Sergio Fernandez
Apple Valley,MN
Summary
Driven Incestigator proudly offering over 5 years' experience in project management, data analysis, and fraudulent pattern identification. A determined professional known for reviewing and identifying suspicious activity. Offering a relentless commitment to finding solutions to problems.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Investigator
Minnesota Attorney Generals Office
Saint Paul, MN
09.2023 - Current
- Interviewed witnesses and persons of interest to gather statements for use in criminal investigations.
- Utilized surveillance techniques to observe subjects in public areas.
- Drafted legal documents such as search warrants, subpoenas, arrest warrants, and indictments.
- Reviewed police reports, medical records, and other documents for evidence.
- Analyzed data gathered during investigations to determine the validity of claims or theories.
- Liaised with law enforcement agencies to investigate and solve crimes.
- Reported results of investigations with written observations and photographs, and produced final reports.
Fraud Analyst 4
US Bank NA
Minneapolis, MN
06.2021 - 09.2023
- Communicated effectively with customers regarding suspected fraudulent activities or suspicious behavior.
- Monitored customer accounts and identified any discrepancies or irregularities in account activity.
- Monitored real-time queues and analyzed high-risk transactions from specified points of sale within customer accounts.
- Utilized specialized software tools designed for detecting patterns associated with fraudulent activity.
- Made recommendations for closing accounts and performed associated follow-up.
- Communicated with customers and company personnel, utilizing active listening, and interpersonal skills.
Customer Care Advocate
Blue Cross and Blue Shield MN
Eagan, MN
04.2017 - 05.2021
- Worked collaboratively with other departments such as billing, coding, clinical documentation improvement specialists when necessary.
- Accessed patient information through various software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
- Obtained proper authorization and identification to release confidential medical records.
- Coordinated with patients and healthcare professionals to meet patient needs.
- Provided customer service by answering inquiries, resolving complaints, and providing general information to clients regarding healthcare services.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Researched complex billing errors that required an in-depth review of all available documentation before resolution could be reached.
- Assessed accuracy of claim payments by comparing submitted bills to benefit allowance guidelines.
- Reviewed medical records and documents to determine coverage eligibility of claims for insurance benefits.
Education
Bachelor of Science - Management Information Systems
Metropolitan State University
Saint Paul, MN12-2022
Associate of Science - Business
Normandale Community College
Bloomington, MN05-2019
High School Diploma -
Apple Valley Senior High School
Apple Valley, MN06-2015
Skills
- Evidence Collection
- Report Preparation
- Claims Processing
- Strong Interpersonal Skills
- Insurance Verification
- Medical Billing
- Fluent in Spanish
- Transaction Review
- Telephone and Email Etiquette
- Fraud Detection
- Data Analysis
Certification
- AML Fintech Compliance Associate
- SAP Product Portfolio Award-2022
- US Bank Python Bootcamp 2022
Languages
Spanish
Professional
Timeline
Investigator
Minnesota Attorney Generals Office
09.2023 - Current
Fraud Analyst 4
US Bank NA
06.2021 - 09.2023
Customer Care Advocate
Blue Cross and Blue Shield MN
04.2017 - 05.2021
Bachelor of Science - Management Information Systems
Metropolitan State University
Associate of Science - Business
Normandale Community College
High School Diploma -
Apple Valley Senior High School
- AML Fintech Compliance Associate
- SAP Product Portfolio Award-2022
- US Bank Python Bootcamp 2022
Similar Profiles
Kayla ArreagaKayla Arreaga
Intern at Massachusetts Attorney Generals OfficeIntern at Massachusetts Attorney Generals Office
John ThompsonJohn Thompson
Director 25th Judicial District Drug Task Force at 25th Judicial District Attorney Generals OfficeDirector 25th Judicial District Drug Task Force at 25th Judicial District Attorney Generals Office
Sergio FernandezSergio Fernandez
Investigator at Minnesota Attorney General OfficeInvestigator at Minnesota Attorney General Office