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10+ years of experience
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.
0-5 years of experience
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
0-5 years of experience
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
0-5 years of experience
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.
0-5 years of experience
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
0-5 years of experience
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.
0-5 years of experience
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.
0-5 years of experience
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.
6-10 years of experience
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.
0-5 years of experience
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)
0-5 years of experience
Reviewed daily wire transfer alert list and reviewed each account in order to detect, investigate, resolve and prevent fraud.
- Created detailed notations in investigation, notified officer of account of possible fraud, sent notification of possible account closure to customer.
- Performed extensive research via internet sites.
- Created management report of all accounts with fraud.
- Communicated between various departments of the bank in order to resolve and prevent fraud.
6-10 years of experience
Conducted hundreds of investigations involving counterfeit checks, altered checks, forged maker checks, forged endorsements, empty envelope deposits resulting in the recovery of hundreds of thousands of dollars.
- Served as the point of contact for investigations involving stolen IRS refund checks and US Treasury ACH credits. Coordinated the return of thousands of dollars from unscrupulous return preparers to the IRS.
- Prepared reports for federal, state and local law enforcement that led the to prosecution of major check fraud rings; including one involving a guilty pleas in forty-three related cases and thousands of dollars.
- Assisted law enforcement and other banks by providing video surveillance photos and other documents for trials.
- Appeared in court for hundreds of preliminary hearings and trials. Testified many times in court.
0-5 years of experience
Documented all investigated activities and prepared written reports of investigation findings.
- Prepared evidence for presentation in court and testified in court regarding investigation findings.
- Interviewed witnesses or suspects and took statements and coordinate investigative efforts with lawyers and officers.
- Advised businesses or agencies on ways to improve fraud detection.
- Gathered financial documents related to investigations.
- Conducted in-depth investigations of suspicious financial activity, such as suspected money-laundering efforts.
- Created and maintain logs, records, or databases of information about fraudulent activity
0-5 years of experience
Fraud Investigator Conducted investigations of consumer fraud. Interviewed suspects, witnesses, and victims. Determined appropriate action for resolution.
- Guided ID theft victims, in filing police reports, and claim process.
- Identified criminal and policy violations through analysis of data. Fulfilled subpoena requests and explained data to the requesting party.
- Attended California Financial Crimes Investigator meetings.
- Developed Power Point presentations and delivered fraud awareness training to employees on identifying and preventing fraud.
0-5 years of experience
Conducted complex investigations of alleged Medicare fraud in response to internal and external complaints or referrals.
- Conducted thorough, appropriate and timely investigations/cases using the established department procedures and Quality Assurance Plan.
- Acted as lead and as a team member on investigations when conducting unannounced onsite audits at home health and hospice agencies.
- Worked with other Medicare contractors and Medi-Cal partners on joint onsite audits and referrals to Law Enforcement.
- Provided CMS and Law Enforcement with pertinent information related to anti-fraud activities and provided informal training on Medicare to Law Enforcement as requested.
0-5 years of experience
Conducted research on Medicare claims data, and other sources of information to identify and detect situations of potential fraud.
- Presented issues of concern, citied regulatory violations, alleging schemes or scams to defraud the government.
- Educated providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program SAFEGUARD matters.
- Communicated effectively with agencies to interpret laws and regulations.
- Performed on-site visits and interviews with providers and beneficiaries of Medicare.
0-5 years of experience
Conducted detailed analysis on transactions to determine the presence of fraud
- Analyzed financial transactions to determine irregularities and suspicious activity
- Utilized Lexis Nexis /Accurint, and various web based investigative software to perform in depth investigations
- Analyzed and documented trends to be reported to management for corrective action
- Trained and supervised team members
- Primary point of contact for banks, insurance companies and service providers engaged in litigation
0-5 years of experience
Monitored daily reports, online transactions and negative savings accounts as well as audited indirect lending profiles for any inconsistencies or fraudulent activity for a credit union with assets in excess of $1.8billion, over 130,000 members and 22 locations throughout the United States.
- Monitored daily ATM, Mobile Check Deposit, Negative Savings Accounts, internal and external reports and incoming and outgoing ACH and wire transfers for fraud, helping the credit union minimize losses
- Worked closely with members who were victims of fraud as well as local law enforcement and outside collection agencies to recoup losses for the credit union.
