Years of professional experience
Rosa M Morales
Charlotte,NC
Summary
Diligent Fraud Claims Representative with solid background in processing and managing claims efficiently. Adept at assessing coverage and liability, and resolving complex claims issues. Proven ability to utilize strong analytical and communication skills to deliver exceptional service. Experienced with data analysis and interpretation to drive business decisions. Utilizes advanced statistical techniques and data visualization tools to uncover trends and improve performance. Track record of effective project management and collaborative team efforts.
Overview
13
13
Work History
Senior Fraud Analytics Consultant
Wells Fargo Bank
03.2023 - 03.2025
- Hybrid position, worked closely with our team, targeting unusual and risky customer activity, to identify instances of account takeover fraud. Identifying risks and implementing risk control measures, developing, and overseeing strategies for detecting and preventing financial crime and fraud.
- Leveraging cutting - edge tools, systems, and methodologies to identify risks, developing and overseeing strategies for detecting and preventing financial crimes. Analyzing data in Oracle SQL, Excel, and Tableau creating and recommending strategies to prevent ATO fraud, incident response, risk management, and project management.
- Manipulating data in Excel, conducted data analysis to identify trends, correlations, and patterns in the data. Root cause analysis programs. Provided insights into the performance of various marketing strategies and initiatives, analyzed large datasets using SQL queries. to address underlying issues related to financial crime, fraud, and IT security.
Senior Quality Assurance Administrator
Wells Fargo Bank, N.A.
03.2020 - 03.2023
- Remote position, Customer Remediation Team, implement internal auditing practices to create standards and statutory obligation compliance reports, investigate, consult with internal and external partners to provide feedback, challenge issues and maintain employee adherence to quality policies and procedures.
- Conducting investigations of fraud and Remediation cases, documenting investigative findings in Excel, and determining whether the case should be escalated. Reviewing and investigating customer profile information mailing address, email, and phone, accurately and thoroughly gather the necessary information for meet production targets, management skills, maintaining high attention to detail.
- Prepare calibration scores and feedback to facilitate our team calibration meetings and ensure consistency of quality scores delivered to clients. Ensure alignment with Wells Fargo's and vendors' expectations. Make business decisions that are based on an understanding of the facts, especially regarding the risks generated. Technical writing and updating procedure manuals, conduct customer impact assessments and escalate customer complaints.
Lead Fraud & Claims Operations Representative
Wells Fargo Bank
5 2016 - 03.2020
- Investigate and research cases while working with internal and external Wells Fargo customers, call center environment, worked fraudulent international wire transfers (Chips) and Fedwire, cross sale credit protections insurance plans, ITO insurance sale, reviewed domestic transactional account activity. Investigate cybersecurity and software piracy, sanctions, and corruption.
- Conducting quality review of work performed and documented by Investigators, including drafted case documentation, to ensure that the narrative and supporting documents are in line with the applicable client procedures. Evaluate the adequacy and effectiveness of policies, control assessment, prioritize threats, and collaborate with different LOBs. Internal controls perform investigative research, root cause assessment, highly complex financial crime transactions, operational risk, fraud policy violations, and customer complaints.
- Work in compliance with BSA/AML regulations, determining risk levels, and recommending resulting fraud prevention strategies, mitigate risk, account takeover (ATO) fraud, IT cybersecurity research reporting and investigations, determine, mitigate, and recover losses. Provide work direction, manage daily workflow activities for our fraud team, mentor less experienced staff.
Bilingual - Fraud Claims - Specialist 3
Wells Fargo Bank
11.2013 - 5 2016
- Handled incoming calls, call center environment, claim intake, perform detail case examination to detect fraud trends and patterns, acceptance or denial of claims and making monetary adjustments, working sorting data in Excel, reviewing moderate to complex account activities which requires research that may involve multiple transaction channels.
- Cybersecurity research investigations, performing general account handling functions, maintaining files, records, databases, and preparing standard reports. Perform a detailed examination to detect transactional and relationship patterns, trends, anomalies, and schemes across multiple businesses or products, ITO insurance sales, bank products and services sales. Drafting and preparing required documentation including Suspicious Activity Reports (SARs), Elder Abuse reports.
- Collaborated with cross-functional teams to resolve claim disputes and improve customer satisfaction. Managed high-volume claim submissions, prioritizing tasks to meet deadlines efficiently.
- Mentored junior team members, enhancing their understanding of complex fraud claims scenarios.
Education
Bachelor of Arts - English/Psychology
University of North Carolina At Charlotte
Charlotte, NC05-2018
Certificate - Certified Financial Crimes Specialist
Bankers College
04-2021
Skills
- Fraud investigation expertise
- Consulting and trend analysis
- Process improvement recommendations
- Experience in collaborative work, sales, customer service, and the ability to interact with all levels of an organization, experienced in compliance monitoring, Regulatory & Compliance Expertise, research, trends, strong analytical skills and risk management experience
- ITO insurance referral sales, banks product and services sales, remote working environment experience, Enterprise Complaints and Remediation (ECR) (BSA/AML), Tableau, SharePoint, Prevent, SVP, Universal Workstation (UW) DAT, Jira, Oracle SQL, SHRP, LexisNexis, FDR, and Hogan
- Intermediate Excel, PowerPoint, and Microsoft Office skills, understanding of Agile, security Frameworks and KPI governance Ability to manage multiple competing priorities, Bilingual communication and written skills
- Advanced Excel , strong work ethic, problem-solving, time management, attention to detail , SQL for Fraud prevention strategies, report writing, microsoft Access, Cross-functional communication, process management, workload prioritization, understanding of Reg E, Reg CC
Accomplishments
- Improved relationship with Wells Fargo Stakeholders by developing a unique business intelligence solution to meet complex requirements.
- Developed risk management strategies that included continuous monitoring, risk assessment, and implementing preventive measures.
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Collaborated with team of 3 in the development of SQL Strategies.
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Senior Fraud Analytics Consultant
Wells Fargo Bank
03.2023 - 03.2025
Senior Quality Assurance Administrator
Wells Fargo Bank, N.A.
03.2020 - 03.2023
Bilingual - Fraud Claims - Specialist 3
Wells Fargo Bank
11.2013 - 5 2016
Lead Fraud & Claims Operations Representative
Wells Fargo Bank
5 2016 - 03.2020
Bachelor of Arts - English/Psychology
University of North Carolina At Charlotte
Certificate - Certified Financial Crimes Specialist
Bankers College