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Skills

  • Insurance law knowledge
  • Communications
  • Case management leadership
  • Team management
  • Supervision
  • Attention to detail
  • Organization
  • Compliance with system
  • Advanced analytical skills
  • Process streamlining

Work Experiences

  • Collaborated with internal data analysts to incorporate predictive modeling, reducing fraudulent payouts by 45%.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Oversaw claim negotiations within a $2 budget and assisted in successful litigation for complex issues.
  • Saved $2 by putting in place cost-cutting measures that addressed long-standing issues.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Conducted claimant interviews.
  • Achieved an average investigation time reduction of 9 days.
  • Collaborated with local law enforcement officials.
  • Collaborated with internal data analysts.
  • Conducted investigations into 5 claims of insurance fraud.

Summaries

  • Achieved 15 successful fraud prosecutions.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Achieved a 16% reduction in fraudulent claims.
  • Adhered to industry best practices.
  • Collaborative Insurance Investigator adept at streamlining fraud investigations by working with external consultants and legal teams. Improved resolution times by 85% and reduced risk of litigation.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the method business.
  • Oversee 10 cases per month with care.
  • Committed to reducing fraudulent claims.
  • Costs were consistently reduced while profits were increased.
  • Achieved a 59% verification rate for investigated cases.

Accomplishments

  • Resolved product issue through consumer testing.
  • Documented and resolved process which led to framework.
  • Ensured compliance with state and federal insurance regulations in 15 investigations, resulting in zero auditor findings over one year.
  • Implemented a fraud-prevention strategy that led to a 81% decrease in claims flagged for review over 18 months.
  • Reviewed historical claim data to identify recurring fraud patterns, contributing to the development of targeted investigative workflows.
  • Reviewed over 18 claim files monthly for accuracy, successfully uncovering 43% fraudulent or misrepresented claims.
  • Collaborated with law enforcement and third-party experts to collect evidence, leading to the prosecution of 4 fraudulent claim cases.
  • Developed customized investigative templates that streamlined report generation and cut operational costs by $11,000.
  • Reduced investigation costs by 62% through efficient allocation of resources and use of data-driven tools.
  • Successfully presented investigative findings to legal teams and external auditors, leading to accurate court rulings on disputed claims.

Affiliations

  • Special Investigations Unit (SIU) Certification
  • Member of Fraud Advisory Panel (FAP)
  • Society of Insurance Licensing Administrators (SILA) Member
  • Society of Women Engineers
  • International Association of Special Investigation Units (IASIU) Member
  • International Association of Administrative Professionals
  • Member of the National Fire Protection Association (NFPA)
  • California Association of Licensed Investigators (CALI) Professional Network
  • Professional Liability Underwriting Society (PLUS) Affiliate
  • Jaycees

Certifications

  • Certified Public Accountant
  • Certified Anti-Money Laundering Specialist (CAMS)
  • ServSafe
  • Workers' Compensation Litigation Specialist Certification
  • Health Care Anti-Fraud Associate (HCAFA)
  • Property and Casualty Adjuster License
  • Apple Certified Associate (ACA)
  • Google Certified Professional Cloud Architect
  • Advanced Insurance Investigation (AIIP) Certification
  • Certified Public Accountant (CPA)

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