- Assisted in creating training materials for the department as well as an audit template for reviewing patterns of irregular practices within indirect lending. This led to fraudulent findings and saved the credit union from future losses
- Worked closely with members to better serve their needs and promote the credit union
6-10 years of experience
- Opened and reviewed credit card fraud cases and closures on Tsys and FDR systems.
- Studied claims in an effort to reduce losses through maintenance an investigations with law enforcement regarding recovery on reported fraud claims.
- Conducted interviews in an effort to divert false claims and/or identify suspects for restitution.
- Corrected financial adjustments on all confirmed fraud cases and recovered losses through initiation of chargebacks and Letters of Responsibility.
- Managed all compliance reporting on fraud accounts within Bank, Federal and Association guidelines.
6-10 years of experience
- Worked with banks, law enforcement, and legal to retrieve stolen funds through the indemnity process
- Balanced and cleared General Ledgers when needed, issued and mailed official checks
- Reviewed and investigated forgery claims for counterfeit checks, washed checks, stolen checks, impersonation claims and identity theft claims.
- Analyzed video surveillance for possible suspects in impersonation/identity theft claims.
- Trained new incoming investigators to know the claim investigation process
0-5 years of experience
Investigated fraud cases and supported more than 200 retail bank branches; served as a liaison to retail bank employees when dealing with fraudulent activity.
- Assigned fraud cases involving unlimited dollar amounts to prevent, mitigate, investigate, and resolve financial fraud claims related to Reg-E (Debit Card & ACH); additionally investigated smaller cases under $5,000 related to check fraud, account takeovers, and claims.
- Investigated cases of internal theft, employee protection, and physical security for all supermarket Capital One branches in Maryland, Washington D.C., and Virginia.
- Conducted fact-finding investigations on a wide variety of matters, including fraudulent activity, potential violations of company policies, industry regulations, and civil and/or criminal laws.
- Initiated and received phone calls and written correspondence from account holders, bank personnel, and other organizations regarding the fraudulent use of accounts, suspicious activity, and policy violations.
- Recovered on all financial loss (including theft of property) for the company by placing claims on assets, filing criminal charges, and/or working with the Legal Department on civil issues
- Developed and maintained relationships with law enforcement authorities and other organizations.
- Prepared cases for criminal investigation and prosecution by federal, state, or local law enforcement
- Represented Capital One in civil and criminal litigation matters.
- Provided training to bank personnel and retail management concerning fraud-related issues.
0-5 years of experience
Investigated mortgage loan fraud in the form of income, employment, asset, and appraisal.
- Composed Suspicious activity reports (SAR) submitted to regulators, FINCEN
- Investigated high risk country banking wires
- Completed No SAR’s as well as SAR for the wire investigations
0-5 years of experience
Performed extensive background investigation of borrowers of defaulted mortgage loans and comparing to the original application seeking misrepresentation and possible fraud.
- Prepared interview logs to record verbal information obtained during the investigative process.
- Reviewed written re-verifications obtained from employers, former employers, title companies/attorney’s, financial institutions, government agencies, brokers, accountants and other entities that were involved with the approval and closing of the mortgage loan.
- Prepared business profiles on companies to obtain background information and possible undisclosed relationships with borrowers, seeking possible misrepresentation.
- Conducted online searches of various government and private databases, such as Secretary of State, to obtain information that is useful in the investigation of defaulted mortgage loans.
- Documented findings with a comprehensive written review upon completion of a thorough verbal and written investigation.
0-5 years of experience
Identified fraud schemes and connect related cases while responding quickly to fraud events
- Ability to Prevent and mitigate monetary losses
- Gathered information from victims, witnesses, video surveillance, physical documents and testimony from interrogation and interviewing in relation to fraud and financial crimes against Nordstrom bank.
- Prepared concise reports, suitable for submission to government agencies, courts, law enforcement, and BSA
- Researched and resolved internal and external customer fraud inquiries
- Monitor accounts and transactions regularly to identify fraudulent activities
0-5 years of experience
Monitored cell phone merchants processing activity to minimize potential loses.
- Investigated, monitored, and worked collaboratively with internal and external agencies to resolve assigned cases.
- Analyzed and examined fraud losses to determine trends.
- Developed and initiated upon approval the procedures to counter new trends.
- Updated fraud statuses, verified fraud balances, and documented investigative notes
0-5 years of experience
Collected and recorded physical information about arrested suspects, including fingerprints, height and weight measurements, and photographs.
- Gathered all relevant facts including conducting interviews, gathering and safeguarding evidence, and providing recommendations.
