Colleen Wendland
Stratford
Summary
Dynamic professional with extensive expertise in fraud detection and prevention, adept at leveraging advanced analytical tools and conducting comprehensive investigations to identify and mitigate fraudulent activities. Strong commitment to collaboration and achieving measurable outcomes, while seamlessly adapting to evolving industry demands. Renowned for integrity, critical thinking, and exceptional communication skills, consistently delivering results that enhance organizational security and efficiency. Proactively seeks opportunities for continuous improvement and innovation in fraud prevention strategies.
Overview
25
25
years of professional experience
Work History
Fraud Investigator III
CareCentrix
03.2013 - 11.2025
- Perform in depth analysis and investigation of potential fraudulent healthcare claims and prepare supporting documentation for further actions.
- Utilize data analysis techniques to determine inconsistencies and create leads for auditing purposes.
- Timely and professional documentation of all actions.
- Perform investigative practices (conduct interviews, compile documentation and evidence, maintain extensive notes, negotiate and settle cases, arbitration/litigation testimony).
- Audit cases holistically and see them through to conclusion.
- Work in conjunction with various law enforcement agencies and regulatory bodies.
- Follow all laws, rules and regulations when auditing case files.
- Collaborated with cross-functional teams to develop effective fraud prevention strategies.
- Analyzed complex fraud patterns to identify potential risks and threats.
- Implemented process improvements that enhanced operational efficiency and reduced fraud incidents.
Senior Fraud Investigator
United Healthcare
01.2011 - 03.2013
- Investigate health insurance claims billing to determine if services billed were supported or fraudulent/abusive misrepresentation was evident.
- Secure information internally and externally to identify evidence of fraudulent/abusive activities by applying internal processes, industry standard practices and HIPAA requirements.
- Effectively communicate audit finding with providers and/or attorneys to resolve identified overpayments by way of financial settlement, coding educational or arbitration/litigation.
- Establish and maintain liaisons with law enforcement and state fraud bureaus while investigating allegations in accordance with state/federal guidelines.
- Developed and implemented fraud detection strategies, reducing overall fraud rates through proactive measures.
- Led investigations into complex fraud cases, utilizing advanced analytical techniques and data analysis tools.
Senior Project Coordinator
United Healthcare
03.2007 - 01.2011
- Supported the project communication process and managed relationships with business liaisons.
- Worked with diverse project teams and subject matter experts to oversee, track, receive, and provide status updates related to master project plan.
- Tracked project progress including status updates and escalation as appropriate of issues, risks, action items and decisions.
- Managed project documentation repository.
- Developed comprehensive project plans, outlining objectives, timelines, and resource allocations.
- Led cross-functional teams to ensure project milestones were met on time and within budget.
Benefits and Processing Analyst
Hewitt Associates
12.2000 - 03.2007
- Oversaw data file processing and job scheduling/monitoring.
- Identified, reported and tested process improvement opportunities.
- Executed issue resolution and ensures proper documentation and follow-up takes place.
- Coordinated system updates and year end processing and reporting.
- Worked directly with clients, third parties and internal shared services to resolve benefit / operational issues.
- Liaison for both client and benefits center representatives to research and resolve participant issues as well as larger group problems.
- Analyzed complex data sets to identify trends and inform strategic decision-making.
- Developed detailed reports for senior management, enhancing visibility of key performance indicators.
Education
Bachelor of Arts - Communication Disorders/Speech Pathology, Psychology
Southern Connecticut State University
New Haven, CT08.1998
Skills
- Proficient in Microsoft Word
- Excel spreadsheet management
- Slide deck creation
- Relationship management
- Research documentation
- Fraud detection
- Fraud detection strategies
- Fraud investigation expertise
- Client case management
- Data interpretation
Timeline
Fraud Investigator III
CareCentrix
03.2013 - 11.2025
Senior Fraud Investigator
United Healthcare
01.2011 - 03.2013
Senior Project Coordinator
United Healthcare
03.2007 - 01.2011
Benefits and Processing Analyst
Hewitt Associates
12.2000 - 03.2007
Bachelor of Arts - Communication Disorders/Speech Pathology, Psychology
Southern Connecticut State University