Kuru Smith
Elkridge,MD
Summary
Results-driven SIU Analyst at Magellan Health with expertise in fraud investigation and data analysis. Proven track record in conducting thorough audits and composing detailed reports, enhancing compliance and transparency. Strong analytical thinker with a collaborative approach, effectively identifying anomalies and supporting informed decision-making in cross-functional teams.
Overview
2026
2026
years of professional experience
1
1
Certification
Work History
SIU Analyst- SIU Investigations
Magellan Health
Columbia , MD
05.2016 - Current
- Conducted thorough investigations into behavioral health providers for suspected fraud and service abuse.
- Performed data-driven analysis of claims to identify anomalies related to potential FWA activities.
- Identifying potential areas of investigation: Pinpointing specific areas, providers, or members that may warrant closer scrutiny based on the analysis.
- Collaborated with cross-functional departments, including Claims, Medical Coding, and SIU personnel, to evaluate behavioral health-related incidents and collectively determine appropriate outcomes, aligned with organizational policies and regulatory standards.
- Composed detailed investigative reports, communicating findings to promote compliance and transparency.
- Executed comprehensive audits of providers, ensuring adherence to state and federal regulations.
- Provided subject matter expertise during SIU team presentations, enhancing fraud detection protocols.
- Conducted fraud assessments by evaluating claims for red flags, including exaggerated losses.
- Assisted in data collection and analysis for project reports, supporting informed decision-making.
SIU Administrative Assistant
Magellan Health
Columbia, MD
05.2015 - 09.2016
- Input and categorize incident details for tracking, analysis, and reporting purposes.
- Maintained electronic filing systems to ensure information accessibility.
- Answered phone calls and emails to provide information, resulting in effective business correspondence.
- Entered data into spreadsheets using Microsoft Excel or other similar programs.
- Organized and maintained filing systems for physical and electronic documents, ensuring accuracy and confidentiality of records.
- Handled confidential documents in an organized fashion according to established protocol.
- Composed letters, memos, reports, emails, presentations and other written correspondence as required by management staff.
- Coordinated mailings including sorting mail, preparing packages for shipping via courier service or postal service.
Patient Representative
University of Rochester, Strong Memorial Hospital
Rochester, NY
- Assisted with patient registration and verification of insurance information.
- Processed prior authorizations from insurance companies for medical treatments or procedures.
- Promoted patient data confidentiality by following strict rules and regulations endorsed by facility.
- Verified insurance eligibility for services rendered to ensure accurate billing procedures.
- Collected patient payments, reconciled accounts receivable, and prepared financial reports.
Office Assistant
University of Rochester
Rochester, NY
- Maintained filing systems and ensured documents were easily accessible to staff.
- Collaborated with team members to improve administrative processes and workflows.
- Provided administrative support to staff members, including copying and scanning documents, filing paperwork, and ordering supplies.
- Maintained an organized filing system of paper documents and electronic files.
- Performed data entry tasks into various computer systems accurately and efficiently.
- Utilized office equipment such as printers, copiers, and fax machines efficiently.
- Facilitated communication within the office and with external partners.
- Opened, sorted and routed incoming mail and prepared outgoing mail.
Education
High School Diploma -
West Forsyth High School
Clemmons, NC05-1991
Some College (No Degree) -
Howard Community College
Columbia, MDSkills
- Fraud investigation
- Data analysis
- Claims auditing
- Report writing
- HIPAA and regulatory adherence
- Audit support
- Cross-functional collaboration
- Analytical thinking
- Documentation and reporting
Certification
- NHCAA Coding Clinic
- BSH Case Management - Clinical Documentation Basics
Affiliations
- Avid runner
Timeline
SIU Analyst- SIU Investigations
Magellan Health
05.2016 - Current
SIU Administrative Assistant
Magellan Health
05.2015 - 09.2016
Patient Representative
University of Rochester, Strong Memorial Hospital
Office Assistant
University of Rochester
High School Diploma -
West Forsyth High School
Some College (No Degree) -
Howard Community College
Similar Profiles
Judy TaylorJudy Taylor
Call Center Representative at Magellan HealthCall Center Representative at Magellan Health
Stherlande FaustinStherlande Faustin
Remote Customer Experience Associate at Magellan HealthRemote Customer Experience Associate at Magellan Health
JANELL FORDJANELL FORD
CEA Customer Experience Associate at Magellan HealthCEA Customer Experience Associate at Magellan Health
Humfred MayahHumfred Mayah
Lead Tableau Developer / BI Product Manager at Magellan HealthLead Tableau Developer / BI Product Manager at Magellan Health
Edwina NelsonEdwina Nelson
Customer Service Representative at Automated Health Systems Inc.Customer Service Representative at Automated Health Systems Inc.