- Investigated crime, financial crime, fraud, and other violations of federal or state statutes.
- Conducted complex SIU investigations.
- Recorded evidence and documents, using equipment such as cameras and photocopy machines.
- Testified in Commonwealth Court and Court of Common Pleas.
0-5 years of experience
- Reviewed fraud claims, supporting evidence and correspondence to determine if Suspicious Activity Report (SAR) filing is required.
- Collaborated with the FBI, internal Legal and Elder Financial Abuse unit to resolve issues.
- Researched on all involved parties in account systems and internal databases to ensure the bank is not vulnerable to other occurrences of fraud.
- Research into other global accounts, cross referencing to Anti-Money Laundering and other high profile cases.
- Composed a narrative containing all pertinent information that clearly describes the event, possible connections and my recommended action.
0-5 years of experience
Thoroughly reviewed accounts and prospective clients applications to determine their validity by using multiple systems and comparing them to account application indicators
- Assisted management in identifying and recommending workflow improvements and efficiencies based on reporting metrics
- Identify and investigated fraud trends to determine the initial cause as well as provided recommendations to the department
- Worked on fraud related projects to help mitigate fraud loss
0-5 years of experience
Assisted Senior Management with departmental matters including but not limited to escalated customer concerns, team building/improvement analysis, and special projects
- Entrusted to facilitate the training of new employees while still maintaining daily responsibilities
- Completed administrative tasks assigned by upper management in order to ensure compliance with Federal Regulations
- Developed strong business relationships with all lines of businesses to achieve objectives of department
6-10 years of experience
Rated by Investigative Managers as one of the top ten corporate security fraud investigators within the Bank for 2009.
- Complete a Suspicious Activity Reports (SAR), when required, to ensure compliance with the [company name], the USA Patriot Act, and related statutes and regulations.
- Completed over 800 investigations of different types of criminal fraud including claims, wires, debit cards, loans, internals, eCommerce, Online Banking, and mortgage.
- Conduct ethics and policy violations investigations
- Conduct periodic fraud awareness training to other lines of business within the Bank.
- Testify in local, state and federal court reference criminal cases filed, and on behalf of the Bank in civil court
- Established professional relationships with local, state and federal law enforcement, resulting in mutual cooperation for ongoing investigations.
0-5 years of experience
Manage high risk merchant portfolio accounts and monitor for susceptibility to credit risk/fraud
- Thrive in team oriented environment with successful, daily coordination to assess problematic accounts with credit department
- Apply Lithuanian and Russian background and languages to consult international risk division
- Assigned to complex project to help management and staff translate fraudulent transactions in Russia and Poland; successfully completed project well ahead of scheduled termination date
- Handle large volume of high risk daily batches from different partner bank portfolios and provide excellent customer support to merchant accounts
- Regularly exercise discretion and independent judgment in decision making and interaction with various levels of personnel, banks, and independent organizations
6-10 years of experience
- Investigated Part A and Part B Medicare providers in a South Florida three county Special Enrollment Project for healthcare providers who were vetted as high risk.
- Performed inspections of Medicare facilities, which included interviewing physicians, staff, and owners of Part A, B, and Home Health providers.
- Developed investigations that resulted in recommendation of deactivation, revocation, or Law Enforcement referral.
0-5 years of experience
- Conduct investigations, recognize evidence, and determine its value to specific claim; Prepare and submit investigative reports detailing all phases of the investigation in each claim
- Analyze and determine completeness and validity of more than 1,000 claims; Order police reports and determine liability and collection amounts
- Maintain a superior quality rating of 95% in SIU Dashboard Benchmark regarding investigation and resolution of all NICB indicators
- Selected by supervisor to oversee Catastrophe call center and coach temporary staff: monitored call volume, managed staffing needs, provided direction on workflows and procedures, and delegated call out instructions for affected areas
- Successfully meet weekly operational goals while developing expertise in liability and material damage settlement investigations
10+ years of experience
Responsible for the investigations of cases involving new account fraud, forgeries, counterfeit, money laundering (AML), social engineering scams, counterfeits, internet fraud, kiting, ID theft, and true name fraud. (Internal and External fraud)
- Processing referrals for the OIG, FBI and any LE agency for prosecution. Acting as a liaison with the law enforcement when assistance is needed.
- Researched and presented issues of concern, and cited regulatory violations alleging schemes or scams to defraud the banking institution.
