Angela Mosher
Buffalo,MO
Summary
Adept at legal research and fostering teamwork, I excelled at Optum, UnitedHealth Group, by spearheading fraud investigations, enhancing compliance, and minimizing financial risks through innovative data analysis and investigative techniques. Achieved significant case resolutions, demonstrating a blend of rigorous regulatory knowledge and effective communication. Motivated Fraud Analyst touting 4 years of expertise investigating suspicious activity for healthcare insurance. Knowledgeable resource committed to finding answers and working with clients and interdepartmental personnel. Promoting exemplary skills in investigating, analytics and fraud pattern detection.
Overview
12
12
years of professional experience
Work History
Senior Fraud Investigator
Optum, UnitedHealth Group
08.2022 - Current
- Ensured compliance with industry regulations by staying up-to-date on relevant laws and incorporating necessary changes into investigative practices.
- Reviewed records which appeared suspicious to uncover possible fraudulent activity.
- Evaluated provider data to identify and prevent fraudulent activities.
- Interviewed witnesses thoroughly, asking appropriate questions to ascertain critical details about each case.
- Conducted thorough investigations on suspicious cases, ensuring timely resolution and minimizing financial impact.
- Analyzed large amounts of data to find patterns of fraud and anomalies.
Senior Investigator
Optum, UnitedHealth Group
01.2020 - 01.2022
- Developed comprehensive cases that effectively communicated investigation findings to decision makers.
- Updated documents, prepared reports, and maintained case files.
- Carefully documented statements, observations, and evidentiary materials.
- Prepared case reports from allegations, transcripts of interviews and physical evidence.
Inpatient Claims Processesor
United Healthcare, UHG
01.2013 - 01.2020
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Managed workload and priorities to meet claims processing deadlines.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
Education
Bachelor of Science - Sociology
Southwest Baptist University
Bolivar, MO05-2011
Skills
- Legal Research
- Background Checks
- Teamwork and Collaboration
- Insurance fraud
- Evidence collection
- Investigative techniques
- Telephone and email etiquette
- Effective Communication
- Verbal and written communication
- Regulatory knowledge
- Data Analysis
- Procedure review
Affiliations
- ACFE
- NHCAA
Timeline
Senior Fraud Investigator
Optum, UnitedHealth Group
08.2022 - Current
Senior Investigator
Optum, UnitedHealth Group
01.2020 - 01.2022
Inpatient Claims Processesor
United Healthcare, UHG
01.2013 - 01.2020
Bachelor of Science - Sociology
Southwest Baptist University