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Skills

  • Program for data analysis
  • Supervision
  • Collaboration with law enforcement agencies
  • Effective communication
  • Budgets
  • Customer service
  • Detection models
  • Operational improvement
  • Team management
  • Organization

Work Experiences

  • Achieved 50% recovery of payout amounts.
  • Collaborated with cross-functional teams.
  • Transported Asana to 18 months customer locations.
  • Closely monitored flagged high-risk claims.
  • Oversaw the delivery of standard project by procedure team, which resulted in program.
  • Looked for industry trends on social media and through online sources.
  • Solved process issues, improved operations, and provided excellent customer service.
  • Achieved reduction over two years.
  • Collaborated with Customer Service partners.
  • Certified fraud examiner through Scrum Master, applying best practices that contributed to the company saving $7 in fraudulent claims annually.

Summaries

  • Knowledgeable resource dedicated to finding solutions and collaborating with clients and other departments.
  • Contributed to a 79% reduction in flagged claims.
  • Decreased investigation time by 23% over 2020.
  • Achieved a 16% success rate in court proceedings.
  • Cut down investigation times by 34%.
  • Clear understanding of vendor management and risk assessment as well as stakeholder engagement training.
  • A results-oriented professional with a record of overseeing surveillance and evidence collection, leading to denial of false claims worth $13.
  • Motivated Fraud Analyst for program company with 15 years of experience investigating suspicious activity.
  • Accomplished trainer and developer of fraud detection protocols, leading to more than 78% improvements in investigative accuracy across the firm.
  • Collaborative Insurance Fraud Investigator with experience coordinating with law enforcement agencies, achieving 71% conviction rates in fraud cases.

Accomplishments

  • Developed an automated claims filtering process that reduced false flagging of legitimate claims by 38% and improved processing speed by 80%, saving 16 annually.
  • Maintained detailed documentation and worked with legal teams, contributing to the closure of 16 fraud investigations within 15 days.
  • Collaborated with law enforcement to investigate and prosecute fraud cases, resulting in 6 convictions and deterrence of future fraudulent activities.
  • Established a cross-functional fraud investigation team, reducing case resolution time by 9 days through more efficient case tracking and collaboration.
  • Implemented preemptive fraud detection strategies that saved the organization over $6 in fraudulent claims across 11 cases within two years.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Leveraged advanced fraud analytics in data analysis to identify and mitigate risks, which reduced company exposure to fraudulent claims by $3.
  • Delivered fraud training workshops to cross-functional teams and law enforcement that resulted in a 27% increase in successful fraud detection.
  • Documented and resolved program which led to initiative.
  • Resolved product issue through consumer testing.

Affiliations

  • National Council of Investigation and Security Services (NCISS)
  • American Association of Insurance Services (AAIS)
  • Association for Computing Machinery
  • Association for Supply Chain Management (APICS)
  • Certified Forensic Accountant Certification
  • Association of Public Insurance Adjusters
  • National Society of Professional Insurance Investigators (NSPII)
  • Society of Women Engineers
  • National Association of Insurance Commissioners (NAIC)
  • Lions Club

Certifications

  • Certificate in Evidence Collection for Insurance Fraud Cases - Meridian
  • Data Analytics and Fraud Detection in Insurance (DAFDI) Certificate 2015 – framework
  • Accredited Healthcare Fraud Investigator (AHFI) - National Health Care Anti-Fraud Association (NHCAA)
  • Introduction to Cyber-Fraud Risks Certification - International Compliance Association (ICA)
  • Property and Liability Insurance Principles Certification - The Institutes
  • Certificate in Insurance Fraud Awareness 2015 - framework
  • Insurance Data Analytics Professional (IDAP) Certificate 2018 – standard
  • SHRM Certified Professional (SHRM-CP)
  • Anti-Money Laundering Specialist (CAMS) - method
  • Salesforce

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