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Skills

  • Compliance with system
  • Litigation risk mitigation
  • First Aid/CPR
  • Legal testimony preparation
  • Regulatory compliance
  • Evidence collection and preservation
  • Forensic evidence handling
  • Category equipment
  • Case file organization
  • Advanced analytical skills

Work Experiences

  • Achieved a 28% increase in verified claims.
  • Looked into and assessed property damage, as well as reviewing property damage estimates.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Addressed international components.
  • Collaborated with forensic specialists.
  • Oversaw the delivery of process project by system team, which resulted in program.
  • Conducted agent and claimant interviews to review questionable claims to correct omissions and errors.
  • Had an excellent attendance record and was always on time for work.
  • Consistently performed high-level risk analysis on process claims, ensuring appropriate measures were taken to prevent losses greater than $7.
  • Determined liability as outlined in the coverage and assessed documentation from police and healthcare providers to understand the damages incurred.

Summaries

  • Achieved a 16% reduction in fraudulent claims.
  • Adept at preparing detailed reports for senior management and legal teams.
  • Oversee 10 cases per month with care.
  • Committed to excellence in fraud detection.
  • Collaborated with law enforcement and legal experts.
  • Collaborative Insurance Investigator.
  • Collaborative Investigator skilled in building relationships with forensic specialists.
  • Adept at reducing risk exposure by 38%.
  • Collaborated with law enforcement and internal teams.
  • Achieved success in 12% of fraud-related cases.

Accomplishments

  • Assisted in the refinement of digital fraud detection techniques, reducing manual oversight by 27% and increasing accuracy of claims investigations.
  • Led cross-functional teams in claim investigations involving legal, medical, and financial experts, resulting in the recovery of $138,000 in fraudulent payouts.
  • Provided expert witness testimony in both civil and criminal insurance fraud cases, contributing to 2% favorable outcomes for the company.
  • Reviewed historical claim data to identify recurring fraud patterns, contributing to the development of targeted investigative workflows.
  • Collaborated with third-party investigators and forensic experts to uncover fraud schemes, leading to $150,000 in recovered funds.
  • Mitigated risk in high-value insurance claims by conducting in-depth analysis and reporting, reducing client disputes by 61%.
  • Analyzed trends in denied insurance claims to create proactive screening processes that reduced fraud potential by 7 cases per year.
  • Participated in the integration of new claim auditing software that improved accuracy of assessments by 43%.
  • Reviewed CCTV footage and cross-referenced with claimant statements, identifying fraudulent activities in 31% of disputed cases.
  • Documented and resolved process which led to framework.

Affiliations

  • International Fraud Prevention Research Group (IFPRG) Participant
  • Special Investigations Unit (SIU) Certification
  • Certified Insurance Fraud Investigator (CIFI) 2016
  • Professional Liability Underwriting Society (PLUS) Affiliate
  • Southern Loss Association (SLA) Participation
  • Certified Forensic Interviewer (CFI) – Professional Association
  • Toastmasters
  • National Association of Insurance Commissioners (NAIC) Professional Collaboration
  • International Association of Financial Crimes Investigators (IAFCI) Member
  • International Association of Special Investigation Units (IASIU) Member

Certifications

  • Associate in Claims (AIC)
  • Associate in Insurance Services (AIS)
  • First Aid/CPR Certified
  • ServSafe
  • Project Management Professional (PMP)
  • Certificate in Fraud Investigations (CFI)
  • Cisco Certified Internetwork Expert (CCIE)
  • Accredited Claims Adjuster (ACA)
  • SHRM Certified Professional (SHRM-CP)
  • Advanced Insurance Investigation (AIIP) Certification

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