Phillana Gordon-Garcia
Mebane,NC
Summary
With over 24 years of experience as a licensed insurance professional, consistently delivering the highest level of professionalism, excellence, and resourcefulness to company executives and government agency clients. Account Manager/Benefits Consultant at the James Group, successfully managing a book of business consisting of 36 to 40 groups. Excelled as a Sales Account Representative (SAR) at Anthem Blue Cross Blue Shield, overseeing a book of business with 186 groups in the 50-250 segment. Played a key role at UnitedHealth Group in training a team of field account managers responsible for managing one of United Healthcare Inc.'s largest clients, boasting over 508,000 members at its peak. Dedication lies in creating an environment where team members actively support and hold each other accountable for growth and success.
Overview
28
28
years of professional experience
Work History
Benefits Consultant
Alight Solutions
09.2024 - Current
- Partnered with payroll departments to ensure accurate processing of deductions related to employee benefit elections.
- Managed open enrollment periods, ensuring timely communication of benefit updates and assisting employees with their selections.
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
Benefits Advisor
American Family Life Assurance Company (Aflac)
02.2024 - Current
- Company Overview: Aflac is a supplemental benefits company specializing in supplemental plans for groups and individual plans
- As a Benefits Advisor the primary functions includes, assisting clients in understanding their benefits packages, helping them navigate the enrollment processes, providing guidance on coverage options, and resolving any issues or concerns related to their benefits
- I also educate clients on changes to their benefits and help them make informed decisions about their coverage
- Aflac is a supplemental benefits company specializing in supplemental plans for groups and individual plans
Account Manager/Benefits Consultant (Hybrid)
Adams Keegan the James group LLC Brokerage Firm
01.2023 - 07.2023
- As an account manager/benefits consultant, I worked closely with the benefits consultant/account executive to build plans to present to the group; this process is called spreadsheeting, in which we utilize Excel to show a side-by-side comparison of what each carrier is offering so the group can make a firm decision on which plan to select
- As a benefits consultant, I managed a book of business with about 36-40 groups
- I was responsible for building relationships with the group and the different carriers
- I worked as a liaison between the group and the insurance carriers to identify and resolve various issues the group may have, such as billing/claims, eligibility, appeals, plan changes, and much more
Account Manager/Customer Care Representative
Adams Keegan the James group LLC Brokerage Firm
03.2022 - 01.2023
- As a customer care representative, I work as a subject matter expert (SME), assisting groups and members with eligibility, medical claim, provider search, prescription search, prior approvals, and appeals
- Assists the Account managers and Benefit consultants with spreadsheeting of plans from all major carriers to show the different renewal options available to the group upon renewal
- I also ensure all sold and renewed group paperwork is collected and in the database so the group can be adequately closed out for the next renewal year
Sales Account Representative/Account Management
Anthem Blue Cross Blue Shield of Georgia
06.2017 - 02.2022
- As a SAR (Sales Account Representative) I was responsible for a book of business containing 186 groups
- I also supported the Account Management team in the retention of business
- Conducted meetings with group employees who have a choice of carriers and promoted, sold, persuaded, and influenced associates to enroll in Anthem's products
- The typical group size was 50-250
- Played a major role in the renewal process, ensuring that groups were enrolled in the correct plan, and plan documents were accurate
- In addition, ensured ID cards are delivered to the members in a timely manner
- For fully insured groups with wellness incentives tied into their benefits, I conducted wellness meetings with the broker, group, and members if requested by the group
Independent Agent
Healthmarkets Insurance Agency
11.2015 - 01.2017
- As an independent agent, I sold various lines of individual and family insurance products
- Using my knowledge of all ACA plans along with supplemental insurance to cover the members' unforeseen bills, I then serve as each client's primary point of contact to resolve any issues
