Sample SIU Investigator Resume

Posted in Investigator Resume Examples

Jesse Ferree
497 Turkey Pen Road
New York, NY 10013
(111)-223-6434
[email]

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

Work Experience:

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.

Education

Bachelor’s Degree in Business Administration, Johnson State College, Johnson, VT

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