and Quality Assurance Director at Mmm Holdings Llc. Keyla E. Negrón Díaz holds Master Of Business Administration (M.B.A.), Finance, General from Inter-American University Of Puerto Rico - Metropolitan Campus.
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Abarca Health
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Profile bio
About Keyla E. Negrón Díaz
A growing career over the past 19 years, comprised of a diversity of roles in the health industry, contributing in each position to the strengthening of analysis processes, feasibility studies and reporting, which are key to both decision-making and strategy development. This led to the opportunity to take on a managerial role within a short period of time, which has been characterized by an ability to form a firm structure with a focus on continuous improvement. A leader who is passionate about sharing knowledge and fostering learning by forging highly competitive groups. *Strategic management of a quality department with a high volume of transactions.*Experience in a variety of insurance products: health, life and disability.*Validation of plans and forms to ensure regulatory adherence.*Knowledge of programming, which is key to monitoring related projects.*Automation of processes for efficiency and visibility of information.*Updating of systems to adapt to changes in requirements.*Design of tools that guarantee service during emergencies.*Assessments involving statistical and financial data.*Company representative in audits and on other assignments.*Development of policies, guidelines and procedures.*Promotion of synergy and consensus with other groups (inside and outside).*Coordination of functions with multidisciplinary teams.*Experience in providing training, talks and teaching.*Lean Yellow Belt CertificationSPECIALTIES:Validation Projects, Utilization / Actuarial Analysis, Forecast, Math & Statistics, Budgeting and Planning, Business Intelligence Tools, Metrics, KPIs, Dashboards, Regulatory Compliance, Accreditation Processes, Internal Audits, Quality Reviews, Technical Writing, Team Coaching, Public Speaking
Listed skills include Data Analysis, Ad Hoc Reporting, Queries, Hyperion Enterprise, and 10 others.
Current workplace
Keyla E. Negrón Díaz's current company
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Abarca Health
7 roles
Keyla E. Negrón Díaz work experience
A career timeline built from the work history available for this profile.
Pharmacy Operations Support And Quality Assurance Director
Lead the Pharmacy Quality Assurance and Back End Pharmacy Operations Teams that manage (annually) over 30 projects and company initiatives, over 70 audits and monitoring (internal and external), over 100k test claims, over 300k claims review, 600 reports, resolve over 12k PDE records and identify more than 18K claim to recoup within a company dedicated to providing services related to health care to the Medicare and Medicaid population of Puerto Rico. Oversee projects for compliance with the Puerto Rico Department of Health, Puerto Rico Insurance Commissioner, CMS, ASES, NCQA and HEDIS. Ensure adherence to contractual agreements. Lead a team of 9 associates and 2 supervisors.
Sep 2019 - Mar 2022
Quality Assurance And Fraud Waste And Abuse Manager
Lead the Quality Assurance, Pharmacy Audit and Fraud, Waste and Abuse Departments that manage over 2,500 validations for implementations (creation and/or changes to formularies and pharmacy benefit plans) in QA and over 200k pharmacy claims reviews for Pharmacy Audit and FWA, within a company dedicated to administrating pharmacy benefits, clients include: Triple S, MAPFRE, MCS, Constellation Health, PR Government Health Plan, MMM Healthcare, JAI Medical, Health Plan of San Joaquin and Connective Rx; Direct groups: Banco Popular, Bristol Myers and MMM Healthcare Employees, Walmart, Edward Lifesciences among others. Oversee projects for compliance with the Puerto Rico Department of Health, Puerto Rico Insurance Commissioner, CMS, HRSA, HEDIS, OIG and URAC. Ensure adherence to contractual agreements. Expense Budget: $500K+; lead a team of 15 associates and 1 supervisor.
Mar 2019 - Aug 2019
Quality Assurance Manager
Lead the Quality Assurance Department that manages over 2,500 validations for implementations (pre and post), changes to formularies or plans (new or existent), within a company dedicated to medication coverage, administering formularies and pharmacy claim processing. Clients include: Triple S, MAPFRE, Constellation Health, Plan de Salud del Gobierno and MMM Healthcare; Direct groups: Banco Popular, Bristol Myers and MMM, among others. Oversee projects for compliance with the Puerto Rico Department of Health, CMS and HRSA. Ensure adherence to contractual agreements. Expense Budget: $250K+; lead a team of eight to ten associates.
Jan 2013 - Feb 2019
Utilization Analyst - Administrator (Senior Consultant)
Prepared statistical reports (internal, client and regulatory), drug trends, reports to CMS, and RFPs; performed utilization analysis and cost-effective strategies for clients (Step Therapy, Duplicate Therapy, Contraindicated Therapies). Identified possible fraud, waste and abuse patterns, during an accelerated growth period in key clients: Triple S, PSG and Edwards Life Sciences.
