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Skills

  • Fraud prevention training development
  • Data-driven fraud risk assessment
  • Relationship development
  • Data analysis
  • Problem resolution
  • Collaboration with the National Insurance Crime Bureau (NICB)
  • Procedure review
  • Communications
  • Team building
  • Fraud detection

Work Experiences

  • Looked into insurance and credit card fraud cases involving up to $2 per case.
  • Collaborated with regulatory bodies.
  • Applied best practices.
  • Conducted in-depth interviews with witnesses, asking pertinent questions in order to learn crucial details about each case.
  • Assessed flagged high-risk claims.
  • Closely monitored and assessed flagged high-risk claims, contributing to a 69% drop in fraudulent payouts during 2018.
  • Built strong working relationships with law enforcement agencies and other industry partners to facilitate the arrest and conviction of fraud suspects.
  • Authored comprehensive reports that accurately documented investigative findings and led to favorable settlements or prosecutions in 36% of cases.
  • Answered 4 calls per the past year to help customers with their questions and concerns.
  • Briefed senior management on fraud risks.

Summaries

  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Collaborated with law enforcement.
  • Developing exceptional project management, analytics, and fraud pattern detection skills.
  • Consistently recognized for top-tier fraud investigation skills.
  • Accomplished trainer in fraud detection.
  • Insurance Fraud Investigator is a multi-talented Insurance Fraud Investigator who is consistently rewarded for planning and operational improvements.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the process business.
  • Consistently recognized for top-tier fraud investigation skills with an emphasis on delivering accurate and actionable intelligence in high-pressure circumstances.
  • Adept at cross-functional collaboration with legal, financial, and audit teams to support fraud litigation efforts and recover millions in company losses.
  • Achieved 60% conviction rates in fraud cases.

Accomplishments

  • Trained an internal team of 18 on detecting and handling fraudulent claims, resulting in a 51% reduction in manual errors during investigations.
  • Resolved product issue through consumer testing.
  • Prepared comprehensive investigative reports that contributed to a 53% increase in prosecution success rate for fraud cases.
  • Developed a predictive modeling tool using Adobe Creative Suite that increased proactive detection of suspicious claims by 81%.
  • Documented and resolved program which led to initiative.
  • Continually reviewed industry patterns and developed new protocols for processing suspicious claims, reducing fraudulent claims volume by 76%.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Designed and implemented a training program on fraud detection for over 7 department employees, increasing fraud awareness and prevention by 77%.
  • Created early detection algorithms that saved the company $12 by identifying emerging fraudulent trends from historical data in 2015.
  • Delivered fraud training workshops to cross-functional teams and law enforcement that resulted in a 27% increase in successful fraud detection.

Affiliations

  • Society of Risk Management Professionals
  • International Council of Nurses
  • Association of Information Technology Professionals
  • Society of Human Resource Management
  • American Academy of Forensic Sciences (AAFS)
  • Health Care Compliance Association (HCCA)
  • Association for Computing Machinery
  • Institute of Internal Auditors (IIA)
  • Jaycees
  • Loss Executives Association

Certifications

  • Certified Public Accountant (CPA)
  • Certified Insurance Fraud Investigator (CIFI) - International Association of Special Investigation Units (IASIU)
  • Certified Loss Control Professional (CLCP) - The Institutes
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Property and Liability Insurance Principles Certification - The Institutes
  • Certified Fraud Examiner (CFE) – Association of Certified Fraud Examiners (ACFE)
  • Fraud Prevention and Detection Techniques Certificate - Institute of Risk Management (IRM)
  • Certificate in Professional Investigative Techniques for Insurance – Raleigh, initiative
  • Anti-Money Laundering Specialist (CAMS) - method
  • Certified Business Analysis Professional (CBAP)

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