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Click here or scroll down to respond to this candidateCandidate's Name
Norfolk, VA Street Address
EMAIL AVAILABLE
PHONE NUMBER AVAILABLE
Remote Dynamic Data Entry Fruad Specialist with 3 years of success in gathering and digitizing fraudulent
data, maintaining metrics, implementing data entry standards, and ensuring data accuracy. Proven
capacity to work with a wide range of databases, while leveraging a keen eye for detail in ensuring 100%
accuracy. Offering proficiency in many different software and programs, and exceptional communication,
organizational, time management, and typing skills. I have 6 years of remote claims specials experience
with car insurance and also healthcare experience with 6 years of experience providing quality care and
support to individuals with disabilities. I have a proven track record of medical terminology and recording
and entering data into client profile and physician data systems. I am looking to climb the ladder and
move up within a company, I want a career, not just a job.
Authorized to work in the US for any employer
Work Experience
Senior Resolution Coordinator II/Fraud Operations
Walmart-Remote
May 2022 to Present
Data entry for explaining why a customers case is fraudulent or not.
Working customers accounts and doing research to decide whether the customer engaged in fraudulent
activity.
Work on claims, appeals, denials, suspension of account or any follow up action needs to be taken.
Transferred back and forth through multiple programs to determine whether cases were fraudulent
and non fraudulent.
Worked with customers confidential information and maintained the safety and security of each and
every one.
Develop and implement a comprehensive strategy for fraud prevention and investigations, in
collaboration with compliance, legal, cyber security, product, vendors, field, and global security teams.
Performing data analytics using company systems and tools to identify potential fraud, waste, and
abuse.
Identifying new fraud trends through in-depth investigation.
Up-skilled many times and kept my metrics above average at all times.
Home Health Aide (HHA)
Hotep Home Health-Virginia Beach, VA
January 2022 to March 2024
Kept track of patient care, condition, progress, and problems, then report supervisor or emergency
personnel if needed.
Ensured the well-being, safety, and comfort of clients in accordance with physicians' orders.
Built rapport in order to create a safe and trusting environment in which to provide care.
Provided mental and emotional support to clients in order to improve physical outcomes and overall
happiness and independence.
Maintained a strong understanding of medications and medical terminology and continued to learn
through extensive training monthly.
Ensured the prescribed medications was given to client in the correct time frame throughout the day.
Did daily documentation to reflect the day to day changes and come up with support plans to fix any
issues that arise.
Claims Specialist
GEICO-Virginia Beach, VA
May 2016 to August 2022
Determines covered insurance losses by studying provisions of a policy or certificate.
Establishes proof of loss by studying documentation and assembling additional information from outside
sources.
Documents specific claims by completing and recording forms, reports, logs, and records.
Analyzes insurance claims to prevent fraud.
Prepares reports by collecting, analyzing, and summarizing information.
Resolves claims by approving or denying documentation, calculating benefits due, and determining
compensation settlement.
Ensures legal compliance by following company policies, procedures, and guidelines, as well as state
and federal insurance regulations.
Maintains quality customer service by following customer services practices and responding to
customer inquiries.
Provides legal support by assembling documentation for settlement action.
Protects operations by keeping claims information confidential.
Maintains a good relationship with insurance departments.
Customer Service Team Lead/ Shipping & Printing
FedEx Office-Chesapeake, VA
January 2020 to January 2022
Answered 20-60 calls per shift by answering customers questions or concerns, retrieving customer
information, presenting relevant product information, and canceling services.
Processed purchases and handled payment transactions using a POS system.
Processed sales and return transactions in a timely and accurate manner to ensure customer
satisfaction.
Under guidance of management, coordinate work tasks for assigned team and ensure manpower is
available to perform required work.
Dealt with customer requests and concerns creatively.
Managed customer relations and customer service through daily communication and interaction.
Coordinate and perform duties of assigned team.
Created schedules and modified when necessary.
Preserved revenue streams where possible, using refunds as a last resort to maintain customer
satisfaction with strong communication and negotiation skills.
Educated customers about promotions to increase sales.
Direct Support Professional
Saint Mary's Home for Disabled Children-Norfolk, VA
April 2016 to January 2020
Establishing a secure, positive environment that nurtures residents' needs, self-expression, and goals.
Overseeing residents and taking care of their needs, and performing housekeeping duties.
Delivering individualized training and care for residents in compliance with healthcare professionals
instructions and other specific guidelines.
Advancing residents decision-making, productivity, and participation in a range of activities.
Promoting independence and growth by teaching classes daily which differs from each individual as
they have their own needs to work on.
Facilitate resident s inclusion in the community's experiences and activities.
Maintaining knowledge of residents day to day changes and communicated this with family and
physicians.
Complying with the facility s policies and procedures.
Maintaining documentation in compliance with company procedures.
Operating facility's vehicles in compliance with company policies and governmental statutes.
Understanding medical terminology and continuing to learn as this is very important when relaying
information to physicians.
Education
Certificate in CNA
Tidewater Community College - Norfolk, VA
January 2016 to April 2016
High School Diploma
Liberty County High School - Hinesville, GA
April 2006 to August 2010
Skills
Developmental Disabilities Experience
Customer service (8 years)
Fraud prevention and detection (1 year)
Microsoft Office (5 years)
Problem solving (5 years)
Critical thinking (6 years)
Data analysis skills (2 years)
Project leadership (2 years)
Case Management
Fraud Detection (1 year)
Medical Terminology (8 years)
Teamwork (6 years)
Fraud prevention and detection (1 year)
Remote Work (6 years)
Data Analytics
Cybersecurity
Databases
Computer Networking
Process Improvement
Microsoft Word
Additional Information
Hand picked for many different pilot trainings at Walmart for the Fraud department.
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