Jul 2012 - Dec 2012
Senior Utilization Analyst
Oct 2007 - Jun 2012
Actuarial Analyst
Analyzed the experience, estimate risk and recommended renewal rates, prepared and reviewed loss ratio report for different group benefits including: life, short and long-term disability (STD, SINOT y LTD), mortgage life, accidents (GAP and SAP) and health. Prepared reserve estimates, incurred but not reported (IBNR) claims. Prepared utilization reports of drug and health benefits for insured groups and statistical reports for local and corporate offices and government agencies.
Feb 2005 - Oct 2007
Team & coworkers
Colleagues at Abarca Health
Other employees you can reach at abarcahealth.com. View company contacts for 317 employees →
AH
Allison H.
Colleague at Abarca HealthDayton, Ohio, United States
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JJ
José Jusino Rodríguez
Colleague at Abarca HealthPuerto Rico
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J(
Julia (Julie) Sterk
Colleague at Abarca HealthWorthing, South Dakota, United States
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JA
Jose Abraham Laboy
Colleague at Abarca HealthToa Baja, Puerto Rico
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GT
Glen Tong
Colleague at Abarca HealthSan Diego, California, United States
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AS
Aileen Sierra-Carrión
Colleague at Abarca HealthVega Baja, Puerto Rico
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AM
Armando Martinez
Colleague at Abarca HealthTrujillo Alto, Puerto Rico
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JP
Josie Platt
Colleague at Abarca HealthRuidoso, New Mexico, United States
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AP
Adiel Perez
Colleague at Abarca HealthSan Sebastian, Puerto Rico
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LA
Luis A. Reyes
Colleague at Abarca HealthPuerto Rico
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Allison H.
Colleague at Abarca HealthDayton, Ohio, United States
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JJ
José Jusino Rodríguez
Colleague at Abarca HealthPuerto Rico
View →
J(
Julia (Julie) Sterk
Colleague at Abarca HealthWorthing, South Dakota, United States
View →
JA
Jose Abraham Laboy
Colleague at Abarca HealthToa Baja, Puerto Rico
View →
GT
Glen Tong
Colleague at Abarca HealthSan Diego, California, United States
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AS
Aileen Sierra-Carrión
Colleague at Abarca HealthVega Baja, Puerto Rico
View →
AM
Armando Martinez
Colleague at Abarca HealthTrujillo Alto, Puerto Rico
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JP
Josie Platt
Colleague at Abarca HealthRuidoso, New Mexico, United States
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AP
Adiel Perez
Colleague at Abarca HealthSan Sebastian, Puerto Rico
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LA
Luis A. Reyes
Colleague at Abarca HealthPuerto Rico
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2 education records
Keyla E. Negrón Díaz education
Master Of Business Administration (M.B.A.), Finance, General
Bachelor Of Science - Bs, Mathematics
FAQ
Frequently asked questions about Keyla E. Negrón Díaz
Quick answers generated from the profile data available on this page.
What company does Keyla E. Negrón Díaz work for?
Keyla E. Negrón Díaz works for Abarca Health.
What is Keyla E. Negrón Díaz's role at Abarca Health?
Keyla E. Negrón Díaz is listed as Director, Operational Performance at Abarca at Abarca Health.
Where is Keyla E. Negrón Díaz based?
Keyla E. Negrón Díaz is based in Puerto Rico while working with Abarca Health.
What companies has Keyla E. Negrón Díaz worked for?
Keyla E. Negrón Díaz has worked for Abarca Health, Mmm Holdings Llc, Mc-21 Corporation, and Mapfre Puerto Rico.
Who are Keyla E. Negrón Díaz's colleagues at Abarca Health?
Keyla E. Negrón Díaz's colleagues at Abarca Health include Allison H., José Jusino Rodríguez, Julia (Julie) Sterk, Jose Abraham Laboy, and Glen Tong.
How can I contact Keyla E. Negrón Díaz?
You can use AeroLeads to view verified contact signals for Keyla E. Negrón Díaz at Abarca Health, including work email, phone, and LinkedIn data when available.
What schools did Keyla E. Negrón Díaz attend?
Keyla E. Negrón Díaz holds Master Of Business Administration (M.B.A.), Finance, General from Inter-American University Of Puerto Rico - Metropolitan Campus.
What skills is Keyla E. Negrón Díaz known for?
Keyla E. Negrón Díaz is listed with skills including Data Analysis, Ad Hoc Reporting, Queries, Hyperion Enterprise, Microsoft Excel, Cognos, Sql, and Access.
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