Fraud Investigator Resume Samples

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Fraud Investigators evaluate cases of suspected fraud in order to determine whether or not a fraud actually occurred and, if so, offer recommendations on the proper course of action. Tasks highlighted on sample resumes of Fraud Investigators include performing investigations of all complaints, sources, and leads, and conducting field visits and surveillances; and interviewing participants who are under investigation in order to examine the information presented. While not required, some applicants show a background in law enforcement or a related field on their resumes.

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1

Fraud Investigator

Investigation of complex medical, dental, vision, prescription, and identity theft claims. Analyzing and developing facts and evidence. Conducting and/or directing patient interviews. Coordinating investigations with outside Special Investigation Unit contacts in various state departments of Insurance and various law enforcement agencies. Team coordinator for the Fraud Hotline and Alertline. Team representative for the quarterly Iowa Healthcare Fraud Task Force meeting at the Des Moines, Iowa Attorney General's Office.

  • Researched and implemented change to hours of coverage for the Fraud Hotline. Research results demonstrated a discontinuation of services of one hour per day which resulted in a savings to staffing and costs.
  • Proposed and implemented a revision of patient questionnaire letters. The revisions resulted in the patient receiving only one letter which increased patient satisfaction, staff productivity, and decreased mailing and supply costs.
  • Successfully maintained an average of 20 active Fraud Investigation cases. This resulted in the Initial review being completed within 5 business days and no more than a 30 day lapse between activities in the case review process.
  • Consistently maintained a quality above the set goal of 98.5. 2009=99.9, 2010=99.6, 2011=99.6.
  • Initiated the development and delivery of fraud detection training required by state laws.
Candidate Info
62
years in
workforce
12
years
at this job
C
Teacher Aide
C
Medical Transcription
2

Fraud Investigator

Responsible for investigating customer's fraud claims and mitigate potential losses for the bank

  • Performed Ad-Hoc requests as assigned by management
  • Worked directly with customers regarding current and past fraud claims
  • Exceeded productivity expectations while ensuring to meeting quality standards
  • Reduced losses to the bank by identifying and escalating fraud trends
  • Educated new hires on job responsibilities with side by side training
  • Escalated business enhancement ideas identified via Limme submissions
Candidate Info
6
years in
workforce
1
year
at this job
AS
Associate of Science
BS
Management
3

Agent Fraud Investigator

Led the agent investigation team in total cases, transactions, and dollar amount closed in 2011

  • As subject matter expert conducted job shadows with potential job candidates and visiting leadership
  • Consistently recognized for strong verbal and written communication
  • Consistently selected to work high-profile high-dollar cases when upper-management was involved
  • Worked with satellite offices in Europe, Africa, Asia, South America, and North America to conduct investigations
  • Developed documentation to assist with effective systematic investigative training of new hires or cross training
Candidate Info
13
years in
workforce
2
years
at this job
AS
Business
BA
Finance
MA
Accounting
4

Verification Specialist/mortgage Fraud Investigator

Diligently evaluated mortgage loan files in an effort to identify and investigate lender non-compliance, including potential fraud, with PMI Mortgage Insurance Company's Insurance Policy guidelines and regulation. Re-verified all residential/commercial loan files and supporting documentation provided at the time of loan origination for accuracy and/or misrepresentations. Investigated potential misrepresentations through borrower interviews, loan officer interviews, data mining, and public record searches.

  • Exceeded department expectations with the percentage of positive results in investigations and number of files completed per month.
  • Effectively communicated the results of investigations with clients, underwriters, and management.
  • Submitted accurate and detailed reports of investigations in a timely manner.
  • Met all deadlines of investigations from start to finish.
  • Material misrepresentations uncovered have assisted clients in loss mitigation of potentially tens of millions of dollars.
  • Created and implemented department training manual.
Candidate Info
9
years in
workforce
7
months
at this job
BA
Criminal Justice
MS
Accounting
Criminal Justice
5

Fraud Investigator

Detect fraudulent activity related to access checks. Conduct investigations to verify identity and eliminate fraud concerns related to access checks through handwriting and signature comparisons, the use of credit bureau information, and correspondence with customers via phone and mail in effort to validate transactions.

  • Recognized for flexibility in working extra hours to meet deadlines
  • Received top performance for reviewing and stopping fraudulent checks
  • Consistently receive 100% on Quality Assurance reviews
Candidate Info
10
years in
workforce
3
years
at this job
BA
Health And Wellness Promotions
6

INVESTIGATIONS, REVENUE and ENFORCEMENT Administration/ Fraud Investigator

Investigated participants/ applicants/ providers involved in illegal or fraudulent misappropriation of social benefits.

