Pamela Wiggins-Highsmith

Work History

Life Insurance Agent –(Part-Time)

Primerica

Somerset, NJ

07.2024 - Current

Advised clients on life insurance policies, facilitating informed decision-making and ensuring optimal coverage based on individual needs and circumstances.
Conducted intermediary services between clients and the insurance provider, effectively managing communications and enhancing client satisfaction.
Also offer the opportunity to be part of my team.
Explained advantages, features, and disadvantages of various policies to promote sale of plans, boosting overall sales 90 calls per day.
Participated in professional development opportunities such as training sessions and conferences to stay informed on best practices within the life insurance industry.
Attended continuing education courses and workshops to gain additional insurance industry knowledge.
Developed comprehensive financial plans for clients, ensuring proper coverage and security for their families.
Crafted clear, informative reports to explain life insurance policy features and benefits.
Retained existing clientele through regular follow-ups, policy reviews, and timely adjustments based on changing circumstances or needs.
Analyzed customers' financial situations to recommend appropriate life insurance policies.
Assisted clients in navigating complex claims processes, ensuring timely payouts and minimal stress during difficult times.
Provided exceptional customer service by addressing concerns promptly and maintaining open lines of communication.

Member Services Representative

Aetna

Somerset, NJ

11.2024 - 01.2025

Resolved member inquiries and issues by providing effective customer service through phone, email, and in-person interactions.
Managed account transactions and updates, ensuring accuracy and timely processing to maintain high member satisfaction levels.
Contributed to enhanced member experience by addressing concerns promptly and maintaining a professional demeanor.
30-50 Inbound calls per day
(Reason for Leaving: Layoff)

Medical Insurance Coordinator

Oticon

Somerset, NJ

06.2024 - 08.2024

Managed client inquiries and complaints regarding products and services, ensuring prompt and effective resolution.
Responded to client 50 in bound calls per day along with emails, providing accurate information and assistance with processing and product-related questions.
Resolved disputes efficiently, maintaining high levels of client satisfaction through professional communication.
(Reason for Leaving: Ended)

Care Advisor

United Healthcare

Somerset, NJ

02.2023 - 12.2023

Consulted directly with family members to assess and understand the specific needs of their loved ones, utilizing a compassionate and analytical approach.
Received 50-90 In bound calls per day from members with complex health issues.
Advised and guided families in selecting appropriate caregiving solutions, ensuring alignment with available options and client needs.
Communicated effectively with family members to provide support and detailed information on care solutions, both verbally and in written form.
Oversaw the care solution program from inception to completion, ensuring an exceptional client experience.
(Reason for leaving: Layoff)

Senior Customer Service Advocate

United Healthcare

Somerset, NJ

07.2021 - 02.2023

Addressed 50-100 incoming inquiries from members and providers regarding benefits and claims, ensuring clear and accurate information was provided.
Educated members on utilizing the online platform to access plan benefits and claims, enhancing their ability to manage healthcare information independently.
Facilitated effective stakeholder communication by providing timely and reliable assistance to resolve inquiries and concerns.
(Reason for leaving: Promoted))

Benefits Associate

Aflac

Basking Ridge, New Jersey

06.2020 - 03.2021

Advised clients on life insurance products, ensuring a clear understanding of policy benefits and coverage options.
Managed 70 out bound calls, emails and faxes per day from members
Facilitated communication between clients and the insurance provider to streamline policy transactions and resolve inquiries.
Sold life insurance policies, contributing to the financial security of policyholders' beneficiaries.
(Reason for leaving: COVID)

Licensed Agent

Mass Mutual

Edison, NJ

02.2020 - 06.2020

Managed 50-100 in bound and out bound calls per day, emails and chat.
Advised clients on life insurance policies, facilitating informed decision-making and ensuring optimal coverage based on individual needs and circumstances.
Conducted intermediary services between clients and the insurance provider, effectively managing communications and enhancing client satisfaction.
(Reason for leaving: Layoff/COVID)

Licensed NJ Producer Agent (life)

American Income

Edison, NJ

05.2019 - 01.2020

Provided expert advice and facilitated intermediary services between Managing 100 calls per day to clients and the insurance company, ensuring clear communication and client understanding of life insurance policies.
Succesosfully sold life insurance polices, enhancing financial security for clients by ensuring payouts upon the policyholder's death.
Successfully sold life insurance policies, enhancing financial security for clients by ensuring payouts upon the policyholder's death.
(Reason for leaving: Better opportunity)

Denial Follow-up Rep

Aergo Solutions

Iselin, New Jersey

08.2018 - 03.2019

Researched, appealed, and resolved insurance claims, effectively reducing denied claims and facilitating timely reimbursement.
Managed follow-up and collection processes for electronic claims, addressing billing errors and responding to insurance carrier correspondence and patient billing inquiries.
Managed 50 in coming calls per day, fax and emails.
(Reason for leaving: Layoff)

Patient Account Representative

Carrier Clinic

Belle Mead, New Jersey

06.2015 - 01.2018

Managed the organization and delivery of inpatient and outpatient claims, ensuring timely and accurate electronic and hard copy submission processing.
Managed in coming and out bound calls, managed 90 claims, fax and emails from members and providers,
Followed up on prior authorizations, provider complaints and appeals,
Conducted follow-up on outstanding aged accounts, applied necessary adjustments, and efficiently handled account updates, refiling claims and appeals when required.
Performed benefit verification and pre-authorization while addressing patient inquiries and complaints to enhance service satisfaction.
(Reason for leaving: Medical issue)

Reimbursement Specialist

Mckesson

Somerset, NJ

08.2014 - 05.2015

Processed insurance claim denials and filed appeals, ensuring timely resolution, resubmission, or appeal of all suspended or denied claims while meeting daily, monthly, and quarterly billing metrics.
Covering CSR 30 in coming calls during breaks
Reviewed 90 audited aging accounts receivable reports, verified receipt of patient registration data, and communicated potential coding issues to clients, facilitating efficient follow-up with patients and third-party payers.

Customer Service / Call Center Representative

JFK Medical Center

Edison, New Jersey

07.2012 - 07.2014

Managed 30 incoming and follow-up calls addressing inquiries from patients, providers, healthcare facilities, and insurance companies, ensuring efficient communication and resolution.
Executed front desk operations, including billing and statement inquiries, payment processing, and refund tasks, contributing to streamlined customer service processes.

Customer Service/Call Center Representative

Qualicare

Piscataway, New Jersey

11.2005 - 01.2011

Managed 90-120 inbound calls per day, follow-up on email communications regarding member, provider, and healthcare facility inquiries and processed all incoming patient correspondence.
Negotiated payments and insurance denial disputes, utilizing knowledge of fair debt collection practices, HIPAA compliance, and Medicare & Medicaid guidelines.

Summary

Overview

Work History

Life Insurance Agent –(Part-Time)

Member Services Representative

Medical Insurance Coordinator

Care Advisor

Senior Customer Service Advocate

Benefits Associate

Licensed Agent

Licensed NJ Producer Agent (life)

Denial Follow-up Rep

Patient Account Representative

Reimbursement Specialist

Customer Service / Call Center Representative

Customer Service/Call Center Representative

Education

High School Diploma -

No Degree - Healthcare Mangement

Skills

Certification

Timeline

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