Kya Reliford
Ruston,LA
Summary
Experienced with fraud detection, risk assessment, and mitigation strategies. Utilizes advanced analytical techniques to identify potential threats and implement preventive measures. Track record of maintaining high standards in fraud prevention, ensuring integrity and security of organizational operations.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Customer Support Specialist
Roadie
Remote
08.2024 - Current
- Conduct fraud investigations identifying drivers operating multiple accounts, reducing policy violations and protecting platform integrity through systematic account verification and cross-referencing techniques
- Enforce platform policies through targeted communications ensuring driver compliance with operational standards, safety protocols, and regulatory requirements
- Prepare detailed investigative reports for management review and escalation decisions, documenting findings, evidence, and recommended actions with precision
- Collaborate cross-functionally with team leads to analyze delivery anomalies, investigate suspicious patterns, and break down complex cases for resolution
- Maintain up-to-date knowledge of policy changes and communicate updates to drivers, ensuring consistent application of platform rules
- Support teammates in navigating complex delivery situations through analytical problem-solving and policy interpretation
- Developed and implemented training materials to enhance team knowledge and service quality.
Prior Authorization Specialist
Conduent
Remote
08.2020 - 07.2024
- Investigated medical claims for accuracy, fraud indicators, and policy compliance, achieving 98%+ claims accuracy through meticulous verification processes
- Enforced insurance policy requirements by analyzing coverage eligibility, benefits, and authorization criteria across multiple payer systems
- Documented compliance violations and policy discrepancies in detailed case notes, escalating complex issues to management with evidence-based recommendations
- Processed prior authorizations and appeals by applying regulatory guidelines, medical necessity criteria, and payer-specific policies with precision
- Utilized Epic, Advanced MD, Athena health, and CRM platforms for data verification, audit trails, and compliance tracking
- Maintained 90%+ appeal approval rate through thorough research, evidence compilation, and persuasive case documentation
Education
Bachelor of Arts - Business Administration
Capella University
Minneapolis, MN05-2026
Associate of Arts - Business Administration
Campus Inc. / MTI College
Sacramento, CA12.2025
Skills
- Fraud Detection & Investigation
- Policy Enforcement & Compliance
- Multi-Account & Identity Verification
- Case Documentation & Reporting
- Data Analysis & Pattern Recognition
- Cross-Functional Collaboration
- Regulatory & Claims Compliance
Certification
- Generative AI Fraud Detection and Compliance Certification
- Google Project Management Certification, In Progress
- HubSpot Digital Marketing Certification
Timeline
Customer Support Specialist
Roadie
08.2024 - Current
Prior Authorization Specialist
Conduent
08.2020 - 07.2024
Bachelor of Arts - Business Administration
Capella University
Associate of Arts - Business Administration
Campus Inc. / MTI College
Technical Proficiencies
Epic, AdvancedMD, Athenahealth, ICD-10/HCPCS Coding, CMS 1500/UB-04 Forms, Medical Terminology, SQL, Jira, Salesforce, CRM Platforms, Data Verification, Audit Trail Documentation, Fraud Pattern Detection, Multi-Account Verification, Policy Enforcement, Case Management, Regulatory Adherence