Petrice Wiggins

• Handled complex claim issues, effectively communicating with patients, providers, and insurance companies to ensure resolution.
• Ensured prompt payment from insurance companies through diligent follow-up on outstanding claims balances.
• Enhanced accuracy of processed claims with meticulous attention to detail and knowledge of coding systems.
• Improved patient satisfaction by efficiently processing medical claims and addressing inquiries.
• Increased efficiency in claim submission process by staying up-to-date on changing regulations and industry best practices.
• Demonstrated adaptability by handling various types of medical claims across multiple specialties while maintaining accuracy.
• Managed high-volume claim submissions, consistently meeting deadlines and maintaining a high level of accuracy.
• Prevented fraudulent claims by performing rigorous investigations into suspicious cases, safeguarding company resources.
• Assisted in training new Medical Claims Representatives, sharing best practices for efficient claim processing.
• Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
• Monitored and updated claims status in claims processing system.

Lead machine runner packer

• Operated packing machinery to efficiently package products for distribution.
• Ensured adherence to safety protocols while handling materials and equipment.
• Collaborated with team members to maintain clean and organized workspaces.
• Conducted quality checks on packaged goods to ensure compliance with specifications.

• Identified and forwarded claims to specialized internal and external resources in areas such as medical review, investigations, tender of claim, claim subrogation or physical damage experts.
• Reduced the number of pending claims through diligent follow-ups and thorough case management.
• Negotiated settlements with legal representatives to reach fair agreements while minimizing financial risk for the company.
• Enhanced claim processing efficiency by meticulously reviewing medical records and identifying relevant information.
• Maintained a high level of accuracy in data entry, ensuring correct claimant information and benefit calculations.
• Handled sensitive information with professionalism, maintaining strict confidentiality in accordance with HIPAA guidelines.
• Responded to telephone and written inquiries from clients, insurance carriers, claimants, attorneys, repair shops, appraisers, physical damage experts and physicians within statutory requirements.
• Examined claims forms and other records to determine insurance coverage.
• Worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial.
• Achieved timely claim approvals by effectively communicating with healthcare providers for prompt receipt of necessary documentation.

• Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
• Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
• Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
• Increased first-call resolution rates by carefully listening to customers'' needs and providing accurate information based on their inquiries.
• Expanded knowledge on medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
• Responded to customer requests, offering excellent support and tailored recommendations to address needs.
• Followed-through on all critical inter-departmental escalations to increase customer retention rates.
• Investigated and resolved customer inquiries and complaints quickly.
• Stayed calm under pressure to and successfully dealt with difficult situations.
• Facilitated smooth communication between patients, insurance companies, and medical staff for seamless coordination of care.