Karli Fallos
Wayne,ME
Summary
Strategic operations leader with extensive experience in enhancing member and care operations. Proven track record in team leadership, contract negotiation, and strategic initiative execution. Skilled in fostering high-performance cultures and driving sustainable growth. Adept at optimizing workflows and implementing cost-saving solutions.
Overview
15
15
years of professional experience
Work History
VP, Member and Care Operations
Brightline
05.2023 - Current
- Led a diverse team to complete major operational projects, increasing efficiency and member satisfaction.
- Directed service line operations, collaborating with executive leadership to establish strategic goals.
- Negotiated and managed high-value contracts, enhancing organizational profitability and minimizing risk.
- Achieved delegated credentialing status with major health plans, ensuring compliance with regulatory standards.
- Spearheaded the launch of a government-sponsored mental health program, expanding access to pediatric care.
- Exceeded 8 Member Support service metrics month over month (including average speed to answer, abandonment rate, response time to calls, chats, voicemail, and email).
- Average quality score of 97% for member support team with a comprehensive quality program and high bar for member satisfaction.
- Demonstrated proficient leadership skills to motivate employees and build competent teams, driving engagement scores from 33% favorable in August 2023 (post RIF) to 94% favorable in June 2024
- Established a culture of continuous improvement, fostering innovation and driving sustainable growth across the organization to minimize attrition rates (~2% annual attrition).
Senior Director, Member Support
Brightline
09.2022 - 05.2023
- Directed design and execution of business transformation initiatives to drive performance, profit optimization and growth opportunities.
- Fostered work culture of collaboration and inclusion to increase morale and reduce turnover.
- Set gold-standard for member satisfaction and service levels to exceed industry standards.
- Exceeded 8 defined call center metrics, month over month, for 3 consecutive years.
- Introduced and staffed to multiple shifts to maximize availability to member demographic.
- Launched multilingual member support specialist workflows, and hired/trained Spanish speaking representatives to support high priority contracts.
Director, Member Support
Brightline
06.2021 - 05.2023
- Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
- Introduced promotional pathways to increase morale and retention.
- Created framework of Member Support metrics to hold team accountable and provide insight to performance.
- Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
- Vetted, interviewed and hired 12 Member Support Specialists and 1 member Support Manager over 3 week time span to cover evolving coverage needs though 50 state therapy expansion.
Senior Manager, Member Care
Grand Rounds
08.2019 - 06.2021
- Provided strong leadership to enhance team productivity and morale.
- Led cross-functional teams to achieve project milestones and deliver high-quality results.
- Grew team from 30 to over 300 Care Coordinators
Care Coordination Manager
Grand Rounds
05.2018 - 08.2019
- Acted as liaison between coordination team and other departments within organization, ensuring seamless communication and collaboration on all projects.
- Optimized workflow processes by regularly reviewing current procedures and making adjustments as needed for maximum efficiency.
Senior Supervisor of Customer Satisfaction
L.L. Bean
08.2014 - 05.2018
- Recruited, hired and trained staff and provided ongoing feedback and performance evaluations for development.
- Enhanced team productivity by implementing efficient workflow processes and providing consistent guidance.
- Implemented cost-saving initiatives, reducing operational expenses without compromising quality or productivity.
Contact Center Team Manager
TD Bank, NA
06.2010 - 08.2014
- Led employee relations through effective communication, coaching, training, and development.
- Developed high-performing team by recruiting top talent, providing ongoing training, and fostering a positive work environment.
Education
Bachelors of Science - Marketing
Roger Williams University
Bristol, RI05.2005
Skills
- Operational Optimization
- Cross-Functional Team Leadership
- Strategic Initiative Development
- Workflow Efficiency
- Multilingual Support Implementation
- Verbal and written communication
- Member and Client Satisfaction (15 years)
- Operations Management (7 years)
- Team Management (15 years)
- Creativity and Innovation
- Budget Management
- Contract and Vendor Management
- Hiring and Retention
- Charismatic Leader
- Project Management
- Strategies and goals
- Experienced in: Google Suite, Microsoft Suite, Mode, Tableau, Lookr, Acuity, Zendesk, Dialpad, Salesforce, Workday, Healthie, Notion, Guru, Greenhouse, Rippling, Airbase
Timeline
VP, Member and Care Operations
Brightline
05.2023 - Current
Senior Director, Member Support
Brightline
09.2022 - 05.2023
Director, Member Support
Brightline
06.2021 - 05.2023
Senior Manager, Member Care
Grand Rounds
08.2019 - 06.2021
Care Coordination Manager
Grand Rounds
05.2018 - 08.2019
Senior Supervisor of Customer Satisfaction
L.L. Bean
08.2014 - 05.2018
Contact Center Team Manager
TD Bank, NA
06.2010 - 08.2014
Bachelors of Science - Marketing
Roger Williams University
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