Dominique Gadsden
Dallas
Summary
Experienced with uncovering fraudulent activities through detailed investigations and data analysis. Utilizes advanced investigative techniques and cross-functional collaboration to ensure thorough and accurate findings. Track record of maintaining compliance with legal standards and providing reliable results.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Fraud Senior Analyst
Cigna
03.2024 - Current
- Analyze information gathered by investigation and report findings and prepare written summary/recommendations
- Lead virtual interviews of member/providers and pharmacies as necessary to obtain necessary information regarding the investigation
- Prepare reports to expedite tracking and reporting of investigations
- Prepare evidence package referrals to internal and external parties including; contract holders, law enforcement agencies/medical boards
- Develop and execute investigation plans addressing risks and formalizing sound recommendations
Healthcare Fraud Investigator
Qlarant
07.2022 - 03.2024
- Enters investigative information into the case tracking systems and will meet with Lead Investigators to assign investigations to the Investigative team.
- Works with the team to prioritize complaints for investigations.
- Places potential fraudulent providers on prepay review and monitor adjudication of claims.
- Analyzes data for appropriateness of fraud, waste and abuse issues in accordance with pre-established criteria, requesting additional documentation if necessary.
- Refers all potential adverse decisions to the Lead Investigator/Manager.
- Identifies, collects, preserves, analyzes and summarizes evidence, examining records, verifying authenticity of documents, preparing affidavits or supervising the preparation of affidavits as needed.
- Drafts and evaluates investigation reports and promote effective and efficient investigations.
- Initiates and maintains communications with law enforcement and appropriate regulatory agencies including presenting case findings for their consideration to further investigate, prosecute, or seek other appropriate regulatory or administrative remedies.
Senior Customer Care Specialist/Fraud Specialist
GRUBHUB
01.2019 - 06.2023
- Navigate more complex issues (analyze/identify the problem then provide the appropriate resolution) with the aim of first contact resolution - own the issue through to completion
- Determine existing fraud trends by analyzing accounts and transaction patterns
- Identify system improvements to prevent fraudulent activities
- Recommend anti-fraud processes for changing transaction patterns and trends
- Recommend new software tools used for fraud detection, prevention and reporting activities
- Monitor & investigate potentially fraudulent transactions on software like Acceritfy and use the tools at hand to prevent future chargebacks
- Complete fraud queues as needed to ensure the proper and timely review of all suspicious transactions
- Collaborate with other departments including Accounting, Delivery Operations, Sales,and Data Operations to research and resolve inquiries
- Respond to issues, and escalations, accurately and professionally in a courteous andattentive manner with minimum supervision
- Act as a SME (Subject Matter Expert) for all Customer related facing processes.
Adult Probation Officer
Maricopa County
04.2017 - 12.2018
- Counsel probationers in problems related to compliance of terms and lawful interactionwithin the community
- Establishes and maintains effective relationships with other team members, probationers,community partners, and the public
- Direct and refer probationers to community resources such as treatment centers or otheragencies based on observation of activities, assessments, behavior, and conditions of probation
- Assess behavior/personality, social history, risk to the community, individual needs, andother relevant factors to formulate case plans
- Document and maintain confidential case records
- Prepares a variety of electronic and written reports, to include pre-sentence/pre-trialreports and violation reports; testifies at court hearings.
Installation Technician
Recovery Healthcare
07.2014 - 04.2017
- Responsible for installing and monitoring our offender surveillance and alcohol monitoring technologies for courts, probation & parole departments, treatment providers and other agencies in our Dallasoffice
- Delivers participant completion, non-compliance, and payment reports to the appropriate supervising agencies.
- Meet with clients to install, remove, or perform maintenance on the monitoring technologies and provide customer service duties to clients and the agencies served.
- Creates individual customer accounts and tracks participant as well as taking payments forservices provided.
Juvenile Correctional Officer III
Gainesville State School
06.2015 - 10.2015
- Serves as a youth supervisor with responsibility for the safety, personal conduct care, andrehabilitation of the youth
- Assumes responsibility for the custody and care of youth through knowledge of and adherence tolaws, rules, regulations, policies and standard operating procedures governing the Texas Juvenile Justice
- Department
- Maintains security in buildings, grounds, and other posts; intervenes during emergencies oraltercations to prevent escapes and gain physical control of youth.
Security Guard
G4S/Wackenhut
07.2011 - 07.2014
- Watches for irregular or unusual conditions that may create security concerns or safety hazards
- Monitor over 1,500 security cameras throughout the building and contact emergency personnel incase of fire or presence of unauthorized persons
- Permits authorized persons to enter property and monitors entrances and exits
Security Guard
Security Group of Texas, Inc
01.2010 - 07.2011
- Direct Traffic for taxis, shuttle buses and motor cars
- Secure the premises of hotels, warehouses, business buildings and The World Trade Center
Education
Bachelor of Science - Criminal Justice
Texas A&M University - Commerce
Skills
- Exceptional Communicator
- Project Management
- Senior Leadership Support
- Dispute Resolution
- Fraud Prevention and Detection
- Report Writing
- Problem-Solving Expertise
- Validating Data
- Data Analysis
- Customer Accounts Management
- Proficiency in Excel, Access, Word and Tableau
Certification
Association of Certified Fraud Examiners
- CFE - Certified Fraud Examiner - Currently Pursuing
Google Data Analytics Professional Certificate
- [Analytics] Certification - Currently Pursuing
State of Arizona Dept Of Public Safety
- Level One Fingerprint Clearance Card
Timeline
Fraud Senior Analyst
Cigna
03.2024 - Current
Healthcare Fraud Investigator
Qlarant
07.2022 - 03.2024
Senior Customer Care Specialist/Fraud Specialist
GRUBHUB
01.2019 - 06.2023
Adult Probation Officer
Maricopa County
04.2017 - 12.2018
Juvenile Correctional Officer III
Gainesville State School
06.2015 - 10.2015
Installation Technician
Recovery Healthcare
07.2014 - 04.2017
Security Guard
G4S/Wackenhut
07.2011 - 07.2014
Security Guard
Security Group of Texas, Inc
01.2010 - 07.2011
Bachelor of Science - Criminal Justice
Texas A&M University - Commerce