Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
Work Availability
Timeline
Hi, I’m

Pamela Wiggins-Highsmith

Somerset,NJ
Pamela Wiggins-Highsmith

Summary

Dedicated customer service and insurance professional with over 10 years of experience in healthcare support, insurance sales, claims management, insurance verification, authorizations, and benefit specialist. Proven ability to deliver high-quality service in fast-paced, high-volume call center environments. Strong communicator with a customer-first mindset, adept at remote work, and highly skilled in navigating complex systems and member concerns.

Overview

20
years of professional experience
1
Certification

Work History

Primerica
Somerset, NJ

Life Insurance Agent (Part-Time)
07.2024 - Current

Job overview

  • Advise clients on personalized life insurance plans based on needs and financial goals.
  • Manage 90+ outbound calls daily, boosting sales and client engagement.
  • Guide clients through policy selection, claims processes, and underwriting.
  • Retain clients through proactive follow-ups and personalized financial planning.

Aetna
Somerset, NJ

Member Services Representative
11.2024 - 01.2025

Job overview

  • Resolved member concerns via phone and email (30–50 inbound calls/day).
  • Handled account updates, billing questions, and plan explanations.
  • Maintained professional and empathetic communication.
  • (Reason for leaving: Layoff)

Oticon
Somerset, NJ

Medical Insurance Coordinator
06.2024 - 08.2024

Job overview

  • Responded to 50+ inquiries daily related to product and coverage issues.
  • Supported team efforts in claims processing and client education.
  • (Reason for leaving: Temporary role ended)

United Healthcare
Somerset, NJ

Care Advisor
02.2023 - 12.2023

Job overview

  • Handled 50–90 complex inbound calls per day from members with chronic health needs.
  • Advised families on caregiving solutions and implemented care plans.
  • Coordinated with healthcare professionals and verified insurance coverage.
  • (Reason for leaving: Layoff)

United Healthcare
Somerset, NJ

Senior Customer Service Advocate
07.2021 - 02.2023

Job overview

  • Managed 50–100 member/provider inquiries daily.
  • Guided users on using online platforms and resolving claims.
  • Consistently exceeded call center KPIs and customer satisfaction scores.
  • (Reason for leaving: Promoted)

Aflac
Basking Ridge, NJ

Benefits Associate
06.2020 - 03.2021

Job overview

  • Handled 70+ daily client interactions through phone, email, and fax.
  • Provided policy recommendations and processed insurance applications.
  • (Reason for leaving: COVID-related)

Mass Mutual
Edison, NJ

Licensed Agent
02.2020 - 06.2020

Job overview

  • Consulted with clients via 50–100 daily interactions to recommend life insurance options.
  • Coordinated between policyholders and underwriters.
  • (Reason for leaving: COVID-related layoff)

American Income Life
Edison, NJ

Licensed Producer Agent
05.2019 - 01.2020

Job overview

  • Conducted 100+ client consultations weekly.
  • Sold life insurance policies aligned with client goals.
  • (Reason for leaving: Better opportunity)

Aergo Solutions
Iselin, NJ

Denial Follow-up Representative
08.2018 - 03.2019

Job overview

  • Managed denial resolutions and appeals, reducing outstanding claims.
  • Took 50+ provider and insurance calls daily.
  • (Reason for leaving: Layoff)

Carrier Clinic
Belle Mead, NJ

Patient Account Representative
06.2015 - 01.2018

Job overview

  • Managed in/outpatient billing and claims follow-ups.
  • Handled 90+ accounts and calls daily for prior auths and disputes.
  • (Reason for leaving: Medical leave)

McKesson
Somerset, NJ

Reimbursement Specialist
08.2014 - 05.2015

Job overview

  • Appealed denied claims and managed A/R aging reports.
  • Provided CSR phone coverage during peak times.

JFK Medical Center
Edison, NJ

Customer Service/Call Center Representative
07.2012 - 07.2014

Job overview

  • Responded to 30+ calls daily from patients and providers.
  • Managed front desk operations, payment processing, and inquiries.

Qualicare
Piscataway, NJ

Customer Service Representative
11.2005 - 01.2011

Job overview

  • Fielded 90–120 calls daily about insurance disputes and payments.
  • Handled Medicaid/Medicare inquiries with attention to HIPAA compliance.

Education

New Brunswick Senior High School

High School Diploma

University Overview

Skills

  • Life & Health Insurance
  • Claims Resolution & Escalation
  • Customer Relationship Management
  • Remote Communication & Support
  • Medical Terminology & Billing
  • CRM & Billing Software (eg, Epic, Availity)

Certification

Licensed Life Insurance Agent, NJ

Accomplishments

Accomplishments
  • Resolved product issue through consumer testing.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Documented and resolved claim denials which led to overturned and payment received.
  • Collaborated with team of 5 in the development of SAP.
Availability
See my work availability
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Available
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tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline

Member Services Representative
Aetna
11.2024 - 01.2025
Life Insurance Agent (Part-Time)
Primerica
07.2024 - Current
Medical Insurance Coordinator
Oticon
06.2024 - 08.2024
Care Advisor
United Healthcare
02.2023 - 12.2023
Senior Customer Service Advocate
United Healthcare
07.2021 - 02.2023
Benefits Associate
Aflac
06.2020 - 03.2021
Licensed Agent
Mass Mutual
02.2020 - 06.2020
Licensed Producer Agent
American Income Life
05.2019 - 01.2020
Denial Follow-up Representative
Aergo Solutions
08.2018 - 03.2019
Patient Account Representative
Carrier Clinic
06.2015 - 01.2018
Reimbursement Specialist
McKesson
08.2014 - 05.2015
Customer Service/Call Center Representative
JFK Medical Center
07.2012 - 07.2014
Customer Service Representative
Qualicare
11.2005 - 01.2011
New Brunswick Senior High School
High School Diploma

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