Senior Fraud Investigator Resume

PROFESSIONAL EXPERIENCE

Confidential

Senior Fraud Investigator

Responsibilities:

I Interviews participants who are under care, under application that are under investigation, examining information presented/invalidating fraudulent documents.
W Writes reports/summaries including problems/ Confidential /findings/recommendations/other factors, to create comprehensive case files/electronic records upon which decisions/recommendations/judgements can be made.
A Assist with supervisory functions including assuming full supervisory responsibilities during the absence of the supervisor and on an ongoing basis, provides one to one training to new investigation.
A Attends/participants in supervisory, one - on-one case conference sessions as requested/ specified, to consult with update supervisor on status of cases/reassign/reassess priority order of active case/change course of action from original work plan.
P Prepares completes daily weekly/monthly activity sheets/schedules, specifying/entering data of case specific information work performed/schedules/time spent, by making work performed/schedules/time spent, by making entries’ on a daily basis/ totaling the information following a standard format, to provide/document a record of activities.

Confidential

Senior Fraud Investigator

Responsibilities:

I Investigate Confidential of suspected fraudulent acts and violations of Medicaid laws, rules, regulations, policies and procedures via field visits and surveillances to gather evidence substantiating Confidential / Confidential for Fair Hearing court cases.
R Receive/review case referrals from the District Attorney/Inspector General’s office; administrative disqualification hearings, civil litigation or prosecution.
V Verify documents validate fraudulent documents and gather evidence and/or statements in order to prepare cases for field visits or further investigation of Medicaid applicants/participants.
G Gather pertinent information, reports, statements, affidavits, review credit reports and other forms of evidence to draw logical conclusions; legal actions or for presentation in Fair Hearings proceedings.
T Train and mentor entry level fraud investigators in various caseloads.
S Supervise units in the absence of unit supervisor Achievements
R Responsible for savings over $3,500,000 in fraudulent and erroneous Medicaid payments.

Confidential

Fraud Investigator

Responsibilities:

Review, evaluated, analyzed and assess resources of Medicaid applicants through various resources including: computer matches, nursing home documentation and financial records; In House and Field investigations
Ensure cash assistance payments were made in compliance with Agency requirements; knowledgeable of Federal, State and City policies and procedure and recoup and collected all monies issued in error.
Created and maintained data on excel spreadsheets for tracking and analysis purposes of cash expenditures; insuring appropriate cash payments were made and accurate, timely investigations were instituted.
Interfaced and issued reports to Agency attorneys and the NYC Department of Investigations for possible use in criminal prosecution.

Confidential

Fraud Investigator

Responsibilities:

Investigated fraud through and due to improper filing of applications, inappropriate receipts, misconduct or criminal acts.
Conducted field investigations through at home interviews with a wide range of clientele.
Determined eligibility, reduction, recoupment or termination of Medicaid Services.
Prepared reports documenting cases that may be incorporated as evidence in a criminal investigation
Trained, planned, managed and reviewed work of subordinates.
Scrutinized and prepared statistical, quantitative, qualitative and financial data analysis, prepared reports based on this information and interfaced with management regarding policy decisions based on the information.