Sample Medicare Fraud Investigator Resume

Posted in Investigator Resume Examples

David Mayo
4828 Amethyst Drive
Okemos, MI 48864
(333)-312-2153
[email]

Career Objective To work hand in hand with established firm in which to put my investigative skills to good use while enhancing my skills and knowledge in this field.

Summary of Qualifications:

  • Remarkable experience in Medicare medical/utilization review and investigation
  • In-depth knowledge of Medicare and Medicaid data
  • Wide knowledge of medical terminology
  • Ability to perform research and draw conclusions
  • Ability to develop a case file, accurately and correctly document all steps taken
  • Ability to prepare correspondence, reports and referral summary letters
  • Excellent ability to communicate effectively, internally and externally
  • Ability to interpret laws and regulations

Work Experience:

Medicare Fraud Investigator, August 2005 – Present
Medical Related Company, Okemos, MI

  • Contributed to the development of new ideas and methods.
  • Supervised and provided the experience to functional project teams and took part in cross-functional initiatives.
  • Mentored and guided lower level employees.
  • Served as an expert providing direction and guidance to process enhancements and establishing policies.
  • Presented the organization to outside customers and clients.

Medicare Fraud Investigator, May 2000 – July 2005
Forensic Medical, Okemos, MI

  • Detected the Medicare claims fraud by implementing a wide variety of proactive strategies.
  • Planned, designed and executed the investigations of Medicare fraud by focusing on identifying deviant claims patterns and fraud indicators.
  • Developed fraud case referrals for referral to law enforcement.
  • Supported subsequent law enforcement actions by aiding law enforcement agents and prosecutors in further case development and testified in court.
  • Recognized national fraud trends and prepared fraud alerts and vulnerability reports.

Education

Bachelor’s Degree in Business Administration, William Carey University, Hattiesburg, MS

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