Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
Experience
Special Investigations Unit Coordinator, 09/2013 - Present Fidelity Life Association – City, STATE,
Reporting to the VP and Assistant VP of Operations, and coordinating with Underwriting, Corporate Counsel, Customer Service and the Claims team, I am responsible for maintaining and managing anti-fraud activities, while designing and implementing procedures for SIU activities required for compliance tracking and reporting suspected fraud to law enforcement and state agencies.
Audit sales recordings with the ability to handle multiple priorities simultaneously to prevent, detect, and mitigate fraud.
Maintain 500+ active investigation files regarding potential fraud or sales compliance issues Develop training module and conduct annual fraud awareness training for all company personnel Tasked with filing Annual SIU reports and anti-fraud plans to regulatory bodies Examine and identify fraud trends to determine control-deficiencies Complete investigations as necessary to ensure compliance with company's rules and regulations Utilize internal monitoring tools to identify suspicious activity Execute processes defined for fraud detection and prevention, while identifying new trends in fraud Adept in identifying, researching and reporting fraudulent action inquiry Review monthly AML report for suspicious activity.
Assisted established Investigative & Security leader to provided services to National and Regional insurance carriers and third-party administrators in their attempts to investigate and mitigate suspected fraud.
From within this capacity I was tasked with conducting background verifications, activity checks, social media searches, and medical canvasses.
I was also able to play a role in obtaining criminal convictions and establish area sources that were then utilized to obtain information on targets of our inquiries.
I exercised considerable discretion in my responsibilities, including the ability to manage a growing caseload with minimal supervision.
Compiled an average of 50-60 extensive investigation reports per month Increased profitability during an average week's caseload to around $4,000.00 (USD) Answer client inquiries with regards to investigation findings via email and phone support Assigned to oversee active investigations to assure legal compliance and quality assurance Handled sensitive/confidential information in accordance with privacy policies sensitive information Responsible for mentoring and training newly hired team members.
Investigative Examiner, 04/2010 - 02/2012 Sedgwick – City, STATE,
Assisted SIU provider in workers' compensation, general liability and disability claims investigations at the capacity of an Examiner.
It was from within this position I was able to utilize various investigation tools to monitor claimant activity, assign files, review and finalize colleagues' reports, and submit my findings to clients.
I was able to become proficient in the Lexis Nexis platform, ISO Claim Search, PACER, TLO and additional databases utilized to obtain records on real property/business ownership, employment history, criminal/civil history, past claims, driving records, motor vehicle/watercraft ownership, recreational/professional licenses, and Internet and social media presence.
Key in assisting in the investigation of a $1.8 million check fraud scheme Acknowledged for maximizing additional orders, resulting in over $1,000 per week profit Skillful in all aspects of investigation and reporting by gathering information on a claimant Recognized fraudulent Workers' Compensation Claims Identified red flags and leads to make recommendations for surveillance Supported and supervised colleagues by prioritizing and communicating their case load and deadlines Strong time management and administrative skills.
Education
M.A: Law Enforcement and Justice Administration, Expected in 05/2013 - Western Illinois University - Macomb, IL GPA: Law Enforcement and Justice Administration
B.S: , Expected in 05/2010 - Western Illinois University - Macomb, IL GPA:
Summary
My objective is to continually apply my current knowledge, skills, and experience within a challenging work environment. It is my long-term goal to continue to develop professionally and personally from within a fast-paced, forward-thinking company. I am a detail-oriented, proactive, highly-motivated, organized individual with 8 years of experience investigating fraud cases.
Ability to Analyze | Multi-Tasking Effectively | Due Diligence | Work Independently | Customer Focus
Problem-solver | Collaborative | Attention to Detail | Team Oriented | Compliance
Highlights
Microsoft Office (Outlook, Excel, PowerPoint, Word)
Mindflash | Lexis Nexis | TLO | NAIC | ISO Claim Search | PACER
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