Ne’Shauna Riley
Hazelwood,MO
Summary
Relentless professional known for working hard to determine risk levels. A well-spoken Fraud Analyst promoting exemplary talents in reviewing accounts and identifying issues.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Detail-oriented Compliance Officer dedicated to improving policies and procedures in all business areas. Hardworking and driven with quality-focused and proactive approach. Bringing Number years of experience in Industry.
Fantastic critical thinker with great memory and efficiently organize vast amounts of data. Great at performing internal audits, conducting investigative reporting and transcribing information.
Overview
12
12
years of professional experience
Work History
Fraud Analyst
Citibank
09.2021 - Current
- Reviewed reports and individual transactions which appeared suspicious to uncover possible fraudulent activity.
- Analyzed large amounts of data to find patterns of fraud and anomalies.
- Contacted customers directly to notify of fraudulent activity and minimize impacts.
- Collaborated with team members to discuss fraud trends and brainstorm methods to combat this type of crime.
Compliance Specialist
Citibank
08.2020 - 09.2021
- Served as subject matter expert by advising staff and customers and working directly with external agencies throughout audits or to remedy compliance issues.
- Directed and implemented strategic improvement plans to integrate solutions to audit findings and workflow process issues.
- Managed quality programs to reduce overdue compliance activities.
- Performed quality control reviews of all loan packages to check adherence with federal and state regulatory requirements.
- Supported Job title by pitching in to complete special projects.
- Tracked customers' loan status to update appropriate teams and facilitate subsequent steps, leading to timely closings.
- Monitored closing disclosures to verify documents contained required signatures.
- Maintained current knowledge of loan products and applicable requirements, processes, procedures, internal policies and regulations.
Claims Representative
Elevance Health
02.2018 - 09.2021
- Interviewed policyholders to verify information and obtain additional details.
- Examined reports, accounts and evidence to determine integrity and accuracy of information.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
Prior Authorization Representative
UnitedHealthcare
06.2015 - 02.2018
- Verified eligibility and compliance with authorization requirements for service providers.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Maintained compliance with patient privacy and security regulations such as Area of certification.
- Authorized surgical and Type requests in accordance with applicable plan guidelines.
School Bus Driver
Hazlewood School District
04.2012 - 12.2015
- Maintained State driver's license to enable legal operation of school buses for student transport, field trips and other purposes.
- Adhered to scheduled routes and accomplished timely drop-offs and pick-ups to comply with preset route criteria.
- Transported passengers safely along prescribed routes according to tight schedules.
- Inspected emergency equipment and verified safe working order for student and driver use.
- Communicated information to parents to promote good communication and transparency.
- Assisted passengers with disabilities and other physical issues in boarding and exiting bus to promote passenger safety.
- Obeyed federal, State and local traffic laws and regulations to enable safe transportation outcomes for participants.
- Complied with personal grooming and conduct guidelines and regulations to promote high standard of professionalism.
- Created and enforced bus rules and kept expectations posted.
Education
General Studies
Mc Cluer North
Florissant, MOSkills
- Creative Solutions
- Training Junior Team Members
- Risk Level Determination
- Procedure Reviewing
- Customer Transactions
- Customer Accounts Management
- Fraud and Anomaly Analysis
- Customer Care
- Communications Strategies
- Telephone Etiquette
- Cancellation Processing
- Fraud Patterns
- Detecting Customers
- Fraud Prevention and Detection
- Account Information Review
- Effective Communication
Timeline
Fraud Analyst
Citibank
09.2021 - Current
Compliance Specialist
Citibank
08.2020 - 09.2021
Claims Representative
Elevance Health
02.2018 - 09.2021
Prior Authorization Representative
UnitedHealthcare
06.2015 - 02.2018
School Bus Driver
Hazlewood School District
04.2012 - 12.2015
General Studies
Mc Cluer North
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