Summary
Overview
Work History
Education
Timeline
Generic

Holly Gordon

Chicago,Illinois

Summary

Dependable and hardworking Professional with over 25 years experience in the Health Insurance Industry. An unwavering commitment to providing exceptional, quality service. Excellent customer service skills, outstanding problem solving, trouble shooting, multi-tasking, active listening skills along with the ability to diffuse difficult situations.

Overview

20
20
years of professional experience

Work History

Health Concierge

CVS Caremark
01.2023 - 01.2024
  • Enhanced patient satisfaction by providing personalized assistance and addressing their healthcare needs promptly.
  • Handled more than 60 daily inbound calls from health plan customers.
  • Resolved problems related to benefits, eligibility and claims.
  • Helped members navigate enrollment process and choose appropriate options.
  • Managed sensitive information with discretion, maintaining strict confidentiality in accordance with HIPAA regulations.

Patient Account Representative II

Change Healthcare
03.2022 - 10.2022
  • Provided exceptional customer service, handling sensitive patient situations with professionalism and empathy.
  • Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
  • Worked with outside entities to resolve issues with billing, claims and payments.
  • Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
  • Researched billing errors and discrepancies to initiate corrective action.
  • Processed debtor payments and updated accounts to reflect new balance.
  • Maintained accurate records of customer accounts, payments and payment plans.
  • Worked with customer to create debt repayment plan based on current financial condition.

Customer Service Representative

Alight Solutions
05.2021 - 11.2021
  • Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Handled customer inquiries and suggestions courteously and professionally.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Updated account information to maintain customer records.
  • Participated in team meetings and training sessions to stay informed about product updates and changes.

Customer Service Representative

Allied Benefit Systems
09.2017 - 04.2021
  • Interact with plan members and providers to answer questions and provide information in response to inquiries regarding employee benefit plan, eligibility, claim issues, appeal and medical review status.
  • Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
  • Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Handled escalated calls efficiently, finding satisfactory resolutions for both customers and company alike.
  • Participated in team meetings and training sessions to stay informed about product updates and changes.
  • Provided primary customer support to internal and external customers.

Claims Specialist

Family Health Network
11.2016 - 09.2017
  • Administered Medicare and Illinois Medicaid claims payments
  • Ensured claims processing was within time guidelines and in accordance with plan provisions and State provisions.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Checked documentation for accuracy and validity on updated systems.
  • Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.

Call Center Supervisor

Alta Staffing Agency
03.2016 - 10.2016
  • Responsible for organizing and directing day-to-day activities relating to call center operations.
  • Enhanced team performance with consistent coaching, feedback, and development opportunities.
  • Improved customer satisfaction by effectively resolving escalated issues and providing timely support.
  • Streamlined call center operations for increased efficiency by implementing new scheduling and workforce management strategies.

Appeals and Grievance Associate

Cigna HealthSpring
10.2013 - 03.2016
  • Reviewed and responded to complaints received from IL Medicare-Medicaid members and providers in Appeal form as required by State.
  • Appeals were processed in accordance with guidelines established by Centers for Medicare and Medicaid (CMS) and State of Illinois or guidelines set forth by other regulatory agencies where applicable.
  • Helped team meet regulatory requirements by coordinating documentation and filings.
  • Analyzed and interpreted patterns and trends.

Member Advocate Ll/HR Specialist

Aon Hewitt
03.2004 - 09.2013
  • Assisted participants navigate through their health care system when other means have failed.
  • Enhanced member satisfaction by promptly addressing concerns and providing timely resolutions.
  • Improved response times by optimizing workflow processes within Member Advocate role.
  • Maintained detailed records of all interactions, allowing for easy reference and improved follow-up on outstanding matters.
  • Participated in regular team meetings, sharing insights gained from daily interactions with members to benefit overall operations.
  • Managed escalated cases effectively, working closely with supervisors to ensure successful outcomes for all parties involved.
  • Leveraged strong problem-solving skills to address complex member issues efficiently and effectively.
  • Managed high-volume workload within deadline driven environment.
  • Consistently met or exceeded performance metrics related to response times, issue resolution rates, and overall customer satisfaction scores.

Education

Some College (No Degree) - Health Administration

Oakton Community College
Skokie, IL

High School Diploma -

Evanston Township High School
Evanston, IL
06.1980

Timeline

Health Concierge

CVS Caremark
01.2023 - 01.2024

Patient Account Representative II

Change Healthcare
03.2022 - 10.2022

Customer Service Representative

Alight Solutions
05.2021 - 11.2021

Customer Service Representative

Allied Benefit Systems
09.2017 - 04.2021

Claims Specialist

Family Health Network
11.2016 - 09.2017

Call Center Supervisor

Alta Staffing Agency
03.2016 - 10.2016

Appeals and Grievance Associate

Cigna HealthSpring
10.2013 - 03.2016

Member Advocate Ll/HR Specialist

Aon Hewitt
03.2004 - 09.2013

Some College (No Degree) - Health Administration

Oakton Community College

High School Diploma -

Evanston Township High School

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