Sandra Richardson

636 Haven Place Tarpon Springs Florida - - Sandra Richardson Objective: To use my extensive experience and training in the customer service industry to further develop my career providing a stellar customer experience through education and problem solving SUMMARY OF QUALIFICATIONS Sr. Appeals Representative, February 2016-present Analyze/research/understand how a claim was processed and why it was denied Obtain relevant medical records to submit appeals or grievance for additional review Identify and obtain additional information needed to make an appropriate determination Identify contract language and processes/procedures relevant to the appeal or grievance Work with applicable business partners to obtain additional information relevant to the claim Determine whether additional appeal or grievance reviews are required Determine where specific appeals or grievances should be reviewed, and route to other departments Provider Service Representative, July 2013-January 2015 Manage caller conversations appropriately provide, command attention and respect, maintain professional tone, and de-escalate callers as needed Apply knowledge of applicable Service Level Agreements and Performance Guarantees when interacting with callers Maintain ongoing communications with callers during the resolution process to communicate status updates Maintain focus on caller interactions without being distracted by other factors Acknowledge and demonstrate empathy/sympathy with callers' life events education St. Petersburg College- Major: Associates in Science Health Information Management American InterContinental University- Major: Associate of Arts Business Administration REFERENCES Becky Glover- Harold Wires- Jeanine Sweeney -