VICTORIA GORDON
Summary
Detail-oriented healthcare professional with expertise in claims processing and customer account management. Investigates discrepancies and coordinates corrective actions to resolve issues efficiently. Maintains HIPAA-compliant documentation and enhances member satisfaction through effective communication. Builds strong relationships with members and providers to improve service delivery and collaborates with internal teams to ensure compliance with industry standards.
Overview
10
10
years of professional experience
Work History
Claims Rep II
Trustmark Benefits
04.2025 - 08.2026
- Investigated claim discrepancies, identified processing errors, and completed appropriate adjustments to resolve issues.
- Reviewed and processed claim corrections, ensuring accuracy and compliance with company guidelines.
- Verified claim details, eligibility, and benefit information prior to processing adjustments.
- Researched claim issues and coordinated corrective actions to support timely resolution.
- Analyzed claim documentation and updated member and provider records to maintain accurate information.
Customer Success Specialist
CVS
06.2023 - 03.2025
- Conducted proactive customer outreach and follow-up communications to strengthen client relationships and engagement.
- Managed customer accounts and resolved complex inquiries involving benefits, coverage, and account services.
- Collaborated with internal departments to resolve escalated concerns efficiently and accurately.
- Maintained accurate case documentation within CRM systems to support compliance and service continuity.
Client Solutions Specialist
CareCentrix
04.2020 - 05.2023
- Communicated with patients, providers, and internal teams to support seamless service delivery.
- Supported healthcare members with scheduling, authorizations, benefits inquiries, and service coordination.
- Assisted customers with billing inquiries and service-related concerns.
- Investigated complex customer issues and escalated cases.
- Maintained HIPAA-compliant documentation and accurate customer records.
Senior Customer Support Representative
Conduent
Hybrid, TN
06.2016 - 03.2020
- Resolved complex customer concerns through research, problem-solving, and effective communication.
- Managed high-volume inbound customer interactions while delivering exceptional service.
- Assisted with escalation management and resolution of challenging customer situations.
- Coordinated with vendors and internal departments to support timely service delivery.
- Maintained detailed customer records and case documentation within CRM systems.
Education
High School Diploma -
Germantown High School
Germantown, TN05-2016
Some College - Business Administration and Management
Southern New Hampshire University
Hooksett, NHSkills
- Claims Processing
- Eligibility Verification
- Benefits & Coverage Support
- Case Management
- Appeals & Escalations
- Documentation
- Quality Assurance
- CRM Systems
- Salesforce
- SAP
- Zendesk
- Microsoft Office Suite
- SLA Awareness
- Customer Retention
- Conflict Resolution
Timeline
Claims Rep II
Trustmark Benefits
04.2025 - 08.2026
Customer Success Specialist
CVS
06.2023 - 03.2025
Client Solutions Specialist
CareCentrix
04.2020 - 05.2023
Senior Customer Support Representative
Conduent
06.2016 - 03.2020
High School Diploma -
Germantown High School
Some College - Business Administration and Management
Southern New Hampshire University