Shaynna Wiggins
Oak Harbor
Summary
Dedicated and detail-oriented Customer Service Representative with over 3 years of experience supporting healthcare providers and members in remote environments. Proven ability to manage high call volumes, maintain 80/30 service standards, and ensure claims and authorization accuracy in provider contact center settings. Skilled in IDX, Epic, and CRM platforms, with a strong understanding of HMO procedures, referrals, and billing. Recognized for professionalism, empathy, and efficiency in resolving complex issues while upholding HIPAA compliance and organizational standards.
Overview
5
5
years of professional experience
Work History
Remote Customer Service Representative
TTEC
04.2024 - Current
- Handle over 60 inbound provider and member calls daily related to authorizations, claims, and billing inquiries.
- Deliver exceptional service under 80/30 performance standards by responding to 80% of calls within 30 seconds.
- Utilize IDX and CRM systems to track claim progress, update case notes, and ensure data accuracy.
- Collaborate with internal provider support teams to resolve escalations promptly and professionally.
- Maintain HIPAA compliance and confidentiality while meeting quality assurance goals.
Provider Support Specialist
Elevance Health (formerly Anthem)
02.2023 - 03.2024
- Supported the provider contact center by processing claim corrections, eligibility verifications, and authorizations.
- Managed provider escalations, ensuring timely and accurate claim resolutions to improve satisfaction rates.
- Assisted with training new representatives on call handling and documentation protocols.
- Recognized for maintaining consistent call quality and achieving performance targets in a remote setting.
Claims Representative
Optum (UnitedHealth Group)
05.2021 - 01.2023
- Processed medical claims with 98% accuracy, ensuring alignment with HMO and payer guidelines.
- Communicated with providers to clarify claim discrepancies and authorization requirements.
- Worked collaboratively with cross-functional departments to expedite claim approvals and adjustments.
- Balanced productivity goals while maintaining exceptional attention to detail and compliance standards.
Home Health Care Aide
Amedisys Home Health
01.2021 - 05.2021
- Delivered compassionate, individualized care to patients in home settings.
- Monitored and recorded vital signs, assisted with medication reminders, and updated care plans.
- Communicated effectively with nursing teams and case managers to ensure optimal patient outcomes.
- Maintained strict confidentiality and HIPAA compliance.
Education
Bachelor of Science - Health Services Management
Norfolk State University
Norfolk, VA05.2026
High School Diploma -
Repertory Company High School For Theatre Arts
New York, NY06-2020
Skills
- Remote Customer Support & Provider Contact Center Operations
- Health Insurance Claims & Authorization Management
- HMO & Managed Care Procedures
- HIPAA Compliance & Confidential Documentation
- Provider Billing & Member Inquiry Resolution
- Microsoft Office, Google Workspace, IDX, Epic, CRM Systems
- Call Performance Metrics (80/30 Service Standards)
- Communication, Time Management & Problem Solving
Timeline
Remote Customer Service Representative
TTEC
04.2024 - Current
Provider Support Specialist
Elevance Health (formerly Anthem)
02.2023 - 03.2024
Claims Representative
Optum (UnitedHealth Group)
05.2021 - 01.2023
Home Health Care Aide
Amedisys Home Health
01.2021 - 05.2021
Bachelor of Science - Health Services Management
Norfolk State University
High School Diploma -
Repertory Company High School For Theatre Arts
Remote Work Environment
- Dedicated home office with reliable high-speed internet.
- Equipped with dual monitors, noise-canceling headset, and secure VPN access.
- Proficient in Microsoft Teams, Zoom, and secure remote communication tools.
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