
Senior Special Investigator with 20+ years in insurance claims and special investigations, including complex personal and commercial matters. Expertise includes organized insurance fraud, medical provider fraud, staged accident, casualty, and no-fault investigations. Strong record of thorough documentation, sound judgment, and analytical decision-making across cross-functional teams.
• Conducted field and desk investigations for personal and commercial lines claims, including workers' compensation, property theft, fire, water damage, slip-and-fall incidents, foreign objects in food, and product liability.
• Investigated automobile claims involving vehicle damage, bodily injury, medical provider fraud, organized fraud rings, jump-in claims, staged accidents, and low-velocity impact allegations.
• Supported casualty/no-fault vertical team by conducting complex claims investigations in New York and Michigan, enhancing overall case resolution.
• Analyzed claims involving medical providers, attorneys, and staged accident rings to identify organized fraud patterns and inform investigative strategies.
• Interviewed involved parties, gathered and reviewed evidence, documented findings, and prepared clear investigative reports and claim file notes.
• Collaborated with claims professionals, legal partners, vendors, and internal stakeholders to ensure timely and effective claim resolution.
• Applied investigative expertise, claims knowledge, and fraud indicators to identify inconsistencies, emerging trends, and potential organized activity.
• Mentored colleagues and contributed to departmental training, quality initiatives, and process improvement efforts.
• Facilitated development and rollout of vendor full file handling project to streamline operations.
• Led team of vendor SIU case managers handling core automobile and property claims.
• Performed monthly quality assurance reviews and observations to improve efficiency, consistency, and investigative quality.
• Delivered coaching and feedback aligned with Liberty Mutual standards and performance expectations.
• Coordinated workload planning, vendor management, and case-handling quality to ensure consistent service delivery.
• Evaluated workflows to improve documentation quality and refine investigative methods.
- Managed and resolved personal injury protection and casualty claims, ensuring compliance and customer satisfaction.
- Reviewed medical treatment, claim documentation, liability, damages, and settlement factors.
- Supported automobile bodily injury and property damage claims, focusing on low-velocity impact claims and optimizing medical management processes.
- Used claims-handling knowledge to support fair, accurate, and timely claim resolution.
- Trained, coached, and assisted team members as team lead, enhancing team knowledge and performance.