Ervington Saulter
Tampa,FL
Summary
Hard-working professional with 7+ years of experience and a proven knowledge of investigation and compliance. Aiming to leverage my previous skills to a position and be a positive influence on the growth of the company. Possess a proven track record of delivering results through expert investigative techniques and a commitment to upholding the highest ethical standards. Adept at gathering and analyzing evidence, collaborating with cross-functional teams, and delivering comprehensive reports for legal proceedings.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Special Investigations Unit Investigator
AmTrust Financial
05.2021 - Current
- Substantiated validity and admissibility of evidence and preserved data integrity for court hearings.
- Collaborate with Fraud team to recognize fraud patterns and suggest new methods of detection, mitigation, and prevention.
- Own and manage multiple accounts, creating and maintaining accurate reports of account and vendor performance.
- Draft SARs/Fraud Referrals and ensure quality prior to submitting to DOI
- Ensured compliance with legal regulations during investigations, minimizing risk for litigation or procedural errors.
- Enhanced department efficiency with streamlined processes to help achieve department goal of 6.5M
- Conducted independent reviews of potentially suspicious activity involving claimant, insured, provider fraud- CDD, EDD, KYC procedures
- Provide recommendations for risk controls, fraud detection, prevention based on data analysis.
- Guide and supervise case from beginning to end while providing insight and recommendations to internal stakeholders
- Assist and support the entire organization with due diligence processes regarding KYC related matters and screened companies prior to accepting as a client
Workers' Compensation Claims Manager
AmTrust Financial
11.2019 - 05.2021
- Examined claims forms and other records to determine insurance coverage.
- Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
- Synthesized data into comprehensive quarterly written reports for management.
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Trained other claims staff members on proper handling and evaluation of injury claims.
- Analyze and interpret medical and legal documents to assess the extent of injuries and determine appropriate compensation.
- Maintain a high level of customer service by responding to inquiries and providing updates to all involved parties.
- Gathered information from various third parties to determine claim acceptability.
- Managed moderate to complex claims with a caseload ranging from 125-175 claims
Fraud Prevention Specialist
Alight Solutions
01.2019 - 11.2019
- Evaluate and effectively challenge quantification methods used to measure financial and credit risk exposures and communicate the results clearly and effectively to the Management team.
- Review customer accounts for suspicious activity, documented findings and escalated case for further investigations
- Interviewed witnesses thoroughly, asking appropriate questions to ascertain critical details about each case.
- Reviewed reports and individual transactions which appeared suspicious to uncover possible fraudulent activity.
- Gathered evidence, which included recorded and written statements, financial documentation and audio materials for examination.
- Handled 25-35 calls per day to address customer inquiries and concerns.
- Reduced fraudulent activities through continuous monitoring of financial transactions and customer behaviors.
- Proficient in various financial fraud prevention systems, ex. Actimize, Lexis Nexis, etc.
- Enhanced fraud detection by implementing advanced data analytics techniques and tools.
Lead Bank Teller
SunTrust
07.2017 - 01.2019
- Answered customer inquiries regarding account balances, transaction history, services charges and interest rates.
- Built and strengthened customer relationships by leveraging excellent interpersonal and communication skills.
- Reconciled cash drawer and resolved discrepancies.
- Logged cashier's checks and other transactions to maintain accurate account records.
- Learned about customer's financial needs, established trust and optimized sales opportunities resulting in quality customer service.
- Identified sales opportunities and referred customers to branch partners in financial services.
- Conducted CTR reports and communicated with branch personnel on findings
- Conducted enhanced customer due diligence on high risk customers prior to proceeding with transactions
Senior Human Services Program Specialist
Agency For Health Care Administration
10.2015 - 07.2017
- Receive and review Quarterly Fraud Abuse and Activity Reports (QFAAR) and Annual Fraud Abuse and Activity Reports (AFAAR).
- Kept and established comprehensive case files to support proper documentation and record retention.
- Adhered to strict client confidentiality laws and site-specific procedures to uphold privacy and provide best experience possible.
- Utilized complex client management systems, both digital and manual and maintained sensitive information in highly encrypted databases.
- Provided daily management and operational oversight on federally funded grant programs through Medicaid such as (Humana, Coventry, and Welfare).
Education
Bachelor of Arts - Criminal Justice
Saint Leo University
Saint Leo, FL06.2018
Skills
- Compliance Reporting
- Investigations Expertise
- Conflict Management
- Client Communication
- Team Leadership
- Project Management
- Risk Assessment
- Data Management
- Legal Knowledge
- In-depth Research Skills (CDD, EDD, KYC)
Certification
Certified Fraud Examiners License: In Progress
Expected Completion: September 2024
Timeline
Special Investigations Unit Investigator
AmTrust Financial
05.2021 - Current
Workers' Compensation Claims Manager
AmTrust Financial
11.2019 - 05.2021
Fraud Prevention Specialist
Alight Solutions
01.2019 - 11.2019
Lead Bank Teller
SunTrust
07.2017 - 01.2019
Senior Human Services Program Specialist
Agency For Health Care Administration
10.2015 - 07.2017
Bachelor of Arts - Criminal Justice
Saint Leo University
Certified Fraud Examiners License: In Progress
Expected Completion: September 2024
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