Karen Reynolds
Minnetonka
Summary
Detail-oriented and solutions-driven professional with extensive experience in healthcare operations, customer service, and administrative support. Proven ability to resolve escalated issues, interpret complex policies, and drive operational accuracy and compliance. Recognized as a Subject Matter Expert (SME) with a talent for streamlining workflows and improving member outcomes. Skilled in cross-functional collaboration and guiding process improvements through adherence to SOTs, SOPs, and data-driven decision-making.
Overview
20
20
years of professional experience
Work History
Escalation Supervisor
UnitedHealth Group
Minnetonka
07.2017 - 05.2025
- Led and mentored a team supporting complex service resolution, acting as an SME for high-priority, escalated eligibility, claims, pharmacy, authorization, and coverage issues.
- Analyzed member data, eligibility trends, and process deviations to develop compliant, data-driven solutions.
- Ensured team adherence to Sources of Truth (SOT) and Standard Operating Procedures (SOPs), while authorizing exceptions when warranted.
- Conducted case audits and quality reviews to validate eligibility determinations and drive performance improvements.
- Collaborated with internal departments (claims, benefits, IT) to resolve cross-functional eligibility issues and implement streamlined workflows.
- Forecasted resource needs, managed priorities, and supported innovation in eligibility operations while maintaining high standards of service excellence.
- Communicated effectively with stakeholders, translating complex information into clear, actionable insights.
Senior Customer Support Representative II
UnitedHealth Group
Minnetonka
05.2013 - 06.2017
- Delivered a superior customer experience by addressing concerns, demonstrating empathy, and resolving problems swiftly.
- Processed claims in real-time to enhance customer satisfaction.
- Used troubleshooting resolution trees to evaluate technical issues and implement effective solutions.
- Maintained an in-depth understanding of company products to provide knowledgeable responses to customer inquiries.
- Supported customer questions and issues by gathering data, analyzing needs, evaluating resolutions, and implementing best solutions.
Provider Services Representative
UnitedHealth Group
03.2010 - 04.2013
- Assisted providers with inquiries related to policies, billing, referrals, and eligibility.
- Resolved provider and member complaints, ensuring timely resolution.
- Conducted research to provide accurate responses to provider questions.
- Trained providers on policies, procedures, and billing practices.
- Maintained provider records and ensured compliance with contractual obligations.
- Coordinated with other departments to enhance provider services.
- Addressed provider concerns and negotiated contracts when necessary.
Customer Service Representative
[Company Name]
04.2006 - 02.2010
- Managed incoming calls, emails, and chats to support customer inquiries.
- Addressed customer questions, concerns, and complaints professionally.
- Provided information about products, services, and company policies.
- Processed orders, returns, and payments efficiently.
- Troubleshot issues and escalated complex problems when necessary.
- Maintained accurate records of customer interactions.
- Collaborated with other departments to improve customer experiences.
- Ensured a positive and empathetic approach to customer interactions.
Administrative Support
Charles A. Tindley School
12.2004 - 07.2005
- Updated job knowledge by participating in educational opportunities, reading professional publications, and maintaining personal networks.
- Supported organizational goals by accepting ownership of new and different requests and exploring opportunities to add value.
Education
High School Diploma -
Riverview Gardens Senior High School
Skills
- Cross-Functional Team Collaboration
- Policy Interpretation & Regulatory Compliance
- Root Cause Analysis & Problem Solving
- Member Services & Escalation Resolution
- Team Leadership & Performance Coaching
- Workflow Optimization & Resource Planning
- Excellent Written & Verbal Communication
Timeline
Escalation Supervisor
UnitedHealth Group
07.2017 - 05.2025
Senior Customer Support Representative II
UnitedHealth Group
05.2013 - 06.2017
Provider Services Representative
UnitedHealth Group
03.2010 - 04.2013
Customer Service Representative
[Company Name]
04.2006 - 02.2010
Administrative Support
Charles A. Tindley School
12.2004 - 07.2005
High School Diploma -
Riverview Gardens Senior High School
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