Melishsa Martinez
Newark
Summary
Hands-on individual boasting a career involved in forensic analysis, digital investigations and client assistance. A gifted Fraud Investigator making informed decisions while establishing trust with clients. Known for high productivity and efficient task completion. Specialize in financial analysis, digital forensic techniques, and regulatory compliance to identify and investigate fraudulent activities effectively. Excel in critical thinking, problem-solving, and communication, leveraging these soft skills to unravel complex fraud schemes and collaborate with teams for thorough investigations.
Overview
12
12
years of professional experience
Work History
Fraud Investigator
USDA
Newark
02.2025 - Current
- Investigated fraudulent claims related to agricultural programs and services.
- Analyzed documentation and evidence to detect potential fraud patterns.
- Collaborated with law enforcement on fraud-related cases and investigations.
- Prepared detailed reports for review by management and legal teams.
- Developed training materials for staff on fraud prevention techniques.
- Monitored compliance with federal regulations regarding fraud investigations.
- Investigated and documented suspicious financial activity.
Claims adjuster
Gallagher Bassett
07.2023 - 02.2025
- Conducted full field investigations related to insurance claims of Construction injuries, general Liability / Bodily Injury, Property, Commercial Auto Liability and/or Physical Damage, and Workers Compensation.
- Completed vehicle inspections and determined total loss evaluations.
- Conducted scene investigations, signed / recorded statements, and locates for multi-lines of insurance, including construction claims, worker’s compensation, general liability, etc.
- Investigated claims, wrote technical reports, prepared photographic displays and diagrams, and interpreted related internet data.
Permanency Specialist
01.2021 - 05.2023
- Responsible for maintaining regular contact with government agencies, referring workers, and families, to achieve permanency goals.
- Coordinated interdisciplinary treatment and weekly contact with the Therapist and Program Coordinator.
- Facilitated community resource planning, case progress evaluation and permanency planning.
Medical adjuster
Kassan Lawerence Podiatry
10.2018 - 12.2020
- Responsible for insurance verification by analyzing bills and records to determine billing accuracy and submission of electronic and paper claims for various carriers.
- Ordered police report/ animal control reports, for Bodily injury claims.
- Identified vehicle parts and other potential property damage.
- Updated party information, add parties to claim, enter vehicle and insurance information. Summarize police narrative in files.
- Reviewed and processed daily; 40-50 outstanding client accounts receivable, verified insurance and updated information on patient files utilizing Navinet and Epic medical software.
- Prepared patient files, verified completeness and accuracy of information, and secured referrals to the appointment.
Child Protective Service Investigator
Nj Dept of Children and Family
03.2014 - 07.2018
- Utilized social work and investigative skills to work with families being investigated for abuse or neglect to children.
- Responsible for initiating investigations/safety interventions in response to allegations of abuse and / or neglect.
- Met with families in their homes within 48 hours of receiving a report or within 24 hours when immediate danger is suspected.
- Interviewed and assessed all children for safety by interviewing parents/caretaker, alleged subjects, household members and collateral contacts.
- Responsible for making Safety Assessments of children and their families immediately when required or within 7 days.
- Participated in Family Meetings or Conferences with the family or other support systems.
- Provided a determination of abuse or neglect based on the investigation within 60 days of the report.
- Worked with legal staff to file petitions with Family Court when required for supervisory oversight of the family or for removal of children.
Education
Bachelor of Arts - Computer Science and Digital design
St.Joseph University
01.2001
Masters of Science - Criminal Justice
University of Maryland
Skills
- Crime Analysis
- Critical thinking
- Logistics
- Effective Leader
- Data Analysis
- Attention to Detail
- Cybersecurity Fundamentals
- Analytical Skills
- Cloud safety
- Expert testimony
- Fraud detection
- Report writing
- Regulatory compliance
- Claims assessment
- Field investigation
- Problem solving
- Attention to detail
Timeline
Fraud Investigator
USDA
02.2025 - Current
Claims adjuster
Gallagher Bassett
07.2023 - 02.2025
Permanency Specialist
01.2021 - 05.2023
Medical adjuster
Kassan Lawerence Podiatry
10.2018 - 12.2020
Child Protective Service Investigator
Nj Dept of Children and Family
03.2014 - 07.2018
Bachelor of Arts - Computer Science and Digital design
St.Joseph University
Masters of Science - Criminal Justice
University of Maryland