  • Reviewed case records and referrals, recalculated and computed eligible benefits by using OTDA guidelines and Welfare fraud training Manual, used investigative tools/clearances via IRIS, WMS, Lexis Nexis, HRA Viewer, Data Warehouse, ACRIS, DMV, NYS Division of Corporations, etc.
  • Interviewed perpetrators, collateral contacts or witnesses in office and during field visits.
  • Conducted surveillances on internally generated projects, gather evidence and substantiate allegations.
  • Wrote reports/ summaries including chronological developments by presenting underlying problems/ allegations and created comprehensive case files.
  • Prepared case closing packages by disposition- prepare DA packages, fiscal operations recoupment and restitution packages.
  • Recovered over $2.6 million for HRA in restitution through negotiated settlements with welfare clients.
  • Testified in court hearings and other formal proceedings and acted as a witness on cases that were civilly litigated.
  • Recognized twice through Commissioners Excellence awards (in 2013 and 2014) for exceeding IREA's financial goals and objectives.
Candidate Info
12
years in
workforce
3
years
at this job
MS
Human Resource Management
MA
Leadership And Policy Studies
7

Senior Manager Audit - Americas / Fraud Investigator

Responsible for performing operational and financial audits, as well as consulting services/especial projects for senior managers.

  • Consistently improve internal controls processes, effectiveness and identify cost savings opportunities.
  • Participate in and implement the annual risk assessment process to identify key process and risks at corporate and unit levels.
  • Identified a billing process risk and implemented mitigation controls with local management.
  • Investigated suspected fraud and violations of accounting and internal controls while performing financial analysis and investigating planning; executing fieldwork and interviews; coordinating with appropriate internal; external stakeholders and addressing internal control weaknesses and recommending corrective actions. Manage a diverse caseload of numerous issues with varying priority.
  • Successfully investigated a $300K USD embezzlement in Mexico City and a $142K USD skimming scheme in the United States.
  • Assisted Mexico Management Team in identifying internal controls weaknesses and made recommendations for improvement.
Candidate Info
12
years in
workforce
4
years
at this job
MA
Master of Arts
8

Fraud Investigator, Administrative Assistant, & Trainer

Researched, Investigated, and determined types of fraud committed by parties involved with the loan.

  • Wrote detailed reports on information discovered, maintained confidentiality for these reports, suggested business decisions, and filed the results with the Federal Data base.
  • Identified numerous fraud schemes, suspects in those fraud schemes and saved the company potential millions of dollars in losses.
  • Responded to subpoenas, law enforcement and executives in a clear, concise, and unbiased timely manner.
  • Organized activities for my daily routine.
  • Adaptable to emergencies, last minute updates, unforeseen circumstances.
  • Created Power Point presentations on reoccurring Fraud trends and new schemes.
  • Organized a divisional 3 day symposium of executives from across the nation. Arranged flights, meals,entertainment, and specialized training from governmental agencies. Accommodated small confidentialmeetings, one-on-one training with specialized individuals, and impromptu learning opportunities.
Candidate Info
28
years in
workforce
4
years
at this job
BS
Psychology
9

Senior Fraud Investigator

Originally hired to handle recovery measures, within six months took over additional responsibilities. Helped drive development, maintenance and full integration of compliance and velocity programs.

  • Started up two departments: Compliance (reviewed SDN lists and maintained State and Federal AML programs) and Acceptance User Policy/Branding.
  • Resolved escalated issues including systems initiated problems.
  • Successfully maintained strong recovery efforts. In 2008, personal total recoveries exceeded $80,000 while focused primary in the Compliance program.
  • Responsible for overseeing the Junior Compliance Analysts and assisted in the execution of Compliance Monitoring Program.
  • Proactively ran SQL reports to ensure Compliance with Federal Regulations.
  • Performed OFAC Compliance testing (e.g. SDN database tests).
  • Assisted with the coordination of all regulatory agency examinations and other external audits to ensure that compliance issues were adequately addressed.
Candidate Info
17
years in
workforce
7
years
at this job
10

Fraud Investigator

Handled incoming phone calls concerning fraudulent usage on credit card accounts, challenged
cardholders on non-fraudulent situations, and investigated suspicious accounts. Assisted law
enforcement personnel in fraudulent investigations and apprehension of perpetrators.

  • Assisted New Jersey law officials in locating a missing person.
  • Alerted management of an internal fraud situation saving thousands in possible fraud losses.
  • Participated in training new hires.
  • Completed 7 Habits of Highly Effective People course
  • Volunteered in United Way campaign
  • Worked with legal authorities (Local law enforcement, FBI, Postal Inspectors, and attorneys)
Candidate Info
10
years in
workforce
5
years
at this job
BS
Criminal Justice

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