Candice Wiggs
Wilmington
Summary
Results-oriented professional with diverse background in management and customer service. Dedicated to providing excellent customer service and making operational and procedural improvements.
Overview
11
11
years of professional experience
Work History
Customer Advocate II
Centene Corporation
01.2022 - Current
- Serve as a primary liaison for Medicaid and commercial health plan members and providers, resolving complex inquiries related to benefits, claims adjudication, eligibility, and prior authorizations.
- Analyze and interpret policy, regulatory guidelines, and plan documents to provide accurate and compliant responses to members and providers.
- Lead and support special projects aimed at improving provider services and operational efficiencies, including the development and delivery of training materials for new hires and peers.
- Manage high-volume inbound and outbound communications with a focus on first-contact resolution and member satisfaction.
- Collaborate cross-functionally with claims, enrollment, and provider relations teams to ensure seamless service delivery and timely resolution of escalated issues.
- Maintain strict adherence to HIPAA and internal compliance standards while safeguarding sensitive member and provider data.
- Utilize CRM and claims management systems to document interactions, track case progress, and generate reports to inform leadership decision-making.
- Mentor junior team members, providing guidance on complex case handling and policy interpretation.
- Monitor industry trends, regulatory updates, and internal policy changes to ensure team awareness and consistent application.
Patient Access Representative
Accredo Pharmacy
01.2020 - 01.2022
- Processed and completed pharmacy claims by reviewing insurance data and verifying member eligibility, authorizations, and plan requirements.
- Utilized Microsoft Excel spreadsheets daily to organize, track, and complete work assignments related to prescription claims and billing workflows.
- Ensured accuracy of submitted claims by cross-referencing data with payer requirements and internal databases.
- Maintained compliance with HIPAA and company policies while handling sensitive patient and insurance information.
- Collaborated with team members and insurance providers to resolve claim errors or delays and ensure timely medication access for patients.
- Entered and updated patient records in pharmacy systems, ensuring documentation matched claim outcomes and resolution statuses.
- Demonstrated strong attention to detail and time management in meeting productivity goals within a high-volume processing environment.
Enrollment Broker (Live Chat Agent)
North Carolina Department of Health and Human Services
01.2020 - 01.2021
- Acted as a liaison between Medicaid recipients and healthcare providers, assisting clients with health plan selection, enrollment, and education.
- Guided clients through eligibility requirements, plan benefits, and application processes to ensure accurate and timely enrollment in state-funded health programs.
- Communicated with clients via live chat and email to address questions, troubleshoot issues, and provide guidance on healthcare options.
- Verified documentation and conducted needs assessments to match individuals with appropriate medical coverage options.
- Ensured full compliance with HIPAA and state privacy laws while handling sensitive health and personal information.
- Maintained accurate client records and updated internal databases to reflect changes in coverage and eligibility status.
- Educated clients on health plan rights, responsibilities, and regulatory guidelines, promoting informed decision-making and improved plan retention.
Sales Representative
Charter Communications
Morrisville
01.2015 - 01.2020
- Consistently exceeded monthly sales quotas, earning recognition as a top-performing representative across regional sales teams.
- Delivered tailored sales presentations to prospective and existing customers, promoting cable, internet, and bundled service solutions to meet individualized needs.
- Implemented strategic upselling and cross-selling techniques, increasing average revenue per customer while enhancing overall service value.
- Developed strong customer relationships through proactive outreach and retention initiatives, resulting in reduced churn rate and increased customer loyalty.
- Conducted needs assessments to identify customer requirements, leading to personalized recommendations and improved client satisfaction.
- Managed customer accounts and tracked interactions using CRM tools like ICOMS, CSG, and Zendesk to resolve billing concerns and document service upgrades.
- Collaborated with technical support and installation teams to ensure seamless customer onboarding and follow-through on service expectations.
- Trained and mentored new sales agents on product knowledge, system navigation, and consultative sales techniques.
Education
Bachelor of Arts - Interdisciplinary Studies
Winston-Salem State University
Winston-Salem, NC01-2024
High School Diploma -
North Edgecombe High School
Tarboro, NC01-2011
Skills
- Health Claims Processing
- Medicaid Program Expertise
- Medicare Program Expertise
- Policy Interpretation
- Regulatory Compliance
- HIPAA
- CMS Guidelines
- Claims Systems
- CRM
- Zendesk
- Office suite
- Task prioritization
- Case escalation
- Member management
- Provider management
- Conflict management
- Professional communication
- Active Listening
Volunteer Experience
Math Tutor, Wake / New Hanover County Public Schools, 01/17, Present, Provide academic support to middle and high school students in mathematics, including algebra, geometry, and test preparation., Create customized lesson plans, practice materials, and study guides tailored to individual student learning styles and needs. Conduct one-on-one and small group sessions to reinforce classroom instruction and build student confidence. Monitor student progress and provide feedback to both students and educators to support academic development. Encourage critical thinking and problem-solving skills while fostering a positive and supportive learning environment. Volunteer during after-school hours and exam seasons to help students improve performance and prepare for standardized assessments.
Timeline
Customer Advocate II
Centene Corporation
01.2022 - Current
Patient Access Representative
Accredo Pharmacy
01.2020 - 01.2022
Enrollment Broker (Live Chat Agent)
North Carolina Department of Health and Human Services
01.2020 - 01.2021
Sales Representative
Charter Communications
01.2015 - 01.2020
Bachelor of Arts - Interdisciplinary Studies
Winston-Salem State University
High School Diploma -
North Edgecombe High School