497 Turkey Pen Road
New York, NY 10013
Career Objective To obtain a SIU Investigator position with company seeking dedicated and hard working employee.
Summary of Qualifications:
- Remarkable experience in FWA detection, prevention and correction techniques
- Profound knowledge of insurance and claim operations, commercial, personal, and Workers Compensation insurance products and litigation management
- Skilled in writing, interviewing, strategizing and question formulation and presenting information
- Profound knowledge of regulatory issues and case law effecting medical investigations
- Sound knowledge of medical terminology, CPT and ICD-9 coding
- Exceptional ability to handle heavy workload and meet critical regulatory guidelines
- Ability to organize and handle a heavy case load
- Excellent oral and written communication skills
SIU Investigator, August 2005 – Present
Universal American, New York, NY
- Developed and prepared internal Fraud Alerts for company-wide distribution.
- Communicated through telephone interview with members, pharmacies, providers and third parties.
- Conducted and assisted on site audits of pharmacies.
- Met all regulatory and departmental deadlines.
- Developed and maintained contacts and liaison with law enforcement, regulatory agencies, and task force members.
SIU Investigator, May 2000 – July 2005
Direct Auto Insurance, New York, NY
- Recognized suspect issues and prepared an investigative strategy for determining the validity of the claim.
- Analyzed and developed leads for the proper verification of facts and circumstances.
- Developed and executed investigative Action Plans for all referred claims.
- Prepared daily investigative notes and reports in an efficient, cohesive and chronological manner.
- Provided evidence and testified in civil and criminal cases related to investigations.
Bachelor’s Degree in Business Administration, Johnson State College, Johnson, VT