Resume
Experience
2024 - current
Fraud Investigator
Blue Cross Blue Shield of MI
Detroit, MI
As a Healthcare Fraud Investigator I am responsible for identifying, investigating, and preventing fraudulent activities within the healthcare system. I review medical claims, billing records, and insurance policies to detect suspicious patterns, such as overbilling, false claims, or misrepresentation of services. I also collaborate with law enforcement, healthcare providers, and insurance companies to gather evidence, interview witnesses, and ensure compliance with regulations.
2022 - 2024
Sr. Investigative Analyst
Blue Cross Blue Shield of MI
Detroit, MI
As a Senior Healthcare Fraud Analyst, I analyzed large sets of medical claims and billing data to detect suspicious patterns, conduct in-depth investigations, and collaborate with healthcare providers, insurance companies, and law enforcement. In this role I developed strategies to mitigate fraud risks, prepared detailed reports, and provided insights to improve organizational policies.
2018 - 2021
Investigative Data Analyst
Blue Cross Blue Shield of MI
Detroit, MI
As an Investigative Data Analyst it was my overall goal to analyze aberrant behavior to refer for investigation. Leads were generated from an analytical tool and data was queried and analyzed to either support the behavior or determine risks. If risks were determined, an analytics report was written provided to an investigator to initiate complete investigation. Support was provided throughout the course of the investigation until completion. It was necessary to stay abreast of fraud trends and schemes in order to identify potential outliers.
October 2024
Bachelor of Science in Project Management
I hold a Bachelor of Science in Project Management. During my time obtaining my degree I have taken courses in Project Management, Business and Finance while obtaining other relevant certifications.
October 2021
AHFI
NHCAA
I obtained an Accredited Healthcare Fraud Investigator certification from National Healthcare Anti-Fraud Association.
Professional skillset
Investigations
Data Analytics
Project Management
Report Writing
Professional Affiliations
National Healthcare Anti-Fraud Association (NHCAA), member
National Management Association (NMA), member
Healthcare Fraud Prevention Partnership (HFPP), member