Tanisha E. Lopez
Enfield,CT
Summary
Strategic and innovative Fraud Manager with over 20 years of Property & Casualty and Disability Insurance experience. Motivated leader serving as a liaison between frontline staff and senior leadership to achieve business goals through efficient business practices. Consistently focused on process improvement while simultaneously driving towards achieving results and exceeding goals.
Overview
20
20
years of professional experience
Work History
Special Investigations Unit (SIU) Manager
United Services Automobile Association
05.2019 - Current
- Supervise ateam of hybrid fraud investigators; monitor work tasks to safeguard against fraudulent activity through proper investigative procedures and identification of trends and patterns.
- Ensure key performance indicators and metrics align with departmental goals and objectives to protect internal and external stakeholders from fraud abuse.
- Innovate and implement streamlined investigative process improvement to increase digital fraud prevention and minimize impact.
- Manage and mitigate risk for the organization through team adherence to fraud-related compliance, regulatory, and legal practices and policies.
- Collaborate with internal (claims operation, underwriting, policy services, state management) and external (NICB, law enforcement, DOI) business partners to improve fraud prevention strategies.
- Consistently maintain above 94% team investigative quality audit score.
- Serve as leadership feedback liaison between frontline managers and senior leadership.
Fraud Investigator
United Services Automobile Association
11.2013 - 05.2019
- Conducted prompt and thorough investigations on referred files.
- Interviewed and obtained recorded statements from relevant parties regarding inconsistent claim information.
- Reviewed reports and individual transactions that appeared suspicious to uncover possible fraudulent activity.
- Collaborated with internal and external stakeholders to create and maintain fraud prevention strategies.
- Achieved an impact savings for the company of over $600K annually through effective fraud investigation.
Fraud Investigator
The Travelers Insurance Company
04.2010 - 11.2013
- Conducted thorough insurance claim investigations to detect fraudulent activity, reduce exposure, and protect company assets.
- Located subjects/witnesses and obtained recorded statements regarding fraudulent activity.
- Prepared investigative reports documenting each stage of the investigation.
- Provided English/Spanish communication assistance to involved parties.
- Achievements:
- Travelers Investigative Services (TIS)/SIU Roundtable member; collaborated and developed investigative process improvements for the investigation department.
- TIS Diversity Team member; worked amongst investigators to develop and implement diversity improvement initiatives.
- Leadership Skills Development Program cohort.
Concierge Claim Analyst
The Travelers Insurance Company
12.2008 - 04.2010
- Facilitated the vehicle estimate and repair process for policyholders and claimants at the ConciergeClaim location.
- Served as a liaison between customers, repair facility, claim handlers, and Enterprise Rent-A-Car to ensure an efficient auto repair and rental process.
- Provided English/Spanish interpretation assistance to Concierge customers.
Insurance Fraud Investigator
Insurance Fraud Bureau of MA
07.2007 - 10.2008
- Conducted in depth investigations of suspected fraud cases from referring insurance carriers; collaborated with local law enforcement, NICB and FBI on specialized fraudulent cases.
- Researched background information and obtained recorded interviews from relevant parties regarding fraudulent activity.
- Prepared detailed case summary reports of fraudulent cases; submitted reports to appropriate District Attorney’s office for criminal prosecution.
- Provided English/Spanish communication assistance to subjects/witnesses.
Disability Claim Examiner
MassMutual Financial Group
06.2004 - 07.2007
- Adjusted individual disability claims to determine ongoing fiduciary responsibility; managed a reserve caseload with a liability exceeding $100K.
- Reviewed and applied policy provisions to claim scenarios, assisted claimants in proper claim filing procedures.
- Provided time-sensitive communications/decisions within required deadlines (state, federal, ERISA, FICA).
- Communicated and negotiated with agents, producers, and attorneys to ensure ethical and efficient claim decisions.
- Achievements:
- Managed Puerto Rico Claims for Behavioral Health Team; assisted peers with Spanish translation.
- Designed behavioral health letter templates for efficient claims management.
- Received promotion from Associate Claim Examiner to Claim Examiner- September 2005.
- Associate of the Month Award- June 2006.
Education
Master’s - Human Resource Management
University of Arizona Global Campus
06.2024
Life Producer license (CT) -
Kaplan Financial Education
02.2023
Certified Fraud Examiner (CFE) professional designation -
Association of Certified Fraud Examiners (ACFE)
12.2017
Property & Casualty Adjuster license (TX) -
Texas Department of Insurance
02.2017
Fraud Claim Law Specialist (FCLS) professional designation -
American Educational Institute
Bachelor of Arts - English Literature, Hispanic Studies
Wheaton College, University of Cordoba
Norton, MASkills
- Excellent verbal and written communication skills
- Solid analytical and problem-solving abilities
- Strong critical thinking skills
- Effective decision-making capabilities
- Self-starter
- Process improvement
- Risk management
- Fraud investigation
- Claim adjudication
- Advanced interviewing techniques
- Competent in Microsoft Office and email applications
Timeline
Special Investigations Unit (SIU) Manager
United Services Automobile Association
05.2019 - Current
Fraud Investigator
United Services Automobile Association
11.2013 - 05.2019
Fraud Investigator
The Travelers Insurance Company
04.2010 - 11.2013
Concierge Claim Analyst
The Travelers Insurance Company
12.2008 - 04.2010
Insurance Fraud Investigator
Insurance Fraud Bureau of MA
07.2007 - 10.2008
Disability Claim Examiner
MassMutual Financial Group
06.2004 - 07.2007
Master’s - Human Resource Management
University of Arizona Global Campus
Life Producer license (CT) -
Kaplan Financial Education
Certified Fraud Examiner (CFE) professional designation -
Association of Certified Fraud Examiners (ACFE)
Property & Casualty Adjuster license (TX) -
Texas Department of Insurance
Fraud Claim Law Specialist (FCLS) professional designation -
American Educational Institute
Bachelor of Arts - English Literature, Hispanic Studies
Wheaton College, University of Cordoba
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