INVESTIGATIONS MANAGER Resume Example
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INVESTIGATIONS MANAGER
Highlights
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Experience
INVESTIGATIONS MANAGERIcu Medical Inc. － AL, State
- Manage team of 10 investigators and two administrative staff, conduct evaluations, review work product, and personnel issues and human relations (FMLA, VA) Regulatory Investigations of Florida Statutes pertaining to Health Care.
- Investigate legally sufficient complaints and conduct inspections of facilities regulated by the department.
- Healthcare Fraud, Medical Malpractice Investigations including Pharmacy investigations).
- Interview witnesses, subjects, sources in order to provide a complex comprehensive written investigative report.
- Collect evidence and ability to document change of custody.
- Issue and serve Subpoenas.
- Review patient medical charts in order to document course of action , to substantiate allegations.
- Knowledge of Statutes concerning regulatory medical compliance within each Board and licensee requirement.
- Utilization of computer resources to conduct background investigations (PACER, DAVE, Accurint/Lexis Nexis, CCIS, CJIS).
- Training and development of Staff concerning licensed and unlicensed healthcare.
SR. FINANCIAL CRIMINAL INVESTIGATORBickford Senior Living － Columbus , OH
- Investigate high priority fraud, securities, Ponzi, mortgage fraud and other financial crimes.
- Organized and conducted surveillance of potential targets.
- Conducted Financial Audits and tracked funds for anti-money laundering (AML).
- Reviewed SAR reports.
- Worked directly with Federal Fraud Task Force, headed by the Secret Service, to identify, investigate and eliminate AML and other financial crimes Assisted in presentation of case for prosecutors by the State and Special prosecutors.
COMPLIANCE DIRECTOR & CLAIMS ADJUSTERBreckenridge Enterprises/AMS Staff Leasing/Aspen － City , STATE
- Recovered over 1.9 million in net income from underreported payroll (insurance premiums) adjustments Conducted thorough analysis of banking/financial records, corporate and tax records to determine payroll/workers compensation fraud.
- Reviewed and maintained records, books, ledgers, payrolls, cost reports, billing statements, invoices, computer data and bank statements.
- Collected information, analyzed data trends, identified root causes and developed work products.
- Developed and implemented a strategic plan for handling complex compliance issues.
- Managed and supervised marketing groups within 37 states regarding workers compensation compliance.
- Worked independently of corporate supervision with autonomous authority to make decisions and resolve complex issues.
- Investigated and reviewed clients financial records in order to determine compliance with workers' compensation laws, including compliance with future risk assessment.
- Reviewed claims for fraud issues.
- Company liaison/representative for state agencies and third party administrators (TPA).
- Expert witness for compliance for court proceedings for corporation.
LEAD WORKERS' COMPENSATION INVESTIGATOR
- Conducted financial and premium audits of business records.
- Promoted to Lead Investigator within 12 months of initial employment due to exceptional quality of work and recognized as a top producer.
- Key Note Speaker to numerous industry seminars and training programs.
- Demonstrated knowledge of auditing and investigative techniques Used strong analytical and interpretive skills in order to determine proper classification of codes based on field inspection and understanding of insured's' business operation.
- Lead field training and supervisor of five to eight employees within the department and served as "acting supervisor"; served as expert witness in judicial proceedings.
- Team Collaboration for writing Policy and Procedures for staff Extensive knowledge of statutory law concerning workers' compensation and employer responsibilities, payroll and evaded premiums.
Accomplishments
- Won Team-Award for " Operation Pill Street Blues" Workers' Compensation Top Producer Award Recovered over $1.9 million in net income for company in underreported payroll.
- Outstanding Commitment in the Battle Against Workers' Compensation Fraud- Florida Workers' Compensation Fraud Task Force.
Education
Bachelor of Arts: CriminologyUNIVERSITY OF SOUTH FLORIDACriminology Internship: United States Attorney Office (USAO)
Associate of Arts: HumanitiesEdison Community CollegeHumanities
Work History
Company Name
Company Name
Skills
administrative, Attorney, auditing, banking, billing, charts, Conflict resolution, clients, Staff training, financial, Financial Audits, funds, human relations, inspection, insurance, law, legal, Lexis Nexis, Mac, marketing, money, Office, communicator, payroll, personnel, producer, Speaker, quality, requirement, risk assessment, Risk Management, securities, Self-motivated, seminars, strategic, supervisor, supervision, tax, training programs, written
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Resume Overview
School Attended
- UNIVERSITY OF SOUTH FLORIDA
- Edison Community College
Job Titles Held:
- INVESTIGATIONS MANAGER
- SR. FINANCIAL CRIMINAL INVESTIGATOR
- COMPLIANCE DIRECTOR & CLAIMS ADJUSTER
Degrees
- Bachelor of Arts : Criminology
Associate of Arts : Humanities
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