Summary
Work History
Education
Skills
Generic
Brenda Rivera

Brenda Rivera

Casselberry,FL

Summary

Motivated Fraud Investigator with 25 years of expertise investigating complex suspicious claim activity for Progressive Insurance Company and Allstate Insurance Company. Experience includes first and third party claim handling, litigation oversight and management and supervision with a combined 33 years of claims handling in the automobile insurance industry. Excels in identifying, ,gathering, analyzing and reporting evidentiary findings on claims investigations. Dedicated to detect, deter and defeat fraud in the insurance industry.

Work History

Insurance Fraud Investigator and Supervisor

Progressive Insurance
Maitland, FL
01.2003 - Current
  • Conducted prompt and thorough investigations on referred files.
  • Analyzed large amounts of data to find patterns of fraud and anomalies.
  • Contacted customers directly to notify of fraudulent activity and minimize impacts.
  • Summarized all key information regarding investigation into detailed report for delivery to client.
  • Gathered evidence, which included recorded and written statements, financial documentation and audio materials for examination.
  • Reviewed reports and individual transactions which appeared suspicious to uncover possible fraudulent activity.
  • Collaborated with team members to discuss fraud trends and brainstorm methods to combat this type of crime.
  • Provided exemplary level of customer service to clients and company personnel.
  • Conducted research, gathered information from multiple sources and presented results.
  • Participated in team-building activities to enhance working relationships.
  • Resolved problems, improved operations and provided exceptional service.
  • Completed paperwork, recognizing discrepancies and promptly addressing for resolution.
  • Interviewed witnesses thoroughly, asking appropriate questions to ascertain critical details about each case.
  • Tracked fraud cases and monitored trends to develop strategies for prevention.
  • Produced detailed reports of fraud investigations and presented findings to senior management.
  • Collaborated with internal and external stakeholders to create and maintain fraud prevention strategies.
  • Coached and trained staff on fraud prevention techniques to increase awareness and reduce risk.
  • Worked with third-party vendors to access and analyze data and systems.
  • Established and maintained positive working relationships with external law enforcement agencies to support fraud investigations.
  • Evaluated customer data to identify and prevent fraudulent activities.
  • Reviewed transactions and receipts to identify any suspicious activity.
  • Conducted research and interviews with relevant stakeholders to gather evidence and build case files.
  • Analyzed financial statements to identify discrepancies, irregularities and fraudulent activity.
  • Performed risk assessments to determine level of fraud risk and prioritize investigations.
  • Trained team members in investigative techniques and policies.
  • Conducted investigations into eternal and external customer complaints.
  • Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
  • Maximized performance by monitoring daily activities and mentoring team members.
  • Managed and motivated employees to be productive and engaged in work.
  • Evaluated employee performance and conveyed constructive feedback to improve skills.
  • Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
  • Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
  • Established team priorities, maintained schedules and monitored performance.

Sr. Investigator and Manager

Allstate Insurance Co
Maitland, FL
08.1990 - 01.2003
  • Engaged with customers to effectively build rapport and lasting relationships.
  • Updated documents, prepared reports and maintained case files.
  • Planned and supervised surveillance operations.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Provided primary customer support to internal and external customers.
  • Conducted investigations into Suspicious accidents, Medical Provider Fraud, Suspect Injuries and customer complaints.
  • Conducted thorough face-to-face interviews with employers, families, neighbors, friends, and suspects, and documented investigative findings.
  • Conducted interviews with witnesses and clients.
  • Collected, analyzed and interpreted information, documentation, and physical evidence associated with investigations.
  • Carefully documented statements, observations, and evidentiary materials.
  • Documented findings and prepared detailed reports.
  • Prepared case reports from allegations, transcripts of interviews and physical evidence.
  • Testified in court during civil suit proceedings and trials.
  • Supervised and motivated field investigators and collaborated with personnel to identify strengths and areas of weakness.
  • Organized and executed undercover surveillance operations.
  • Boosted productivity by training and guiding 8 employees.
  • Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
  • Maximized performance by monitoring daily activities and mentoring team members.
  • Maintained professional, organized, and safe environment for employees and patrons.

Education

High School Diploma -

Colonial High School
Orlando, FL

Computer Programming, Specific Applications

Central Florida Computer Institute
Orlando, FL

Claims Law

American Educational Institute
Virtual - Self Study

Skills

  • Understanding of insurance business
  • Fraud detection and prevention
  • Insurance coding (ICD-9 and CPT)
  • Fraud claims handling
  • Insurance claims and denial processes
  • Diagnosis and testing
  • Familiar with commercial and private insurance carriers
  • Reporting and data gathering

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Brenda Rivera