- These lines of products include: Life, Health, Vision, Dental, Supplemental Products, Discount Programs, Annuities, and Indemnity Products
Benefit Specialist/Independent Agent
United Healthcare Inc. (UHC)
01.2014 - 01.2015
- Working along with UHC Service Account Management Team and State Representatives during the open enrollment period to ensure that members of the State Health Benefit Plan (SHBP) know about their benefits, premiums and plan options and receive prompt answers to questions or inquiries
- This position required and obtaining state insurance licenses as a Resident Agent for Life, Accident & Sickness
United Healthcare Dedicated Client Service Manager (DCSM)
United Healthcare Inc. (UHC)
01.2014 - 12.2014
- As a DCSM I assisted customers, brokers and members with Appeals, Pre-Determinations, Notifications, Gap Exceptions, Benefit questions, (post-installation), Billing, Claims, Eligibility, eService Access, ID Cards, Customer reinstatements, Member/subscriber terminations and adds outside of the renewal date, Missing member package of admin kits, Pharmacy Issues, Plan changes, Platform Conversion issues outside of the renewal Provider directories and System feed issues
Field Account Manager for the State of Georgia
United Healthcare Inc. (UHC)
01.2011 - 12.2014
- This position required working on site at the state of Georgia Department of Community Health (GDCH)
- I served as a liaison between UHC and the Governor's office, maintaining a close relationship with GDCH and UHC
- Some of the responsibilities of this position were to: Trained new account managers and team members
- Identified root causes to issues and resolve them
- Implemented new plan designs after Requests for Application (RFA's)
- Created new policies and procedures
- Created tracking systems using Excel, Access, and SharePoint
- Set up timelines for projects and ongoing issues
- Conducted Open Enrollment Meetings throughout the State, and other events geared towards educating members
- Attended Provider educational meetings throughout the state Georgia
- Answered DOI complaints from Georgia Insurance Commissioner's office
Key Accounts Service Consultant for the state of Georgia
United Healthcare Inc. (UHC)
01.2005 - 12.2011
- This position required working on site at the state of Georgia Department of Community Health (GDCH) to serve as a liaison between UHC and the GDCH
- This position required that I be proficient in UHC internal systems (e.g
- ISET, Behavioral Analytics, CES, GPS, Medco, UNET/TOPS, NDB, COSMOS, GPS/MA, eService's, Share Point sites, EDSS, ETSBE, IBAAG, KL, and Health Insight)
- Some of the responsibilities: Identify root cause of claims and eligibility issues for commercial and Medicare Advantage members
- Provide expert telephonic benefit consultation and relationship building with customer
- Conduct Open Enrollment Meetings throughout the State, and other events geared towards educating members
- Create tracking systems using Excel for the SAM team on projects that include retro claims reports, recorded calls and mailings
Administrative Assistant (UHC of Florida)
United Healthcare Inc. (UHC)
01.2003 - 12.2004
- This was a fast-paced work environment, that supported two executives and four account managers in the sales department
- The position required an advanced level of proficiency with MS Windows, Excel, and Power Point
- Some of the responsibilities of this position were to: Compile presentations for sales meetings, and renewal of existing accounts
- Manage calendars, answer phones, and perform other administrative duties
- Process expense reports
- Process e-mail, mail, and faxes
Sales Support Coordinator (UHC of Florida)
United Healthcare Inc. (UHC)
01.2000 - 12.2003
- As an administrator over third-party vendor for 3,500+ small business group plans per month, some of my functions were as follows: Process Commercial Small Group business renewals
- Support the needs of Small Group Members
- Report to Management daily with activity reports
- Generate, develop, and maintain spreadsheets
- Complete high volume data entry in timely manner
- Constantly follow up with incoming e-mails to ensure proper communication and function
- Ensure prompt mailing of documentation prior to deadline
PIP Adjuster
JHJ Holding Insurance Company/ Ocean Harbor
01.1998 - 12.2000
- Personal Injury Protection (PIP) Adjusters; Responsibilities of this position were to: Investigate policy holder claims
- Conduct interviews, collect evidence, and consult with experts
- Contact claimants upon conclusion of the investigation
- Review the claim's details: the amount, nature, and basis.
