Claim Specialist
Erin Wildermuth
State Farm
Granville,Ohio
17
years of professional experience
Claim Specialist investigating, evaluating, and settling complex claims with a focus on fair, prompt case resolution and reduced loss ratio. Applies technical judgment and human relations skills to verify claim data, confirm settlement validity, and handle escalated complaints with timely outcomes. Mentors Claim Specialists and Claim Associates to strengthen file quality and service standards.
Work History
Claim Specialist
9 Years 6 Months- Handle 15-20 claims weekly while balancing investigation, evaluation, and settlement priorities.
- Verify and analyze claim data to confirm validity and settlement alignment with company procedures.
- Resolve complex, severe exposure claims using a high-service approach to file handling.
- Mentor Claim Specialists and Claim Associates to reinforce claim handling standards and professional judgment.
RN Case Manager / Management
4 Years 7 Months- Supervised 15 staff members, assigned caseloads, and conducted employee performance reviews.
- Reviewed 50-75 case files weekly to prioritize assignments and track follow-up across active caseloads.
- Oversaw care coordination to support safe, timely, effective, efficient, equitable, and client-centered care.
- Drafted service plans, reviewed case progress, and determined appropriate case closure based on client needs.
- Advocated for patients and supported informed decisions about clinical status and treatment options.
- Collaborated with the medical team throughout case management to align care decisions and resolve issues.
- Arranged care with social services, health care providers, and governmental agencies to support client access.
Surrogate Case Manager
7 Years 4 Months- Supported surrogate and intended parent relationships by answering questions, resolving issues, and maintaining clear communication throughout the process.
- Handled bill payment, accounting details, and travel planning for surrogates and intended parents with careful follow-through.
- Received and scanned medical records for all surrogates in the database, keeping documents organized and accessible.
Staff Registered Nurse ICU and Hospice
3 Years 8 Months- maintaining patient charts
- administering medications on time
- maintaining proper timing for checking the patient
- monitoring the health and diet of the patient
- providing nursing care and supporting the Doctors
- administering injections to patients
- helping patients before and after an examination or test
- ensuring hygiene standards are maintained
- checking patients during rounds, and updating patient charts periodically.
Education
Master of Arts - Psychology
Bachelor of Science - Healthcare Administration/Business
Associate of Applied Science - Nursing
Skills
Claims investigation
Claims evaluation
Settlement negotiation
Case management
Care coordination
Patient advocacy
Team supervision
Coaching and mentoring
Performance reviews
Documentation review
Policy compliance
Complaint resolution
Timeline
Claim Specialist
State Farm
05.2017 - CurrentRead More
RN Case Manager / Management
Aetna Healthcare
10.2012 - 05.2017Read More
Surrogate Case Manager
Fertility Bridges
01.2010 - 05.2017Read More
Staff Registered Nurse ICU and Hospice
Genesis Healthcare
06.2009 - 02.2013Read More
Ohio University
Associate of Applied Science from Nursing
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Ohio University
Bachelor of Science from Healthcare Administration/Business
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Walden University
Master of Arts from Psychology
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