Natasha Telamond
Boca Raton,FL
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
12
12
years of professional experience
Work History
Senior Fraud Investigator
Peraton/ SafeGuard Services
03.2016 - Current
- Reviewed transactions and receipts to identify any suspicious activity.
- Analyzed large amounts of data to find patterns of fraud and anomalies.
- Tracked fraud cases and monitored trends to develop strategies for prevention.
- Developed and implemented procedures to detect and prevent fraud.
- Performed risk assessments to determine level of fraud risk and prioritize investigations.
- Identified opportunities for process improvement using root cause analysis, reducing future incidences of similar fraud cases.
- Collaborated with internal and external stakeholders to create and maintain fraud prevention strategies.
- Prepared case reports from allegations, transcripts of interviews and physical evidence.
- Collected and preserved physical evidence, photographs and laboratory submissions.
- Documented findings and prepared detailed reports.
- Collected, analyzed and interpreted information, documentation, and physical evidence associated with investigations.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Prepared detailed investigation reports for management teams and legal departments, facilitating effective decision-making processes.
- Mentored junior investigators on best practices and industry standards, resulting in improved team performance and efficiency.
- Analyzed complex data sets to identify patterns, trends, and potential fraud indicators in claims.
Medicare Enrollment Reconciliation Analyst
EmblemHealth
10.2011 - 02.2016
- Ensured compliance with regulatory requirements through meticulous attention to detail and adherence to established guidelines.
- Identified root causes, analyzed discrepancies and provide input on how to resolve reoccurring issues.
- Captured errors prior to submission to CMS.
- Trained employees on Medicare Rules and Regulations.
- Mentor seasonal employees and during Annual Enrollment and ensured they understands procedures for Medicare Enrollment and Dis-enrollment along with updating beneficiaries' information .
- Ran different queries to enhance record validation.
- Created new queries to enhance record validation process.
- Compiled data necessary to prepare onsite deliverables in timely matter.
Reconciliation Analyst
Convey Health
04.2014 - 09.2015
- Implemented robust policies and procedures governing reconciliation activities, promoting consistency across organization.
- Collected and sampled data on different trends that may occur.
- Pulled monthly Enrolment Data Validation Reports.
- Serves as Liaison between IT Team and client.
- Communicate with CMS to resolve conflicting issues.
- Created Standard Operations Procedures (SOP), Job Aides and Policy and Procedures (P&P) for the account to assist coworkers and new hires with their daily task.
Education
Bachelor of Science - Business Administration And Management
University of Phoenix
Tempe, AZ07.2007
Skills
- Regulatory knowledge
- Insurance fraud
- Procedure review
- Ethics Enforcement
- Dispute Resolution
- Data Analysis
- Transaction review
- Fraud prevention
- Irregularity reporting
- Fraud Detection
- Verbal and written communication
- Report Writing
- Communications Strategies
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Senior Fraud Investigator
Peraton/ SafeGuard Services
03.2016 - Current
Reconciliation Analyst
Convey Health
04.2014 - 09.2015
Medicare Enrollment Reconciliation Analyst
EmblemHealth
10.2011 - 02.2016
Bachelor of Science - Business Administration And Management
University of Phoenix
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