Andrew Ryfa
Lake Hopatcong,NJ
Summary
Award-winning investigator with expertise in fraud detection through interviews, database inquiries, and investigative reporting. Mentored team members to enhance capabilities. Notable achievement includes dismantling a 30+ claim staged accident ring and obtaining a million dollar judgment. Committed to anti-fraud efforts.
Overview
16
16
years of professional experience
Work History
Special Investigator, FCLS
Selective Insurance Group of America
Branchville , USA
06.2017 - Current
- Identify, investigate, and make appropriates recommendations for the disposition of losses and claims which appear questionable or fraudulent in nature
- Act as a liaison between company and appropriate government fraud bureaus
- Conducts in-depth investigative assignments of most complex nature involving claims, underwriting and coverage issues submitted to SIU which may be suspicious and makes appropriate recommendations for the disposition of claims
- Conducts training for claims, underwriting and other business partners with regard to fraud detection, prevention and investigation
- Confers and works with law enforcement officials in civil and criminal investigations and prosecutions
- Assists defense counsel on cases in litigation due to fraud or arson
- Examines damaged property for related and/or unrelated damage, identification number tampering, maintenance stickers and proof of alleged betterment
- Keeps abreast of the latest legislation and court decisions that relate to insurance fraud and through programs set up for that purpose
- Documents every file as to action taken and information obtained as well as a complete report outlining the investigation for later use in court or other legal proceedings
PIP Claims Examiner; Claims Investigation Team; SIU PIP Liaison
Mercury Insurance Group
Bridgewater , USA
12.2009 - 06.2017
- Analyzes, adjudicates, and summarizes highly technical information related to multiple complex PIP claims and investigations
- Conduct thorough and timely complex PIP claims and suspected Fraud PIP claims in the states of New Jersey, New York, and Pennsylvania
- Focused on uncovering eligibility issues, potential PIP and/or medical fraud issues of a claim(s)
- Apply critical investigative thinking to develop PIP investigation and claims that have complex allegations and financial impacts to multiple claims and policies and/or organized ring activities
- Provide exceptional customer service by maintaining contact with claims personnel, special investigation department, customers, claimants, and medical providers throughout the life of each claim/investigation
- Acts as a liaison within the company between the Personal Injury department and the Special Investigation Unit in regards to any claims being investigated for suspected fraud
- Serves as PIP liaison/expert on medical fraud/PIP fraud within the company including handling all suspected fraud PIP claims and any PIP litigation claim
- Conduct thorough data analysis utilizing searches through ISO claims system, Accurint, vehicle locator reports, vehicle registrations, social media, review of medical billing, CPT and ICD code analysis, and provider TIN runs to develop potential fraud patterns throughout a multiple of suspected claims
- Conduct training classes for new hire employees dealing with PIP fraud related matters, investigative techniques, database searches for PIP eligibility purposes, and PIP system procedures and applications
- Assist in identifying and communicating trends in suspected PIP fraud patterns to other claims personnel
- Recipient of the Investigation of the Year for 2016 by the New Jersey Special Investigation Association (NJSIA)
- Recipient is an individual that demonstrated a strong commitment to Anti-Fraud efforts by their ability to identify and properly handle suspicious claims
- Conducted a multi claim investigation into a suspected staged auto accident fraud ring
Private Investigator; Investigator Mentor
Photofax
Gilberts , USA
12.2008 - 09.2009
- Conduct surveillance on individuals suspected of insurance or other types of fraud
- Obtain information on the individuals using an array of investigative techniques
- Write detailed reports and keep logs of daily activities on individuals, evidence of fraudulent acts
- Work independently from home but strive for teamwork and excellence that reflects upon myself and the company
- Mentor and counsel new investigators in the field by answering concerns and questions they have about the job, cases, and fieldwork
- Report these concerns and questions on a weekly basis as a progress report to upper management
Education
Fraud Claim Law Specialist (FCLS) -
American Educational Institute
11.2020
Bachelors - Criminal Justice, Psychology
Rutgers University
New Brunswick, NJ01.2008
Skills
- Interview techniques
- Investigative reporting
- Background Checks
- Claims documentation
- Interviewing experience with witnesses, claimants, and other subjects involved in a claim
- Participant in Labor Law Investigations
- Participant in large staged accident ring involving over 30 claims
- Surveillance techniques (use of prior surveillance experience along with SIU experience to conduct a thorough and relevant surveillance investigation)
- Extensive PIP fraud investigative history
- Multi-line and insurance coverage investigation experience
Accomplishments
- 2016 New Jersey Special Investigators Association (NJSIA) Award for Investigation of a large, 30+ claimant investigation into a staged accident ring involving claimants, attorneys, and medical providers involved with treating suspected claimants. Judgment was awarded at over a million dollars.
Timeline
Special Investigator, FCLS
Selective Insurance Group of America
06.2017 - Current
PIP Claims Examiner; Claims Investigation Team; SIU PIP Liaison
Mercury Insurance Group
12.2009 - 06.2017
Private Investigator; Investigator Mentor
Photofax
12.2008 - 09.2009
Fraud Claim Law Specialist (FCLS) -
American Educational Institute
Bachelors - Criminal Justice, Psychology
Rutgers University
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