Raechelle Wiggins
Delaware,OH
Summary
Accomplished and highly resourceful professional with a strong background in disability claims, workers' compensation, and claims adjustment. Known for exceptional organizational and team leadership skills. Seeking a dynamic opportunity to fully utilize my talents in a progressive organization.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Claims Adjuster, Automobile and Casualty
State Farm
Delaware, OH
02.2023 - Current
- Investigate, evaluate, and negotiate claims to determine liability and damages
- Analyze coverage issues and provide advice on policy interpretation
- Review medical records, police reports, witness statements, and other documents related to the claim
- Interview claimants, witnesses, and other parties involved in the claim
- Prepare detailed written reports of investigations and findings
- Negotiate settlements with claimants or their representatives
- Monitor and manage a caseload of claims from initial contact through resolution
- Maintain accurate records of all activities associated with each claim
- Ensure compliance with state laws and regulations governing insurance claims
- Provide excellent customer service by responding promptly to inquiries and requests for assistance
- Develop relationships with customers, agents, and vendors to ensure successful outcomes
- Utilize technology such as mobile applications and web-based systems to streamline processes
Workers' Compensation Claims Adjuster
Amazon
Delaware, OH
01.2022 - 01.2023
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Assessed current policies and procedures related to processing workers' compensation claims for effectiveness and recommend changes as needed.
- Prepared detailed reports on claim findings including all pertinent information such as injury description, cause of accident, employer responsibility, and liability.
- Investigated potentially fraudulent claims with focus on thoroughness, quality and cost control.
- Reviewed police reports, medical treatment records, medical bills and physical property damage to determine extent of liability.
- Maintained current knowledge of claim reserve levels and prepared reports on funds available for distribution to claimants to prevent overdraft.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
- Negotiated settlements between claimants and employers or insurers when appropriate.
- Calculated amounts owed to claimants and issued company checks for appropriate compensation to close claims completely.
- Conducted periodic audits to ensure compliance with statutory requirements.
- Participated in regular meetings with internal teams and external partners regarding ongoing projects related to worker's compensation claims management.
Disability Claims Specialist
Sedgwick Claims Management
Dublin, OH
08.2020 - 01.2022
- Processed 300-350 FMLA claims by state regulations, utilizing client policies and state regulations procedures.
- Interviewed clients to gather information about disability claims, including medical history and symptoms.
- Reviewed medical records and other documentation to determine disability eligibility.
- Examined claims, records and procedures to grant approval of coverage.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Researched state and federal laws related to disability benefits eligibility requirements.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
Revenue Cycle Manager
Ohio Health Medical Center
Dublin, OH
11.2019 - 08.2020
- Managed extension for 30 practices, handling pre-registration, prescription refills, referrals, and payment collections.
- Resolved payer rejections and denials through the appeals process.
- Followed up with insurance companies on outstanding claims.
- Reviewed patient billing information to ensure accuracy and compliance with federal and state regulations.
- Managed collection efforts by providing guidance on follow-up procedures for unpaid invoices.
- Analyzed actual financial results to budget, preparing variance reporting to functional groups.
- Provided revenue cycle process support to all clinical personnel, including resolving procedure challenges.
- Generated reports detailing key metrics such as days in accounts receivable, denial rate.
- Maintained oversight of all billing operations including coding, charge entry, payment posting, collections and appeals.
Education
Bachelor of Science - Health Administration
University of Phoenix
Tempe, AZ05-2013
Skills
- Claims Processing
- Rules of Evidence
- Policy Investigations
- Automobile Appraisals
- Property Claims
- Risk Assessment
- Workers' Compensation Claims
- Advanced Computer Skills
- Highly Motivated
- Claims Investigations
- Database Management
- Allocating Claims
- Litigation Resolution
- Interviewing Techniques
- Medical Coding
- Medical Terminology Specialist
Certification
- Medical Assistant Certificate | Kaplan College
- Professional Coding Certificate | CPC Certification
Timeline
Claims Adjuster, Automobile and Casualty
State Farm
02.2023 - Current
Workers' Compensation Claims Adjuster
Amazon
01.2022 - 01.2023
Disability Claims Specialist
Sedgwick Claims Management
08.2020 - 01.2022
Revenue Cycle Manager
Ohio Health Medical Center
11.2019 - 08.2020
Bachelor of Science - Health Administration
University of Phoenix
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