- Submitted SAR reports in compliance with the government regulations. (Fluent with the Patriot Acts Regulation. Yearly compliance training with all banking regulation -Reg. E, Reg. CC, 4789, Cyber Security, MLA)
- Identified potential fraudulent activity, and takes appropriate action which includes contacting customers, creating logs and databases, summarize losses, interpret data, identify trends and produce reports for management
- Experience in maintaining up to date investigation load, and taking action in a timely matter. Always complying with deadlines
- Conducting victim/suspect interviews with professionalism. Obtaining affidavits, police reports and thoroughly documenting all necessary steps
0-5 years of experience
Primarily responsible for resolving victim fraud claims; proactively working leads to detect fraud; utilizing fraud detection tools, record searches, billing and credit systems to review fraudulent activity to reduce fraud loss.
- Built partnerships between Executive Relations and Corporate Security, by working highly sensitive and escalated cases.
- Selected to collaborate with the head of the IT department to provide feedback for system modifications for new fraud detection tools.
- Developed supplemental training guides, along with facilitating the training.
- Interacted professionally and effectively with a variety of individuals including law enforcement officials.
- Recognized consistently by the Quality Assurance Team as Top Performer.
- Entrusted to be the point of contact in times of supervisor’s absence.
- Served as team recorder, solidifying complete calibration post team meetings.
6-10 years of experience
Planned, led, and executed internal investigations while indirectly supervising 2 employees. Directed investigations regarding employee, customer, and vendor misconduct. Utilized data analytics to identify trends in vendor data indicative of potential unethical conduct. Conducted interviews and interrogations of employees and vendor personnel.
- Developed process and system for reporting investigation results to corporate management.
- Utilized Microsoft Suite Programs, audit tools, Teammate (work paper/audit report creation), and ACL (trending/ analytics). Proficient in various internal financial and production systems and the Ethics Point System.
- Conducted environmental reviews as part of the corporate environmental audit program.
6-10 years of experience
- Evaluated allegations of fraud through research of Medicare regulations and statutes
- Analyzed claims data to detect fraudulent and abusive billing aberrancies
- Developed complex investigations that may involve high dollar amounts and determine appropriate resolution for an administrative action against the provider
- Prepared written reports (referrals to law enforcement) that include well documented findings and conclusions regarding investigative activities
- Trained associates on specific aspects of the investigation process and conducted peer reviews
- Assisted in the development of policies and procedures for ISO Quality Manual
- Vulnerabilities identified were implemented as edits in the Medicare claims system
0-5 years of experience
- Organized and Conducted investigations throughout the company related to financial fraud.
- Interacted with law enforcement agencies and testify in court related matters.
- Provided coaching and serves as subject matter expert.
- Data Entry in customized fraud programs
0-5 years of experience
Reviewed various organizational reports and accounts in order to detect fraudulent activity
- Performed collection efforts on negative/fraudulent accounts.
- Interfaced with legal counsel and other organizations to ensure risks were mitigated.
- Gathered and communicated information necessary to prosecute fraud cases.
- Exchanged information, wrote depositions, and appeared in court.
- Served as a liaison for other department personnel.
- Assisted in adhering to the Bank Secrecy Act.
- Ensured mitigation of fraud.
- Cross-sold products to meet sales goals.
0-5 years of experience
Reviewing worldwide E-Commerce transactions to identify fraud
- Recognized expert at pinpointing and eliminating fraudulent transactions through the use of analysis and supporting tools
- Identify changing patterns of fraud, allowing for the rapid adjustment of preventative tactics to mitigate risks and outmaneuver digital criminals
- Recognized by supervisors for having great communication skills, which has resulted in the analyst being given the responsible to train two other co-workers in his department
- Responsible for monitoring various e-commerce platforms due to the analytical abilities and multi-tasking skills that the analyst has demonstrated
- Being able to run and extract data from SQL queries
6-10 years of experience
Investigate fraud losses for various cases such as ATM operations, overdrafts, direct deposits, and non-sufficient funds
- Perform in depth analysis on account activity that would support suspicions of fraud
- Follow documented departmental procedures taking appropriate actions
- Obtain and provide detailed documentary evidence to support confirmed fraud activity necessary to prepare cases or alerts for criminal prosecution, referral to law enforcement
- Corporate investigations and Collections as appropriate
- Liaison with clients (internal/external), business partners, peer groups, all levels of managements and law enforcement; build and maintain relationships with contacts throughout the industry
- Provide department management with weekly reports on status of current cases and investigations
- Work independently and effectively; ensure individual and department performance are within service level agreements, manage problem solving, and make recommendations for complex or difficult/escalated with minimal oversight
6-10 years of experience
Trained to locate hard-to-find individuals attempting to defraud auto lending institutions
- Conduct interviews of assigned subjects, including relatives and neighbors professionally and discreetly to acquire information
- Use advanced computer programs designed to track individuals attempting to escape detection, knowingly hiding their whereabouts and using others to defraud businesses
- Comply with federal and state laws and regulations as well as corporate client policies
- In-depth use of various social media and Internet technology
0-5 years of experience
As lead fraud investigator, I reviewed and assigned cases to the appropriate investigator.
