Matthew McNally
Buffalo,NY
Summary
Organized and professional Fraud Investigator with over four years of proven success in Special Investigations along with ten years total experience in property and casualty claims. Strong ability to thrive as an independent and team worker. Adept at analyzing fraud indicators and utilizing all available tools to successfully resolve assignments.
Overview
10
10
years of professional experience
Work History
SIU Fraud Investigator
GEICO
03.2020 - 10.2023
- Mitigated fraudulent activity when appropriate on Property and Casualty claims using effective fraud detection tools and strategies.
- Strict adherence to and and strong knowledge of both state and federal laws and regulations while conducting fraud investigations.
- Gathered evidence on claims where fraud indicators were present using industry databases, remotely conducted recorded interviews, Examinations Under Oath, inside company support , online queries and utilization of partner vendors for field work, forensics and medical evaluations.
- Formulated detailed written reports upon completion of each investigation and shared results with claim handlers and management
- Curated and held relationships with law enforcement agencies, industry peers, and industry regulatory organizations in effort to prevent, deter, investigate and resolve both simple and complex fraud cases.
- Experienced with claim investigations of both simple and complex nature including but not limited to Catastrophe, (CAT) cases.
- Completed ongoing education courses in fraud awareness each year while in the position of SIU Investigator.
- Complied with and understood all company polices to ensure risk security.
Claims Examiner
GEICO
08.2018 - 03.2020
- Conduct investigations on escalated claims involving complex questions of liability and coverage for both first and third party property and casualty claims.
- Evaluated coverage, liability and damages by conducting recorded interviews with involved parties, witnesses and adverse carriers.
- Reviewed all evidence to determine liability and coverage and inform all affected parties verbally and by written correspondence including denials and disclaimers.
Medical Claims Examiner
GEICO
07.2015 - 03.2020
- Resolved claims by conducting complete investigations and maintaining accurate documentation on losses involving first party medical coverage.
- Communicated with healthcare providers, healthcare carriers, first and third involved parties, attorneys and law enforcement in order to gather all pertinent information regarding claims..
- Utilized medical management such as independent medical exams, examinations under oath, evaluation of medical bills, recorded interviews and background research in an effort to mitigate claims when appropriate.
- Adhered to all regulatory, legal and company policies during claim processing.
- Sent appropriate referrals to law enforcement, regularly agencies and internal SIU.
- Worked closely with internal and SIU including on claims involving major fraud such as staged accidents.
- Drafted denial and disclaimer letters based on results of claim investigations.
Claims Representative
GEICO
12.2013 - 07.2015
- Fielded first notice of loss reports by telephone and internet to determine next steps in processing each claim.
- Evaluated coverage, liability and damages or assigned claim to appropriate department for further handling.
- Made outbound follow-up phone calls and electronic communications in order to resolve claims that were not completed upon first contact.
- Complete adherence to company policy, industry regulations and laws while maintaining high level of customer service and satisfaction.
Education
Associate of Arts - Liberal Arts And General Studies
Erie Community College
Buffalo, NYSkills
- Expertise in fraud prevention and detection
- Four years experience in successfully investigating questionable property and casualty claims
- Highly experienced in obtaining statements from all interested and associated parties relative to claim
- Ability to obtain appropriate evidence using background databases, peer resources, and any available documentation or information unique to each claim
- Analytical Thinker
- Ability to draw decisive decisions based on findings of investigation
- Able to work in highly organized manner while effectively addressing multiple tasks, efficiency, quality, and excellent service and respect for all parties encountered during the handling processes
- Strong familiarity with local and state regulations pertaining to insurance industry
- Knowledge of medical bills, medical coding and medical terms
- Proficient in usage of multiple computer programs and ability to learn new programs
Timeline
SIU Fraud Investigator
GEICO
03.2020 - 10.2023
Claims Examiner
GEICO
08.2018 - 03.2020
Medical Claims Examiner
GEICO
07.2015 - 03.2020
Claims Representative
GEICO
12.2013 - 07.2015
Associate of Arts - Liberal Arts And General Studies
Erie Community College