Nicki Wilson
Whitehall,NY
Summary
Organized and highly motivated Claims Adjuster proactive in obtaining pertinent information on each loss to resolve cases effectively and efficiently. Experience in evaluating and working towards improving given standards of work. Proven track record of consistently exceeding department metrics to achieve maximum efficiency in each department I enter within the Enterprise.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Claim Adjuster II
AFICS
Remote, NY
10.2022 - Current
- Prepared detailed summaries outlining findings from investigations conducted into customer losses.
- Investigated discrepancies between submitted invoices and payments received.
- Informed customers of their rights regarding payment claims.
- Consistently exceeded weekly performance metrics related to payment claims processing times.
- Monitored progress of pending cases and ensured deadlines were met as required by law.
- Participated in training sessions related to new policies or procedures.
- Demonstrated excellent communication skills when interacting with customers.
Claims Care Center Rep 1
American Family Insurance Company, Customer Care Center
Madison, WI
11.2021 - 10.2022
- Consistently offers exceptional customer service to internal/external customers and business partners.
- Skilled in gathering and documenting important details related to FNOL for Auto and Property claims at the Enterprise level.
- Demonstrated ability to review and apply coverage, assign services, interpret estimates and adjuster notes.
- Demonstrated ability to identify problems and find solutions during crisis calls using standard procedures to make sound decisions.
- Completion of FNOL and cross-functional responsibilities with multiple lines of business across the enterprise.
- Participated in required trainings to enhance understanding of obtaining necessary claim loss detail for companies across our enterprise.
- Expertise in handling inbound and outbound call interactions.
- Demonstrated efficiency in problem solving and working autonomously.
- Effectively utilizes claim systems and other applications necessary to complete job tasks proficiently.
- Understands and complies with confidentiality regulations in handling customer information.
Volunteer Community Service Project Coordinator
Out of The Box Ministries
Whitehall, NY
06.2019 - 10.2021
- Greeted all visitors warmly, initiating introductions of staff and guests to our "Free Store".
- Assisted in the planning, execution, and oversight of community events to meet the financial and physical needs within our community.
- Networked and collaborated with other local community agencies/partners to assist in our goals of assisting those in our community who had need of additional assistance.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our events and services.
- Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Demonstrated self-reliance by meeting and exceeding workflow needs.
- Oversaw routine in-store activities and special holiday events for community members throughout the Washington County, NY area.
Personal Assistant
Alzheimer's and Dementia Caregiver Initiative
Whitehall, Granville, Putnam, NY
08.2017 - 10.2021
- Experience in providing compassionate care to clients both familial and friend of various ability levels and diagnoses including Traumatic Brain Injury, Senior Care, Parkinson’s, Dementia, and more.
- Experience in assisting clients with ADLs, medication management, crisis intervention, and physical/occupational therapy.
- Successfully Completed Requirements for Adult CPR/AED through the American Red Cross.
Billing Specialist
Jiem Rozell Excavation LLC, Plowing, Salting Services
Whitehall, NY
10.2019 - 02.2020
- Demonstrated excellent interpersonal and communication skills making and receiving calls and emails from home office to follow-up with clients and/or resolve any issues related to the accounts.
- Experience navigating through State and Federal government agency programs both through phone calls and email correspondence regarding accessibility to their systems, unpaid claims/invoices, payment discrepancies, and compliance with applicable contract discounts.
- Accurately and ethically managed business accounts, claims, and billing information.
- Demonstrated proficiency in verifying financial data to generate accurate financial statements.
- Demonstrated proficiency in working online with QuickBooks Accounting and invoicing software to maintain accurate business records.
- Proficiency working from home office using a business landline, high-speed internet, and superior computer equipment.
- Proven knowledge of business & accounting processes through successful account management.
- Regularly followed up on unpaid invoices within standard billing cycle both through email correspondence and phone calls.
Data Entry Specialist/Billing Specialist/Administrative Assistant
ValueOptions Insurance
Latham, NY
02.2008 - 02.2013
- Audited and maintained accurate records of medical forms for Behavioral and Mental Health Insurance Company.
- Demonstrated high level of attention to detail with ability to review and identify inconsistencies in large amounts of data.
