Summary of Qualifications A talented and ambitious, coachable and committed retired Law Enforcement Officer with customer service skills, strong technical background skills that possesses self-discipline, and the ability to work with minimum supervision playing key roles throughout the company structure, salesmanship ensuring quality solutions to meet corporate objectives. Possesses a good team spirit, is deadline-oriented and has the ability to organize, present complex solutions clearly and accurately. In the roles I've been responsible for I've conducted high level, complex investigations of known or suspected acts of healthcare/disability fraud and abuse. Routinely handles cases that are sensitive or high profile, those that are national in scope, complex cases involving multi-disciplinary provider groups, or cases involving multiple perpetrators or intricate healthcare fraud schemes. The investigations I've conducted prevented payments of fraudulent claims committed by insured's, providers, claimants, customer members, etc. Makes referrals, both internal and external, in the required timeframe according to company policies. Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators. Assists Investigators in identifying resources and best course of action on investigations. In cooperation with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings. Provides input regarding controls for monitoring fraud related issues within the business units. Completes Proactive work by Utilizing antifraud technology, investigative and analytical strategy to identify potentially suspicious claims and drive SIU referrals. Maintains quality service by proactively communicating with adjusters collaborating with other departments in order to exchange information and coordinate activities returning calls in a timely manner.

Highlights:

• Billing
• Fraud
• Insurance
• Insurance Claims
• Monitoring
• Training
• Account Manager
• Compliance
• Planning
• Policies and Procedures