Tineki Lewis

• Collaborated with stakeholders to define project objectives and criteria.
• Performed gap analysis to identify areas of improvement.
• Interacted with internal customers to understand business needs and translate into requirements and project scope.
• Applied honed problem-solving skills to analyze and resolve issues impacting business operations and goal achievement.

Analyze claims to determine payment or denial.

• Analyzed key aspects of business to evaluate factors driving results and summarized into presentations.
• Generated business intelligence reports to inform strategic decision-making.
• Conducted prompt and thorough investigations on referred files.
• Evaluated customer data to identify and prevent fraudulent activities.
• Reviewed reports and individual transactions which appeared suspicious to uncover possible fraudulent activity.
• Performed risk assessments to determine level of fraud risk and prioritize investigations.
• Analyzed large amounts of data to find patterns of fraud and anomalies.
• Produced detailed reports of fraud investigations and presented findings to senior management.
• Tracked fraud cases and monitored trends to develop strategies for prevention.
• Developed and implemented procedures to detect and prevent fraud.
• Analyzed financial statements to identify discrepancies, irregularities and fraudulent activity.
• Collaborated with team members to discuss fraud trends and brainstorm methods to combat this type of crime.
• Conducted research and interviews with relevant stakeholders to gather evidence and build case files.

Executed processing tasks through facets system to enhance operational efficiency.

• Streamlined operational processes to enhance workflow efficiency and reduce turnaround times.
• Analyzed data trends to identify areas for process improvement and cost reduction opportunities.
• Executed claims processing through facets adjudication to ensure accurate and timely resolutions.