DEMETRIA P-FALU
Albany,NY
Summary
Customer-focused individual with a positive, can do attitude who is driven to learn, improve and succeed. Quality-oriented and proactive in resolving issues with exceptional organizational and communication skills. Business-minded with exemplary skills in time management and service coordination. Bringing over 25 years of related experience combined with superior communication abilities.
Overview
32
32
years of professional experience
Work History
Senior Workers' Compensation Claims Examiner
NYS Workers Compensation Board
Schenectady, NY
04.2019 - Current
- Must timely and accurately maintain up-to-date screening/triaging of cases and work queues and complete all cases in timely manner in accordance with goals and guidelines of Administrative Review Division. Timely, accurately and appropriately issue TFLs to parties in accordance with ARD examining procedures. Must assist Associate Attorney in auditing and maintaining of Team's work queues.
- Must file and mail all approved MODs in timely and accurate manner in accordance with directives of Director or Deputy Director. Must summarize all Data Capture in accurate and timely manner.
- Must timely and accurately perform special assignments/projects.
- Monitor and respond to requests for audio files for Board hearing minutes, from parties.
Front End Supervisor/Pricing Signage Coordinator
Price Chopper
Albany , NY
04.2013 - Current
- Respond to customer concerns with friendly and knowledgeable service.
- Assign work to team members based on company needs, personal strengths and job knowledge.
- Create and maintain cash reports at end of each shift.
- Coached employees and trained on methods for handling various aspects of sales, complicated issues and difficult customers.
- Strengthened merchandising and promotional strategies to drive customer engagement and boost sales.
- Controlled shrinkage through successful inventory management and stock rotation strategies.
- Created printed marketing materials designed to drive campaigns.
- Monitored and replenished display inventory and restructured according to available stock.
- Created interior displays to promote products in alignment with corporate sales objectives.
- Supervised team of up 20 merchandising employees and monitored adherence to company standards.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
Workers Compensation Examiner
NYS Workers Compensation Board
Schenectady, NY
11.2015 - 04.2019
- Prepared proposed administrative decisions regarding claim
- Reviewed requests for appeal of decision, reopened inactive or closed claims to resolve new issues, requested meetings or hearings, ensured that claims case is ready for judges.
- Responded to questions and provided information on appeal procedures to claimants, employers, insurance carriers and attorneys.
- Process Incoming Mail Daily
- Utilized knowledge of WCB laws to process Abeyances
- Promptly process case referrals received and insures that cases are referred appropriately by reading referral reasons and case notes.
- Reviewed pending case work request to determine to see if request needs follow up action this include FROI/SROI.
Assistant Workers Compensation Examiner
NYS Workers Compensation
Albany, NY
01.2012 - 01.2015
- Supported claims processing, adjudication, and monitoring of compliance by parties of interest.
- Analyzed employers reports of injury, medical reports from physicians and health care providers, calculate benefits due, manage claimants cases and prepare information for adjudication.
- Monitored compliance by employers, medical practitioners, insurance carriers and other parties of interest.
Customer Service Representative/Underwriter
Wellpoint
Albany, NY
01.2010 - 01.2012
- Used applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
- Processed eligibility for CHP/ Medicaid program.
- Trained individuals in completing applications for CHP/Medicaid program.
- Assisted Facilitated Enroller's in completing application for the CHP/Medicaid program.
- Provided primary customer support to internal and external customers.
- Recorded account information to open new customer accounts.
Co-manager
Easy Spirit Shoes
Albany, NY
11.2008 - 02.2011
- Managed the day-to-day tactical and long-term strategic activities within the business.
- Maximized company revenue.
- Conducted cost, schedule, contract performance, variance and risk analysis.
- Made hiring recommendations to increase company's productivity and profitability with quality workers.
- Coached sales associates in product specifications, sales incentives and selling techniques, significantly increasing customer satisfaction ratings.
- Set effective store schedules based on forecasted customer levels, individual employee knowledge and service requirements.
- Managed inventory control, cash control and store opening and closing procedures.
Child Support Enforcement Specialist
ACS/NYS Child Support
Albany, NY
11.2008 - 12.2010
- Reviewed, analyzed, and communicated with local district child support enforcement operations.
- Answered questions on payments for custodial/non custodial parents
- Actively listened to customers' requests, confirming full understanding before addressing concerns.
- Performed case management tasks to enforce court-ordered child support obligations.
- Explained policies, procedures and instructions to parents.
- Calculated child support obligations and debts to initiate collection actions.
Customer Service Agent/ Claims Examiner
Aetna
Albany, NY
01.2001 - 01.2008
- Coached and mentor staff members by offering constructive feedback and taking interest in their long-term career growth.
- Assisted providers with credentials and re - credentials issues.
- Answered questions and resolves issues based on phone calls/letters from members, providers, and plan sponsor.
- Handled pre-authorization or post-payment review of requested health care services.
- Processed claims for pricing, new claim handoffs, complaints (member/provider), grievance and appeals.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
Education
Associate of Science - Medical Assistant Business Management
Mildred Elley
2000
Skills
- Deadline-oriented
- Focused on customer satisfaction
- Professional demeanor
- Conflict resolution
- Customer satisfaction
- Team leadership
Accomplishments
- Collaborated with team of one in the development of Reach One Reach Millions which is an online program for teens to reach out and discuss issues dealing with stress and anxiety.
- Currently in the process of getting certified to become a Life and Health Fitness Coach with Health Coach Institute
- Conflict Resolution - Was selected to train others in conflict resolution when handling difficult customers and providing information to ensure resolution of product/service complaints and customer satisfaction.
Timeline
Senior Workers' Compensation Claims Examiner
NYS Workers Compensation Board
04.2019 - Current
Workers Compensation Examiner
NYS Workers Compensation Board
11.2015 - 04.2019
Front End Supervisor/Pricing Signage Coordinator
Price Chopper
04.2013 - Current
Assistant Workers Compensation Examiner
NYS Workers Compensation
01.2012 - 01.2015
Customer Service Representative/Underwriter
Wellpoint
01.2010 - 01.2012
Child Support Enforcement Specialist
ACS/NYS Child Support
11.2008 - 12.2010
Co-manager
Easy Spirit Shoes
11.2008 - 02.2011
Customer Service Agent/ Claims Examiner
Aetna
01.2001 - 01.2008
Associate of Science - Medical Assistant Business Management
Mildred Elley
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