Sandra Gordon

Objective       Summery	To apply extensive Customer Service and claims processing experience in a challenging, creative, stable environment. The desired position will utilize strong organizational and communication skills as well as an aptitude for interpersonal relations. CLIENT RELATIONS PROFESSIONAL                                    A client relations professional with expertise in multi-market relations, HMO, PPO, grievances and appeals, and HCFA guidelines. A team player, possessing strong research, problem solving, decision making, and communication skills. Volunteer to take responsibility, and mentor others. Works well with diversity, and enjoys challenging tasks. Committed to going above and beyond specific duties.
Experience	1989 2002 HUMANA HEALTH PLANS OF FLORIDA Client Relations ·    Promoted through the ranks of a high volume call center where responsibilities included resolving issues for Doctors and insured members. ·    Collaborated with members and market offices to resolve market-to-market transfers. ·    Facilitated changes for members including, primary care providers, address changes, and power of attorney documentation. ·    Responded to written member correspondence, and screened grievances and appeals. ·    Functioned as web specialist for members, agents and providers. ·    Performed multi-market functions and claims processing. ·    Resolved provider relations and contracting issues. ·    Liaison with members and primary care providers       and market relations. ·    Resolved over 1,500 appeals/grievances per month. ·    Met HCFA compliance guidelines and avoided penalties and fines. ·    Continuously exceeded performance expectations for payment, processing, and financial accuracy. ·    Researched and responded to all member and provider email inquiries and requests within 48 hours. ·    Consistently recognized by management for taking initiative to identify and address problems, identifying better solutions, and personal commitment to go above and beyond specific duties.
	PROFESSIONAL DEVELOPMENT ·    Mainframe Claims Processing ·    Researched and gained knowledge on PPO, HMO, POS, and Indemnity plans to accurately interpret coverage for members.
	COMPUTER TRAINING ·    Microsoft Word ·    Intranet ·    Internet AWARDS ·    Customer Service of the Month
	·    Received awards in recognition of excellence in customer service and  claims processing   References Available Upon Request