Nikita S. Wiggins
Burleson,TX
Summary
Detail-oriented Examiner with 10 years of experience looking to seek and maintain a position that offers professional challenges utilizing interpersonal skills, .
Overview
11
11
years of professional experience
Work History
Claims Examiner
Allianz Worldwide Partners
09.2020 - Current
- Establish proof of loss by reviewing all documentation; assembling additional information as required from outside sources; including claimant, client, airlines, and medical records.
- Identified suspicious losses and contacted manager for investigative assistance.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Mitigated fraud risks by identifying suspicious patterns in claims data and escalating concerns to appropriate teams for further investigation.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Improved overall efficiency within the department by streamlining processes and eliminating redundancies where possible.
- Finalized Travel Claim files for insurance claim payment release.
- Examined claims forms and other records to determine insurance coverage.
- Managed caseloads effectively while maintaining high-quality work standards and meeting strict deadlines consistently.
- Served as a mentor to junior examiners, sharing expertise and providing guidance on best practices within the field of claims examination.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Worked flexible hours across night, weekend, and holiday shifts.
Tricare Certification Provider Enrollment Analyst
WPS Health Solutions
03.2019 - 03.2020
- Approve, deny, or return applications submitted by Medicare providers.
- Assist Medical in providers with enrolling in the Medicare program.
- Utilize on-line Medicare files/systems to verify research, update, and document enrollment information.
- Respond to Tricare Provider written inquiries.
- Ensure all provider enrollment data is properly controlled and tracked to ensure applications are approved or denied within standards of timeliness established by department and Centers for Medicare and Medicaid Services (CMS).
- Enter data into on-line national database and internal provider files (PECOS).
- Research and verify proper fees and inspections have been completed on certain suppliers.
Air and Ocean Import Logistic Coordinator
Liebherr USA
06.2017 - 06.2018
- Ensure that all imported goods comply with customs regulations, including proper documentation and tariff classification.
- Prepare and review import documentation, such as bills of lading, commercial invoices, and packing lists, to ensure accuracy and compliance.
- Freight Booking, coordinate the booking of airfreight shipments, select appropriate carriers, and negotiate rates to optimize cost and service.
- Maintain regular communication with suppliers, customs authorities, and carriers to track shipments and resolve any issues that may arise.
- Manage the customs clearance process, including filing necessary documents, paying duties and taxes, and facilitating inspections if required.
- Monitor and manage inventory levels, ensuring that goods are received and delivered on time.
- Stay updated on changes in import regulations and trade laws to ensure ongoing compliance.
- Ensures the reliable, effective, and timely delivery of finished goods to DFS
- Receive, review, and ensure documentation is accurately processed,
- Coordination of daily shipments (documentation, monitoring, arranging pickup/ dispatching, communicate with carriers and issuing invoices etc.)
- Communicate/correspond with vendor, shipper, customer carrier, overseas agents, freight forwarders, customs broker, local pickup, and delivery companies etc. in a timely manner, to include pre-alerts, rate requests, shipment status, etc.
- Track and trace shipments providing updates to clients and sales.
- Responds to emails and rate requests in a timely manner, assisting local sales efforts.
Document Imaging Specialist
Defense Logistics Agency (DLA) Industrial Aviation, GS
01.2013 - 01.2018
- Assist in document management process training new employees and other staff as needed
- Perform a variety of basic to complex tasks including document handling, scanning, copying one & two sided documents, stapling documents, two sided copying with collating, image shifting , sizing color copying, indexing, data entry, reporting, filing and archiving of official records and inserting tabs and covers
- Batch scan sorted documentation into electronic record according to department procedures and workflows, ensuring both quality and productivity meet department standards adhering to high quality control standards to ensure clear scans
- Developed and maintain effective filing system to accelerate paperwork processing
- Collaborate with several departments and external associates for effective and timely data transfer
- Review, organize, and evaluate records for completeness, accuracy, and compliance
- Collect data, assist with the clearance and dissemination of written material and manage paper and electronic record systems
- Prepare documents for placement in high speed scanner using page separators and batch sheets as necessary to deliNeate documents
- Convert hard copy archives into electronic files through the use of various software programs
- Operate various copy machines to produce documents
- Operate Fujitsu and Vidar scanners to scan military documents into computer database
- For small format, operate a Canon DR-708C document scanner that uses CapturePerfect 3.0
- Perform bindery tasks using Velo Bind, strip, GBC binding equipment, paper drills, and folders
- Prepare source data for computer entry by compiling and sorting information and establishing entry priorities
- Utilize basic databases, spreadsheets and log files for indexing and tracking of documents, creating various electronic file systems utilized to review and verify information entered as current, accurate and complete
- Verify information and data entered by reviewing, correcting, deleting, and reentering data, combining data from different systems when account information is incomplete and purging files to eliminate duplication of data
- Ensure hard and soft copies of documents are of superior quality i.e. Neat and legible by comparing scanned documents with hard copies of the records to ensure data quality has been met
- Maintain sequence and overall care, confidentiality and protect operations by keeping information confidential of all government documents
- Secure information by completing daily data base backups
- Ensure that all work is done in a timely manner with priority on quality
- Consistently contributed to team effort by accomplishing related results as needed
Education
GED -
Denbigh High School
Newport News, VA2000
Skills
- Fraudulent Claims Investigation
- Accredited Claims Professional
- Claims Evaluation
- Policy investigations
- Payment Processing
- Insurance policy coverage knowledge
- Claims Investigation
- Coverage Determination
- Policy analysis
- Claims Processing
- First Aid/CPR
- Flexible and Adaptable
Timeline
Claims Examiner
Allianz Worldwide Partners
09.2020 - Current
Tricare Certification Provider Enrollment Analyst
WPS Health Solutions
03.2019 - 03.2020
Air and Ocean Import Logistic Coordinator
Liebherr USA
06.2017 - 06.2018
Document Imaging Specialist
Defense Logistics Agency (DLA) Industrial Aviation, GS
01.2013 - 01.2018
GED -
Denbigh High School
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