Malaijah Calloway
Dothan,AL
Summary
Detail-oriented Fraud Detection Analyst with proven skills in anomaly detection and claims evaluation. Adept at developing policies and resolving disputes, ensuring effective communication and teamwork. Proven ability to resolve billing disputes and enhance processes while maintaining compliance. Committed to delivering impactful solutions in a fast-paced environment. Claims Specialist with comprehensive background in insurance claim processing, policy interpretation, and dispute resolution. Have successfully managed high-volume claims environments, demonstrating keen ability to stay organized under pressure. Known for strong analytical skills, adept at reviewing documentation and validating coverage decisions. Consistently ensure prompt, fair settlements while maintaining compliance with industry regulations.
Overview
1
1
Language
5
5
years of professional experience
Work History
Work from home/Fraud Detection Analyst
Velera
Dothan, Alabama
11.2024 - 07.2026
- Analyzed transaction data to identify potential fraud patterns and anomalies.
- Investigated flagged transactions to determine legitimacy and appropriate actions.
- Conducted investigative research and analysis to resolve billing discrepancies and computed reserve funds for client rebate discounts.
- Verified transactions with cardholders to assess legitimacy. with the card holder to determine if the case is fraudulent or non- fraudulent.
- Assisted with the development of new policies and procedures related to fraud detection and prevention.
- Conducted reviews of flagged transactions and reports that showed potential suspicious activity.
Work from home/Data processing claims specialist
Cigna
Dothan, Alabama
10.2023 - 11.2024
- Evaluated claims for accuracy and compliance with company policies.
- Assisted clients with inquiries regarding claim status and procedures.
- Collaborated with medical professionals to gather necessary information for claims.
- Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
- Checked patient's insurance on file.
- Giving the medical professional the claim status as well as verifying benefits and eligibility for the member.
- Managed appeals process from initial submission through final disposition, ensuring compliance with state laws and contractual obligations.
Customer service data entry/Work From Home Agent
Sarnova
Dothan, Alabama
06.2021 - 08.2023
- Delivered customer support via phone and chat for medical supplies.
- Resolved customer complaints by adhering to established protocols.
- Ensured compliance with company policies while managing sensitive customer data.
- Utilized effective problem-solving skills to assist customers courteously.
- Utilized computer systems to access accounts for research purposes.
- Performed data entry tasks accurately and in a timely manner.
Education
High School Diploma -
Dale County High School
Midland City, AL05-2018
Skills
- Data analysis
- Fraud investigation
- Policies development
- Transaction verification
- Anomaly detection
- Claims evaluation
- Typing speed
- Live chat messaging
- Multitasking
- Teamwork
- Effective communication
- Dispute resolution
- Fraud detection
- Call management
Languages
English
Full Professional
Timeline
Work from home/Fraud Detection Analyst
Velera
11.2024 - 07.2026
Work from home/Data processing claims specialist
Cigna
10.2023 - 11.2024
Customer service data entry/Work From Home Agent
Sarnova
06.2021 - 08.2023
High School Diploma -
Dale County High School