Rose Gordon
Riverdale
Summary
Customer Service Professional dedicated to resolving issues and enhancing customer satisfaction through effective communication and problem-solving. Achieved high productivity and efficiency as Grievance Appeals Specialist by specializing in conflict resolution and regulatory compliance. Focused on delivering value through collaboration, adaptability, and maintaining high standards.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Grievance Appeals Specialist
CareSource
Atlanta
07.2025 - Current
- Reviewed grievance appeals for compliance with regulatory guidelines, ensuring adherence to standards.
- Investigated complex cases and gathered necessary documentation for resolution.
- Collaborated with cross-functional teams to resolve member issues effectively.
- Examined claims, records and procedures to grant approval of coverage.
- Processed claims for payment and coordinated with personnel for further investigation.
- Collaborated with fellow team members to manage large volume of claims.
- Maintained accurate records of grievances and appeals to support tracking and resolution.
Customer Advocate II
CareSource
Atlanta
12.2020 - 07.2025
- Resolved difficult customer situations with professionalism, achieving first-call resolution goals.
- Handled difficult customer situations with grace and professionalism, consistently meeting first-call resolution metrics.
- Listened to customers actively to assess issues and provide accurate information.
- Enhanced customer satisfaction by promptly addressing concerns and providing effective solutions.
- Addressed customer concerns promptly, leading to improved satisfaction through effective solutions.
- Researched and resolved account and service problems with friendly, knowledgeable support.
Team Coach
CareSource
01.2018 - 10.2019
- Evaluated individual skills and strengths to assign team positions that maximized talent.
- Facilitated cross-functional meetings to strengthen interdepartmental communication and align objectives.
- Analyzed trends and data to prepare informative reports.
- Evaluated individual knowledge, skills, and strengths, and assigned team positions to maximize talent areas.
- Strengthened interdepartmental communication by facilitating cross-functional meetings to align objectives and streamline workflows.
- Prepared reports by analyzing trends and data.
Customer Service Representative
Verizon
Kennesaw
06.2016 - 01.2018
- Handled multiple calls while assisting customers with needs and requests, ensuring resolution of all customer issues.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Responded to customer inquiries about products, services, and company information, enhancing customer understanding.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
Store Keeper
LSG SKYCHEFS
East Point
09.2014 - 05.2015
- Improved inventory accuracy by conducting regular stock checks and maintaining updated records.
- Received and organized product shipments in stockroom to ensure efficient access and inventory management.
- Ordered goods from various vendors to maintain store merchandise levels.
- Ordered goods from various vendors to sustain optimal store merchandise levels and prevent stockouts.
- Enhanced store organization by implementing effective storage solutions and space utilization techniques.
- Maintained safe working environment by adhering to safety protocols and guidelines, promoting employee well-being.
- Maintained safe working environment with strict adherence to safety protocols and guidelines.
Shift Supervisor
Wendy's
Hapeville
04.2007 - 05.2014
- Trained new employees and delegated daily tasks and responsibilities.
- Trained new employees and delegated tasks to enhance team efficiency.
- Responded to and resolved customer questions and concerns.
- Resolved customer complaints and provided solutions to improve customer satisfaction.
- Managed cash handling procedures, maintaining accuracy in financial transactions and minimizing discrepancies in daily reconciliations.
- Completed store opening and closing procedures and balanced tills.
- Enforced company policies and regulations to ensure compliance and operational integrity.
Education
Diploma - College Prep
Forest Park High
Forest Park, GASkills
- Claims Processing
- Insurance Verification
- Medical Terminology
- HIPAA
- Computer Skills
- Microsoft Excel
- Microsoft Word
- Management Experience
- Leadership Experience
- Customer service operations
- Customer support services
- Communication skills
Certification
- Food Handler Certification
- Serv Safe
- September 2013 to September 2018
Timeline
Grievance Appeals Specialist
CareSource
07.2025 - Current
Customer Advocate II
CareSource
12.2020 - 07.2025
Team Coach
CareSource
01.2018 - 10.2019
Customer Service Representative
Verizon
06.2016 - 01.2018
Store Keeper
LSG SKYCHEFS
09.2014 - 05.2015
Shift Supervisor
Wendy's
04.2007 - 05.2014
Diploma - College Prep
Forest Park High