Identify potential weaknesses or uncertainties in the claim that could reduce its perceived value. - Directed claims negotiations within allowable limit of $10K and supported successful litigations for advanced issues.
PIP Claims Processor
JHJ Holding Insurance Company/ Ocean Harbor
01.1997 - 12.1998
- Assisted over ten (10) PIP Adjusters with their assigned inventory
- Provide customer service via telephone
- Generate reports, correspondence, and spreadsheets for the Personal Injury Protection Department and Special Investigative Unit
- Complete high volume of data entry in a timely manner
Education
Bachelor of Science - Business Administration And Management
University of Phoenix
4035 S Riverpoint Pkwy, Phoenix, AZ 8504005.2017
All Lines Adjuster License - All Lines Adjuster
Gold Coast School of Insurance
5600 Hiatus Rd, Tamarac, FL 3332111-1998
LPN - Licensed Practical Nurse(LPN)
Sheridan Technical College
5400 Sheridan St, Hollywood, FL 3302101-1997
High School Diploma - with emphasis on office technology
Miramar High
3601 SW 89th Ave, Miramar, FL 3302506-1996
Skills
- Proficient in Windows Suite
- Microsoft Excel proficiency
- PowerPoint
- SharePoint
- Presentation skills
- HIPPA certifications
- Client service
- Detail-oriented
- Organizational skills
- Independent work
- Fast paced environment
- High-pressure environment
- Time management
- Client counseling
- Clear communication
- Benefits administration
- Data analytics
- Vendor relationship management
- Benefits strategy development
- Employee benefits expertise
- Healthcare plan design
- Verbal and written communication
- New employee enrollment
- Benefits explanation
- Documentation and reporting
- FMLA comprehension
- Payroll coordination
- Employee benefits laws
- ADP workforce now
- Human resources management
- Benefits interpretation
- Open enrollment
- Teamwork and collaboration
- Multitasking
- Reliability
- Critical thinking
- Adaptability and flexibility
Timeline
Benefits Consultant
Alight Solutions
09.2024 - Current
Benefits Advisor
American Family Life Assurance Company (Aflac)
02.2024 - Current
Account Manager/Benefits Consultant (Hybrid)
Adams Keegan the James group LLC Brokerage Firm
01.2023 - 07.2023
Account Manager/Customer Care Representative
Adams Keegan the James group LLC Brokerage Firm
03.2022 - 01.2023
Sales Account Representative/Account Management
Anthem Blue Cross Blue Shield of Georgia
06.2017 - 02.2022
Independent Agent
Healthmarkets Insurance Agency
11.2015 - 01.2017
Benefit Specialist/Independent Agent
United Healthcare Inc. (UHC)
01.2014 - 01.2015
United Healthcare Dedicated Client Service Manager (DCSM)
United Healthcare Inc. (UHC)
01.2014 - 12.2014
Field Account Manager for the State of Georgia
United Healthcare Inc. (UHC)
01.2011 - 12.2014
Key Accounts Service Consultant for the state of Georgia
United Healthcare Inc. (UHC)
01.2005 - 12.2011
Administrative Assistant (UHC of Florida)
United Healthcare Inc. (UHC)
01.2003 - 12.2004
Sales Support Coordinator (UHC of Florida)
United Healthcare Inc. (UHC)
01.2000 - 12.2003
PIP Adjuster
JHJ Holding Insurance Company/ Ocean Harbor
01.1998 - 12.2000
PIP Claims Processor
JHJ Holding Insurance Company/ Ocean Harbor
01.1997 - 12.1998
Bachelor of Science - Business Administration And Management
University of Phoenix
All Lines Adjuster License - All Lines Adjuster
Gold Coast School of Insurance
LPN - Licensed Practical Nurse(LPN)
Sheridan Technical College
High School Diploma - with emphasis on office technology
Miramar High
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