Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Bryan Hernandez

Austin,TX

Summary

Diligent SIU Investigator with extensive experience in identifying and investigating fraudulent activities. Skilled in conducting thorough investigations and collaborating with law enforcement agencies. Demonstrated ability to analyze complex data and use advanced techniques to detect irregularities.

Overview

5
5
years of professional experience

Work History

Lead Fraud Investigator

The Cigna Group
03.2022 - Current
  • Conduct comprehensive investigations into healthcare fraud, waste, and abuse across various lines of business, including Commercial, Individual/Family Plans (IFP), and Medicare.
  • Employ strong preliminary investigative techniques to proactively identify and prevent fraudulent activities, ensuring compliance with industry regulations and company policies.
  • Utilize data analysis tools, such as Microsoft Excel and Microsoft Access, to analyze healthcare data and identify suspicious medical codes and provider activities. Conduct detailed assessments of claims data to uncover patterns of fraud.
  • Perform in-depth interviews with healthcare providers, patients, and other relevant stakeholders. Conduct on-site audits and review medical records to gather evidence, building comprehensive investigation packages for potential legal action.
  • Collaborate with the internal legal department to develop and execute settlement agreements with investigated providers, ensuring proper documentation and adherence to regulatory requirements.
  • Work within a multi-state team to manage a diverse range of investigations, including Durable Medical Equipment (DME), laboratory fraud, broker fraud, and rehabilitation facility fraud. Ensure compliance with CMS guidelines and state-specific regulations.
  • Exercise sound judgment to halt claim payments, assert overpayments, and take corrective actions. Collaborate with local, state, and federal law enforcement agencies for investigation support and referrals when necessary.
  • Train and mentor newly hired investigators on claims systems, auditing tools, and standard operating procedures, fostering a strong team environment and ensuring effective knowledge transfer.

Crime Analyst

Texas Department of Public Safety
10.2021 - 03.2022
  • Collected, analyzed, and disseminated a wide variety of data and information between local, state, and federal jurisdictions to support and enhance the successful investigation and prosecution of individuals and groups engaged in criminal activities.
  • Utilized multiple databases including open-source data to compile descriptive statistics on various analytical software illustrating patterns and trends of crime.
  • Prepared periodic analysis reports relative to crime developments, either as they occurred or as they were predicted to occur in the future.
  • Provided assessments related to the threats against, and vulnerabilities of identified state infrastructure.
  • Performed ad hoc tasks, such as drafting administrative subpoenas to support the Criminal Investigation Division (CID) and the Texas Rangers.

Correctional Officer IV

Texas Department of Criminal Justice
02.2020 - 10.2021
  • Participated in daily briefings with officers and supervisors to plan, strategize, and coordinate daily operations, ensuring alignment with productivity goals.
  • Supervised offenders in both housing and work areas, ensuring high levels of productivity while maintaining security and order. Trained new employees on facility policies, procedures, and operational protocols to ensure compliance and efficiency
  • Conducted audits and reviews of building and facility offender counts to ensure accuracy and safety.
  • Analyzed offender records to assess health and safety concerns, providing leadership and technical guidance to staff. Ensured compliance with policies, rules, and regulations, while enforcing disciplinary measures as necessary. Maintained accurate records, forms, and reports.
  • Responded to emergency situations, demonstrating composure under pressure and employing problem-solving skills to resolve incidents effectively

Education

Master of Science - Business Analytics

The University of Texas Rio Grande Valley
Edinburg, TX

Bachelor of Science - Criminal Justice

The University of Texas Rio Grande Valley
Edinburg, TX

Skills

  • Auditing
  • Medical Coding
  • Investigative Interviewing
  • Investigative Reporting
  • Data Analysis
  • R
  • Python
  • Tableau
  • SQL
  • Microsoft Office (Word, Excel, Access, SharePoint, PowerPoint)

Languages

spa
Native or Bilingual

Timeline

Lead Fraud Investigator

The Cigna Group
03.2022 - Current

Crime Analyst

Texas Department of Public Safety
10.2021 - 03.2022

Correctional Officer IV

Texas Department of Criminal Justice
02.2020 - 10.2021

Bachelor of Science - Criminal Justice

The University of Texas Rio Grande Valley

Master of Science - Business Analytics

The University of Texas Rio Grande Valley
Bryan Hernandez