- 6yrs experience reading and auditing medical claims using medical terminology.
- Experienced in the efficient processing of medical billing claims forms.
- Successful data entry of multiple clinical accounts while also processing mail for daily distribution.
- Consistently surpassed daily quotas on all accounts while maintaining work flow at efficient pace.
- NOTABLE ACHIEVEMENTS:
- Initially hired onto team of five to process medical claims forms for the Illinois account and within first year became responsible for the management of the account
- Subsequently trained on 3 additional major accounts which significantly increased department efficiency
- Six years successful completion of HIPAA Certification along with successful completion of Security & Code of Conduct / Fraud & Abuse Training.
Clinique Counter Manager
Bon Ton
Latham, NY
03.2007 - 01.2008
- Maintained accurate (DBR) Daily Business Record of counter revenue, while regularly meeting with Account Executive to discuss business driving opportunities and sales goals.
- Managed all product orders to maintain product availability.
- Created marketing strategies and planned successful events to increase business driving opportunities.
- Effectively trained and developed successful staff of beauty and skin care advisors.
- Increased clientele through hands on product demonstrations and sales events, while also retaining loyal clientele by building those relationships through quarterly gift incentives and loyalty promotions.
- NOTABLE ACHIEVEMENTS:
- Congratulated publicly by VP of Sales, Alton Walker, for increasing store profitability
- Honored with Eastern Region store 42 Award for Highest Percentage Increase in sales for the year
- Received award for creating, planning, and launching major successful sales event which achieved 75% over anticipated sales goal.
Education
Associate of Applied Science - Criminal Justice
SUNY SCCC
Schenectady, NYBachelor of Science - Community And Human Services
SUNY Empire State College
Latham, NYSkills
- Excellent Time Management, Documentation and Organizational skills
- Experienced in Secure Data Practices
- Skilled in both Written and Verbal Communication
- Completed Criminal Justice degree which increased analytical, fraud awareness and detection, critical thinking, and information gathering skills, along with an enhanced understanding of the Criminal Justice System
- BS in Community and Human Services, AAS in Criminal Justice with education and experience in Professional Integrity and Crisis Intervention approaches
Accomplishments
- Tied for first place in the branch for the March 2024 Water/Plumbing 7 Day Settlement Competition
- Recommended by different managers to participate in both the Interior Kaizen and Exterior Kaizen, where I was able to assist with both reviewing and revising the standards of work to increase efficiency in claims handling for both Interior Water claims and Exterior claims, with an emphasis on strategies to decrease vendor expenses and creation of high level training material for new hires in the department.
- Volunteered to create the powerpoint for the Exterior Kaizen presentation that was presented in a mandatory training Friday to the department and successfully coordinated with a colleague in this effort. Also coordinated with Rachel Cizek, Senior Project Manager of the Project and Change Management Unit on the completion of the presentation to ensure proper AFICS branding.
- Presented the Interior Kaizen powerpoint follow up to my team during our huddle, answered questions, and received great feedback.
Certification
- NYS Licensed Insurance Adjuster
- Michigan Licensed Insurance Adjuster
- Louisiana Licensed Insurance Adjuster
- Texas Licensed Insurance Adjuster
- Kentucky Licensed Insurance Adjuster
References
References available upon request.
Timeline
Claim Adjuster II
AFICS
10.2022 - Current
Claims Care Center Rep 1
American Family Insurance Company, Customer Care Center
11.2021 - 10.2022
Billing Specialist
Jiem Rozell Excavation LLC, Plowing, Salting Services
10.2019 - 02.2020
Volunteer Community Service Project Coordinator
Out of The Box Ministries
06.2019 - 10.2021
Personal Assistant
Alzheimer's and Dementia Caregiver Initiative
08.2017 - 10.2021
Data Entry Specialist/Billing Specialist/Administrative Assistant
ValueOptions Insurance
02.2008 - 02.2013
Clinique Counter Manager
Bon Ton
03.2007 - 01.2008
Associate of Applied Science - Criminal Justice
SUNY SCCC
Bachelor of Science - Community And Human Services
SUNY Empire State College
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