Porschia Sanford
FL
Summary
AML Quality Assurance specialist with expertise in reviewing investigative cases for accuracy, completeness, and regulatory compliance. Skilled in analyzing complex transactions, identifying red flags, and ensuring clear, well-supported case narratives. Adept at providing constructive feedback, confirming corrective actions, and applying deep knowledge of AML typologies in correspondent banking and wealth management
Overview
12
12
years of professional experience
Work History
AML Quality Analyst
Citizen Bank
11.2024 - Current
- Conduct thorough quality assurance reviews of AML investigative cases, verifying completeness, accuracy, and adherence to internal policies and regulatory standards. Independently research supporting documentation and ensure case narratives address all relevant risk factors with clear, logical dispositions that can be easily understood by internal/external auditors and regulators.
- Provide consistent, detailed feedback to investigators in line with established QA protocols, offering clarification to Team Leads on exception findings to ensure corrective actions are accurate and timely.
- Apply sound judgment when assessing case narratives, supporting evidence, and transactional activity against QA core competencies, identifying potential red flags and ensuring appropriate investigative conclusions.
- Verify that all investigator corrections to issued exceptions have been completed accurately, while meeting QA production targets and maintaining high-quality standards. Collaborate with cross-functional teams to promote consistent communication and procedural alignment.
- Determine appropriateness of final case dispositions by evaluating investigative findings, transactional patterns, and AML typologies specific to correspondent banking and wealth management clients. Maintain up-to-date knowledge of relevant laws, regulations, and internal policies to identify potential suspicious activity.
- Uphold the firm’s values by demonstrating integrity, professionalism, and personal accountability, contributing to a respectful and collaborative work environment.
Appeals and Grievance Analyst
Florida Blue (Blue Cross and Blue Shield of Florida)
10.2013 - 10.2024
- Manages and adjudicates member and provider disputes arising under the Grievance System including member grievances, appeals and requests for hearing and provider claim and disputes
- Investigates findings of encounter denials and explains to management underlying reasons for identified data quality issues
- Communicates with providers to resolve problems with appeal requests that are not submitted according to Plan's policy
- Review customer complaints, listen to customer phone calls, and review other documentation as available
- Completes the appeals process within an established timeframe documented in current Plan's policy
- Collects, analyzes and reviews historical authorization information to incorporate into departmental appeal documentation
- Accountable for compliance with record retention plan according to Plan's policy
- Coordinates the presentation of appeals to the Appeals Committee and participates as a member
- Communicates decisions (in writing) made by the Appeals Committee to providers within Plan timeframe
- Updates or creates authorizations for services that have been appealed and communicates this information to the Medical Claims department
- Summarize findings in a write up as well as provide an initial opinion on if the nature of the customer complaint qualifies the customer for a refund
- Prepares written case summaries and forwards to the Medical Director for review taking appropriate action as indicated by Medical Director's determination to ensure timely resolution
- Expedited resolution times by proactively communicating with members, providers, and other stakeholders throughout the grievance process.
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
Education
High School Diploma -
Duncan U Fletcher Senior High
Jacksonville, FL05.2006
Skills
- Strong excellent decision making and research skills
- Advanced in Excel and Microsoft word
- Strong analytical experience
- Advanced understanding of the Bank Secrecy Act, USA Patriot Act, and other applicable laws and regulations
- Strong reading comprehension
- Analytical and quantitative skills
- Strong oral and written communication skills
- AML Transaction Monitoring & Investigations
- SAR Drafting, Review & QA
- BSA, USA PATRIOT Act, OFAC Compliance
- Fraud & Structuring Detection
Timeline
AML Quality Analyst
Citizen Bank
11.2024 - Current
Appeals and Grievance Analyst
Florida Blue (Blue Cross and Blue Shield of Florida)
10.2013 - 10.2024
High School Diploma -
Duncan U Fletcher Senior High