- Investigated claims to determine liability and compensability on severe injury and highly questionable cases.
- Investigated claims to determine possible fraud and referred cases to prosecution.
- Assisted the fraud unit with quarterly presentation to the claim department on claim fraud activities.
0-5 years of experience
Conducted comprehensive fraud and investigations work on insured home loans to ensure adherence to master policies and compliance regulations.
- Identified and evaluated misrepresentations and coordinated appropriate action based on information obtained during the investigation process.
- Located red flags related to fraud and researched these findings to determine if they could be used to rescind an insurance policy.
- Contacted and interviewed borrowers, employers, and employees of financial institutions connected to a loan and discussed fraud findings and information inconsistencies.
- Generated written correspondence to clients detailing and explaining findings while maintaining compliance with legal standards and lending practices.
- Reviewed, researched, and responded to client’s rebuttals.
- As a result of my fraud findings I rescinded 123 insurance policies in 2008 resulting is $10.4 million in risk mitigation and had an overall fraud rate of 60.22% on files reviewed.
- In 2009 I reviewed the highest number of files in the Investigations Department and was assigned to a Wells Fargo team where I assisted in expediting the investigations process on a large inventory of Wells Fargo files.
- I reviewed the highest number of files in the Investigations Department with an average of 4.62 files reviewed daily in 2010.
10+ years of experience
- Created and maintained records related to fraudulent activity including highly confidential federal reports.
- Analyzed financial data, made financial adjustments.
- Interviewed customers, merchants and suspects.
- Processed chargebacks to merchants when appropriate.
- Responded to escalated issues.
- Maintained knowledge of current trends in money laundering.
0-5 years of experience
- Conducted thorough investigation of suspicious claims and/or insureds.
- Referred fraudulent activity to DIF or another state’s fraud investigatory analogue.
- Performed company background checks.
- Gathered information through social media.
- Reviewed pertinent material; surveillance, deposition, sworn statements, etc.
0-5 years of experience
- Reviewed fraud reports to analyze fraud losses and identity patterns and trends.
- Verified account activity and customer identity.
- Conducted investigations to determine validity of accounts.
- Identified and reported trends to management.
- Handled inbound and outbound calls with customers and merchants.
0-5 years of experience
- Evaluated new service applications and active accounts for identity fraud.
- Analyzed customer fraud claims and recover losses associated with subscription fraud.
- Responsible for conducting internal fraud investigations involving [company name] sales associates.
- Developed new and innovative ways to help implement business solutions to improve fraud detection.
- Created investigative reports describing the source of potential fraud, recommending corrective action.
- Work closely with local state & federal law enforcement agencies to assist with the prosecution and investigation of external fraud cases.
0-5 years of experience
Demonstrate strong compliance knowledge by researching regulations and policies, the provider’s background, history and any other information
- Accountable for the recovery of over $3 million dollars to the Medicare Trust Fund
- Coordinate efforts with the Office of the Inspector General, Federal Bureau of Investigations and the United States Attorney’s Office to combat fraud, waste and abuse in the Medicare and Medicaid Healthcare Programs
- Quickly and effectively handle customer challenges, using excellent analytical and problem solving abilities
- Using persuasive and assertive presentation skills to deliver complex information to non-technical audiences
6-10 years of experience
Used 10 key to process monetary transactions
- Identify and research incidents and/or allegations involving existing accounts
- Ensures compliance with policies and procedures set by Corporate Security
- Review of new account, negative balance, ACH reports, call center fraud notification, in addition to any suspicious activity on existing accounts
- Maintained and balanced a cash drawer daily.
- Responded to customer inquiries regarding their account and offer Bank products
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Fraud Investigator
Last edited by: Gabriela Barcenas, CPRW, Content Writer II -
Gabriela Barcenas
CPRW, Content Writer IIGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
