Jacki Wherley
Health Insurance Specialist with 30 years experience of claims processing, training, auditing, appeals, client services, project management and call center experience
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About
Dedicated healthcare claims and customer service professional with extensive experience in medical, dental, and workers' compensation claims, member advocacy, project coordination, auditing, and operational support. Recognized for exceptional problem-solving abilities, cross-functional training expertise, and delivering high-quality service in fast-paced environments.
Experience
Carrier / Client Service Representative - International Benefit Administrators
(2022-09 - 2026-05)
- Assisted members by addressing questions, resolving concerns, and providing information through electronic communication channels.
- Processed member and provider appeals while reviewing medical records for medical necessity and pre-existing conditions.
- Participated in projects to identify trends and improve operational processes and outcomes.
- Assisted management with auditing employee work performance for accuracy, quality, and compliance.
- Communicated effectively with clients and vendors to resolve inquiries and provide updates.
- Assisted management with entering plan documentation and processing overpayments and refunds.
Member Advocate / Customer Service Representative / Medical Claims Adjuster - Allied Benefit Systems
- Processed medical, dental, and workers' compensation claims accurately and efficiently.
- Handled high-volume inbound calls in a fast-paced call center environment.
- Responded to escalated member concerns and management callback requests on the Care Team.
- Provided exceptional member support while resolving complex claims and benefit inquiries.
- Assisted with training and cross-training staff across multiple departmental functions.
Project Supervisor / Medical, Dental & Workers' Compensation Adjuster - HCH Administration
(1995-02 - 2012-10)
- Analyzed and monitored trends to improve operational performance and support training of claims adjusters.
- Evaluated and processed claims to ensure compliance with benefit plans, policies, and regulations.
- Handled inbound customer service calls while maintaining high-quality member support.
Education
General Studies - Illinois Central College (2000 - 2003)
Southeastern Academy of Travel & Tourism (1987)
Oak Creek High School (1982 - 1986)
