Open To Work
Brenda Rivera
Winter Springs
Summary
Accomplished investigator with a strong background in fraud detection and case management. Skilled in conducting thorough investigations, mentoring aspiring professionals, and collaborating with stakeholders to achieve compliance and operational excellence. Dedicated to leveraging investigative expertise to drive impactful results in the insurance industry.
Overview
35
35
years of professional experience
1
1
Certification
Work History
Major Case Specialist
Progressive Insurance Company
01.2003 - 01.2025
- Conduct complex claims investigations involving suspicions of individual and organized insurance fraud schemes.
- Proactively detect and consult with claim partners potential schemes to defraud customers, Progressive Insurance and the insurance industry.
- Conducted background checks using various investigative tools to identify potential fraud risks.
- Professional licensing searches, medical bill/record reviews and Examinations Under Oath/Recorded Interviews of all pertinent parties in person or virtually.
- Gathered information, dissected data, analyzed investigative findings, and prepared timely reports recommending investigative direction to claims adjusters, upper management, and legal.
- Developed and delivered fraud awareness and SIU-specific software training to claim partners to enhance fraud detection capabilities.
- Provide mentorship and assist with training to employees aspiring to work in SIU or new to the role.
Sr. Claims Investigator/SIU Manager
Allstate Insurance Company
01.1990 - 01.2003
- Led team of investigators in Northeast Florida's Special Investigations Unit, focusing on fraud detection and prevention.
- Conducted complex claims investigations, targeting specific fraud rings and providers.
- Assigned cases and conducted quality reviews, providing coaching and performance evaluations to enhance team capabilities.
- Motivated team members and facilitated team productivity, ensuring thorough and high-quality investigations.
- Responded to civil remedy and insurance commissioner complaints.
Education
Diploma - Computer Operations
Central Florida Computer Institute
Orlando, FL09-1985
High School Diploma -
Colonial High School
Orlando06-1983
Skills
- Fraud detection
- Investigative interviewing
- Strategic case management
- Case report documentation
- Regulatory compliance
- Policy analysis
- Data analysis
- Records management
- Document management
- Data entry and organizational skills
- Time management and multitasking
- Cross-functional collaboration
- Stakeholder engagement
- Stakeholder presentations
- Research skills and active listening
- Confidentiality and case planning
References
- Edward Abujaber, Manager, Progressive Major Case Unit, Senior Director, National Accounts, Insurance Auto Auctions, 863-370-8276
- Deanne Ricci, Major Case Investigator, Liberty Mutual Insurance, 352-459-8583
- Kathryn Columbia, Special Investigator, National General Insurance, 321-614-8741
Professional Associations Licenses Certifications
- IASIU member (International Association Special Investigations Unit), 01/01/03, 12/31/25
- FIFEC (Florida Insurance Fraud Education Committee) Operations board member, 01/01/21, current
- Member, SCLA (Senior Claims Law Associate), 01/01/01, current
- Florida 6-20 License (Florida All-Lines Adjuster License), 01/01/92, current
Certification
- Florida All Lines Adjusters License
- SCLA - Senior Claims Law Associate
Accomplishments
- Team Excellence Award Level II - PIP Centralization Team 1993
- Employee of the Quarter - 3rd Quarter 1991
- Individual Service Award 4th Quarter 2000
Work Preference
Job Search Status
Open to workWork Type
Part TimeContract WorkLocation Preference
RemoteHybridSalary Range
$45000/yr - $200000/yrTimeline
Major Case Specialist
Progressive Insurance Company
01.2003 - 01.2025
Sr. Claims Investigator/SIU Manager
Allstate Insurance Company
01.1990 - 01.2003
Diploma - Computer Operations
Central Florida Computer Institute
High School Diploma -
Colonial High School