Summary
Overview
Work History
Education
Skills
Timeline
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Simone Turner

New Kent,VA

Summary

Poised and competent with demonstrated ability to easily transcend cultural differences. Can handle high demand deadlines, excellent team-building skills with the quick ability to learn new material. Detailed oriented and result focused with proven ability to use analytical thinking to provide unique sand adequate solutions to complex situations. Experienced in fraud investigation process, claims and customer service, with the ability to serve as a catalyst in driving team unity and morale to be at its best. Fraud prevention professional with comprehensive background in detecting and addressing fraudulent activities. Proven impact in safeguarding organizational assets and enhancing fraud prevention protocols. Known for effective team collaboration, reliability, and adaptability to changing needs. Demonstrated skills in risk assessment and data analysis.

Overview

10
10
years of professional experience

Work History

Fraud Detection Coordinator

Capital One
06.2021 - Current
  • Review fraud reports to analyze and identify patterns and trends, review and investigate cases by verifying authentically of customer’s information to confirm real identities of applicants
  • Verify authenticity of government issues and personal documents to clear identity, file lost/stolen report when fraud has been confirmed
  • Partner with various internal groups (Linkers and Bustout) to clear ID concerns or report fraud activity by providing general identity theft information to identity theft victims and identifying trends to relay for investigation
  • Communicates with customers via letters and outbound calls
  • Outbound department that reviews the validity of documentation sent by customers for applications and accounts for fraud concerns
  • Selected for DVT Uptraining
  • Town Hall representative
  • Morale Committee
  • Recognized: CompCrown 2022 & 2023
  • AFT Gemba representative
  • Job Shadow Program-Lunch & Learn Program- Talent & Admin for FDIR
  • Systems Used: Tsys, IRIS, Hubble and One Communicator, Google applications

Scheduler

VCU Dental Care
09.2019 - 06.2021
  • Handled inbound calls pertaining to dental care per patient requests
  • Verified dental and health insurance for proper payment
  • Coordinating patient care to doctors’ availability
  • Maintained proper supplies, equipment and inventory of hazardous materials
  • Worked closely with orthodontist, pediatric, and oral surgeons along with general dentistry
  • Systems Used: Axius and Google applications

Claims Adjustor II

Anthem
04.2017 - 04.2019
  • Responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures
  • Reviewed daily spreadsheet with assigned returned medical claims
  • Verified data entry per medical policy
  • Knowledge of claims (denied and returned)
  • Responsible for researching and analyzing claims issues, respond to inquiries which may involve customer/client contact

Sr. Customer Service Rep

Anthem
12.2014 - 04.2017
  • Inbound and outbound call center to assist Broker and group administrators regarding their health groups during open enrollment
  • Updated Brokers and group administrators on new ACA laws and group migration changes
  • Knowledgeable of ICD-9 and ICD-10 diagnosis coding system
  • Assisted with health benefits and understanding denied claims under health plan
  • Evolved into a team lead position that overlooked twenty employees
  • Maintained morale and was assigned to a high demand email bank
  • Accomplishment: Team Lead- overseen team of fifteen associates
  • Morale committee representative

Education

Certificate - Pharmacy

Virginia College
Richmond, VA
07.2013

Skills

  • Customer service
  • Team Collaboration
  • Problem solving
  • Morale & unity driving for results
  • Fraud detection & mitigation
  • Judgement
  • Proficient in Microsoft applications (Word, Publisher, PowerPoint, Excel)
  • Outlook
  • Google Mail
  • Google Suites
  • Ability to type 40 WPM

Timeline

Fraud Detection Coordinator

Capital One
06.2021 - Current

Scheduler

VCU Dental Care
09.2019 - 06.2021

Claims Adjustor II

Anthem
04.2017 - 04.2019

Sr. Customer Service Rep

Anthem
12.2014 - 04.2017

Certificate - Pharmacy

Virginia College
Simone Turner