Gregory Frey

• Conducted thorough investigations into suspicious claims, ensuring compliance with regulatory standards.
• Analyzed complex data sets to identify patterns and potential fraudulent activities.
• Collaborated with law enforcement agencies to gather evidence for prosecution cases.
• Trained junior investigators to enhance team capabilities and investigative techniques.
• Developed strategic investigative plans to improve case resolution timelines.
• Prepared detailed reports summarizing findings for effective stakeholder communication.
• Streamlined communication channels among SIU Investigators through regular collaboration meetings.
• Conducted comprehensive interviews to gather crucial information for cases.

Documented investigations of suspected insurance fraud in personal and commercial coverage areas.

Conducted interviews with involved parties including claimants, insurers, and witnesses for insight.

Analyzed case documents to detect red flags and guide investigation processes effectively.

Collaborated with external law enforcement and fraud departments regarding investigation results.

Executed undercover operations through covert surveillance to acquire necessary evidence.

Performed Alive & Well Checks to ensure accuracy of claimant information.

Compiled thorough reports detailing findings to assist in claims decision-making processes.

Maintained detailed records of evidence for future reference in ongoing investigations.

Completed exhaustive investigations to support claims decisions through sufficient evidence collection.

Created strategic plans of action to meet assignment objectives effectively.

Engaged in legal and background research via social media and other databases.

Kept meticulous records of evidence for further state or local fraud assessments.

Reviewed documents, identifying inconsistencies such as red flags in claims data.

Inspected suspicious medical facilities to uncover potential fraud or illegal operations.

Generated comprehensive reports from investigations, providing updates to clients as necessary.

Exhibited high levels of analytical thinking and adept problem-solving during investigations.

Formulated strategic plans to ensure achievement of assignment objectives.

Executed legal and background research, leveraging social media databases.

Documented evidence extensively for future state and local fraud investigations.

Reviewed claim notes, underwriting documents, and police reports to detect irregularities.

Inspected suspicious medical clinics onsite to uncover fraudulent practices.

Compiled detailed investigative reports and supplied timely summaries to clients.

Exhibited high-level analytical skills and effective problem-solving in investigations.

• Investigated and documented cases of suspected insurance fraud for multiple lines of coverage including personal and commercial automobile, property, homeowners, worker’s compensation, and general liability.
• Conducted interviews with parties associated to a claim including claimants, insurers, and witnesses.
• Conducted review of cases documents to develop proper and legal investigations based upon the identification of red flags on a case-by-case basis.
• Collaborate investigation outcomes with outside law enforcement, National Insurance Fraud Bureau (NICB) and state Fraud Departments of Insurance.
• Performed undercover assignments by conducting covert surveillance.
• Conducted Alive & Well Checks.
• Conduct complete in-depth investigation to develop sufficient evidence to recommend claims decision on the legitimacy of a claim to aid in making proper claim handling decisions and communicate such findings with claims and underwriting units.
• Developed strategic plans of action to ensure assignment objectives are achieved.
• Conducted legal and background research including via social media databases.
• Maintained detailed documentation of evidence during investigations to be in case of further state and local fraud investigations.
• Evaluated documents obtained including claim notes, underwriting documents, police reports and other various documents to identify any potential red flags.
• Conducted onsite inspections of suspicious medical of suspicious medical clinics to identify any potential issues of fraud including but not limited to illegally set up “doc-in-the-box” clinics and other illegal issues.
• Provide detailed reports based on results of investigation as well as providing up to date summaries to clients as needed.
• Prominent level of acuity in area of investigation, analytical thinking and problem solving.

• Planned and directed the activities of the in-house SIU staff as well as oversaw the use of the outside vendors hired to investigate potential cases of fraud to ensure proper and lawful investigations.
• Conducted fraud training for claims and underwriting staff.
• Hired in-hours SIU staff and trained them on proper and lawful investigations.
• Worked closely with State Fraud Departments, law-enforcement and the National Insurance Crime Bureau (NICB) on cases of insurance fraud and ensured all cases of such fraud were properly referred to the State Fraud Bureau.
• Collaborated closely with the NICB in the results our SIU department’s identification of fraud, most notably involving fraudulent medical clinics for which NICB opened multiple NICB Task Force Alerts based on our SIU’s investigations, including having one of our investigators being awarded Investigator of the year.
• Upon taking over as SIU Manager, collaborated with upper management to update company fraud plan for identification of red flags including the introduction of fraud detection including utilizing new fraud programs which resulted in both the number of cases referred to SIU as well as increased by millions of dollars the number of claims identified as fraudulent.

• Reviewed and processed no-fault claims in accordance with state regulation for proper handling and referred any claims which had inherent red flags to SIU department for further investigation.

• Reviewed no-fault claims to ensure proper fee-schedules and coding were adhered to.
• Verify eligibility for benefits.
• Conduct over the phone statements for facts of loss and treatment.
• Verified more aspects of claims handling such as verifying coverage such as lost time from.
• Initiate the relevant investigation required upon receipt of new losses.
• Secure statements from all parties involved, either written or verbal.
• Index all injured claimants.
• Make liability determinations based on proper investigation.
• Obtain and review medical records to decide injury value.
• Maintain proper claim reserves.
• Negotiate settlements with claimants and/or attorneys based on verifiable facts on injury.

• Conducted in house reviews of cases involving red flags and developed comprehensive investigation plans.
• Conducted outside field investigations of cases referred to include in-person statements of all parties associated with a claim.
• Conducted clinic inspections of medical facilities to identify potentially fraudulently set up medical facilities.

• Reviewed and processed no-fault claims in accordance with state regulation for proper handling and referred any claims inherent with red flags to SIU department for further investigation.
• Promoted to Sr. Claim Representative and oversaw staff of 5 claim representatives to ensure proper claims procedures were adhered to.