Summary
Overview
Work History
Education
Skills
Summaryofqualifications
Timeline
Generic

Karen Falco

Pine Plains,New York

Summary

I am focused on obtaining a position where I can utilize my diverse business experience. Utilizing my proven leadership experience and problem-solving skills, I will help improve the customer service scores and client retention. Build relationships, help others to bring out their integrity and achieve their performance goals

Overview

15
15
years of professional experience

Work History

Broker and Employer Services

UnitedHealth Care
08.2022 - Current
  • Review and assist incoming healthcare questions from brokers and employers by navigating multiple computer systems and platforms and verifying the data/information necessary for processing (e.g., pricing, prior authorizations, applicable benefits, enrollments, renewals).
  • Ask appropriate questions, analyze, and solve customer problems while documenting required information in computer systems.
  • Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, and attendance.
  • Ability to multitask for extended periods of time, including managing calls while also navigating multiple computer systems.
  • Remain organized, focused, and productive on highly detailed, repetitive tasks.
  • Ability to de-escalate calls, listen to customer needs, and respond appropriately with compassion and empathy.
  • Ability to navigate and learn new, complex computer system applications.
  • Achievements: Excellent problem-solving skills, including the ability to independently research issues using multiple information sources.
  • Ability to balance with multitasking.
  • Call agent to ESM agent.
  • Leadership program.
  • Team Captain assisting other agents with questions they may have, conducting huddles, Mentoring team members to achieve their success
  • Substitute for a Supervise for their team when supervisors are not available, and balance my day-to-day responsibilities

Claims Representative

Sedgwick
12.2021 - 08.2022
  • Review claims, provide guidance within the claims, benefit explanations.
  • Assist client with human resource protocols, including Family Medical Leave.
  • Long-term disability, short-term disability claims.
  • Workers' Compensation Claims
  • Intake review individual cases, case by case.
  • Conducted research into medical terminology related to healthcare claims processing activities.
  • Documented changes in claim statuses using specialized software systems.
  • Collaborated with other departments to resolve billing disputes or address customer concerns quickly.

Office Manager

Bartlett McDonough & Monaghan Law firm
09.2009 - 01.2019
  • Diverse office duties, including hiring new employees, training new employees, training all employees on new computer programs, and implementing new office policies.
  • Enforce disciplinary actions.
  • Manage several locations, coordinate and supervise daily, weekly, and monthly activities of team members, including hiring.
  • Training, calibration, daily meetings, knowledge with different areas of law, including defense medical malpractice, general liability, personal injury, Workers' Compensation, Social Security, Retirement, and PBA Contracts.
  • Developed and implemented office policies and procedures.
  • Assisted with the preparation of budgets, forecasts and financial statements.
  • Supervised staff members, organized schedules and delegated tasks.

Education

High school diploma -

Rye Neck High School
Mamaroneck, NY

Skills

  • Microsoft Office
  • Pro-law
  • Word Processing
  • Excel
  • Word
  • PowerPoint
  • Medical Management
  • Social Security Disability
  • Workers Compensation Law
  • New York State Disability
  • Multiple programs within United Healthcare
  • Multitask
  • Multiple computer screens
  • Medical Billing
  • Office Management

Summaryofqualifications

High school diploma, Rye Neck High School, Mamaroneck, NY, Microsoft Office, Pro-law, Word Processing, Excel, Word, PowerPoint, Medical Management, Social Security Disability, Workers Compensation Law, New York State Disability, Multiple programs within United Healthcare, Multitask, multiple computer screens, Medical Billing, Office Management

Timeline

Broker and Employer Services

UnitedHealth Care
08.2022 - Current

Claims Representative

Sedgwick
12.2021 - 08.2022

Office Manager

Bartlett McDonough & Monaghan Law firm
09.2009 - 01.2019

High school diploma -

Rye Neck High School

Similar Profiles

CREATE PROFILE
Karen Falco