Wendy Fowles
Milwaukee,WI
Summary
Professional with robust background in uncovering fraud through conducting investigations, and utilizing advanced tools to uncover fraudulent activities. Known for integrity, critical thinking, and effective communication.
Overview
22
22
years of professional experience
Work History
Child Care Subsidy Specialist
Department of Children & Families
Milwaukee, USA
09.2022 - Current
- Responsible for authorizing simple to complex childcare authorizations for parents and providers to ensure eligible children and parents participating in Wis Shares are authorized for appropriate hours of care incompliance with state and federal law
- Processes provider payments, issuing adjustments, correcting errors and file maintenance
- Conducted interviews to gather and verify relevant information entering parents schedules, answer questions about various public assistance programs, write detailed case comments, research and identify discrepancies, policies, investigate suspicious activity or documents, ensure quality assurance
- Followed all State policies and procedures to deliver quality work.
- Improved parent calls through proactive problem-solving and efficient authorization processing.
- Championed the adoption of new software (telephone system) that streamlined workflows across multiple departments.
- Received multiple positive reviews acknowledging dedication to excellent customer service.
- Provided exceptional customer support during peak periods, helping maintain the highest level of service quality despite increased demand.
- Earned recognition as an exemplary performer through consistent delivery of exceptional QA results across all assigned tasks.
Fraud Adjudicator/Team Lead
Department Workforce Development -UI
Milwaukee, USA
03.2020 - 09.2022
- Conducted thorough investigations into suspected fraudulent activities, resulting in timely resolution of cases.
- Effectively manages multiple cases with very limited supervision
- Knowledge of starting a UI Claim from receiving the initial claim, investigating the claim to see if it is eligible for regular UI or PUA, setting up the claim to be paid or denied, creating AD holds for specific weeks, preparing the approval and/or denial letters (QE402 or 452) to the claimant regarding his/her claim and finally closing the claim once all procedures are completed
- Trained to handle more complex claims
- Became a Mentor to approximately 62 new hires after working for one-month in this position
- Reviews and updates claims of other coworkers for completion, accuracy, routing and resolution
- Problem solving and completing several complex claims
- Assists Adjudicators and Legislative Assistants with priority claims to ensure a timely and satisfactory resolution
- Ensures that work is accurate and complete, processed in a timely manner with proper spelling and grammar
- Ensured accurate determinations with meticulous research and thorough investigation of disputes.
- Continuously updated personal knowledge on relevant laws, regulations, and policies affecting the adjudication process within the jurisdiction served.
- Improved claim processing times by implementing efficient workflows and prioritizing urgent cases.
- Evaluated claims by analyzing case files, conducting interviews, and reviewing relevant documentation.
- Leveraged strong negotiation skills to mediate disputes between parties and facilitate mutually agreeable settlements where possible.
- Reduced case backlogs by effectively managing workload and meeting strict deadlines for resolution.
- Streamlined case management processes to expedite resolution times while maintaining accuracy in decision making.
- Utilized advanced problem-solving skills to navigate complex issues and reach fair, well-reasoned decisions that withstood scrutiny during appeals or further reviews.
- Promoted fairness in adjudications through impartial assessment of facts and unbiased application of legal principles.
- Mentored junior adjudicators on best practices, contributing to enhanced team performance overall.
- Improved customer trust by promptly addressing and resolving reported instances of identity fraud.
Executive Legal Assistant
Crivello Carlson
Milwaukee, USA
10.2004 - 02.2020
- Company Overview: Milwaukee, WI
- Handled heavy caseload and assisted with all aspects of the litigation cycle including legal research, factual investigation, medical records review, document management and trial preparation
- Drafted legal documents including motions, brief inserts, discovery documents, correspondence and legal memoranda
- Milwaukee, WI
Education
Associate of Applied Science - Paralegal Studies
Milwaukee Area Technical College
Milwaukee, WI06-1999
Skills
- Excellent customer service
- Critical Thinking
- Organizational Skills
- Documentation management
- Expert problem solving
- Fraud investigation of government money (Unemployment)
- Interview techniques (conducting interviews, collecting and researching evidence, recommendations)
- Written communication and documenting information received by clients
- Interpreting & applying childcare policies, procedures and State statutes
- Proficient in multiple software programs (CSAW, CARES, CWW, ECF, BRITS, Mainframe,
Accomplishments
- Mentor in PI (fraud investigations) assisted new employees with policies and procedures relating to fraudulent unemployment claims.
- Above & Beyond Hero Award: Going above and beyond my scope of work for a client.
- Everyday Hero Award: Adhering to the Company's mission statement and assisting a client.
Timeline
Child Care Subsidy Specialist
Department of Children & Families
09.2022 - Current
Fraud Adjudicator/Team Lead
Department Workforce Development -UI
03.2020 - 09.2022
Executive Legal Assistant
Crivello Carlson
10.2004 - 02.2020
Associate of Applied Science - Paralegal Studies
Milwaukee Area Technical College