Summary
Overview
Work History
Education
Skills
Timeline
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Tivona Whiting

Richmond,VA

Summary

Proven expertise in fraud prevention and regulatory knowledge, demonstrated through impactful strategies at Capital One that significantly enhanced customer trust and reduced fraud incidents. Skilled in investigation techniques and excelling in verbal and written communication, always has consistently driven positive outcomes and compliance with industry standards. Experienced with fraud detection and prevention techniques, ensuring protection of organizational assets. Utilizes advanced analytical skills to identify and investigate suspicious activities. Track record of implementing effective fraud prevention strategies and maintaining compliance with regulatory standards. Fraud specialist skilled in risk assessment and fraud detection. Adept at analyzing complex data and identifying suspicious activities. Known for strong teamwork and adaptability in dynamic environments. Possess critical thinking, problem-solving capabilities, and excellent communication skills.

Overview

13
13
years of professional experience

Work History

Fraud Specialist II

Capital One
05.2022 - 09.2024
  • Improved customer trust by promptly addressing and resolving reported instances of fraud.
  • Conducted thorough investigations into suspected fraudulent activities, resulting in timely resolution of cases.
  • Reduced instances of fraud by implementing comprehensive detection and prevention strategies.
  • Maintained detailed records of all detected fraud incidents for future reference and analysis.
  • Identified trends in fraudulent activities through data analysis, which informed updates to anti-fraud strategies.
  • Coordinated with law enforcement on high-profile fraud cases, aiding in apprehension of perpetrators.
  • Contacted customers directly to notify of fraudulent activity and minimize impacts.
  • Collaborated with team members to discuss fraud trends and brainstorm methods to combat this type of crime.
  • Enhanced company security with advanced fraud monitoring systems and tools.
  • Advised senior management on fraud risk management strategies, influencing company-wide policies.
  • Conducted thorough and timely investigations of suspicious activity reports, ensuring compliance with regulatory requirements.
  • Reduced energy theft incidents through diligent monitoring of usage patterns and prompt investigation of suspicious activity reports.
  • Analyzed high volumes of data logs daily to identify suspicious activity patterns indicative of potential breaches.

Loan Application Processor

Capital One
08.2020 - 12.2021
  • Implemented new software systems and tools that streamlined application processing tasks, resulting in increased productivity among team members.
  • Managed high volumes of incoming applications, prioritizing tasks effectively to meet deadlines consistently.
  • Collaborated with team members to develop strategies for improving overall application processing efficiency.
  • Actively sought feedback from supervisors regarding individual performance metrics tracked regularly as part of ongoing efforts towards personal growth within an Application Processor role context specifically tailored around results-driven accomplishments achieved over time thus far throughout career progression journey undertaken internally amongst peers alike collectively striving towards shared organizational goals focused on continuous improvement initiatives aimed ultimately at increasing overall company success rates concerning key performance indicator targets established annually by senior management teams responsible for overseeing strategic planning efforts undertaken across all divisions operating within a larger corporate structure contextually designed around achieving long-term business objectives outlined accordingly within broader industry contexts relevant to specific market segments targeted over time as part of ongoing efforts geared towards expanding overall company reach regionally, nationally or internationally depending upon target audience demographics identified through extensive market research activities conducted regularly throughout each fiscal year.
  • Provided excellent customer service to both internal and external stakeholders, fostering positive working relationships.
  • Maintained accurate records of processed applications using database management systems, ensuring timely retrieval of information when needed.
  • Checked loan applications and supporting documentation for completeness and accuracy.
  • Developed training materials for new hires, ensuring consistent onboarding experiences and knowledge transfer across the team.

Appeals Coordinator

Magellan Complete Care of Virginia
10.2019 - 02.2020
  • Acted as a departmental resource on appeals matters.
  • Created, composed and maintained appeal response templates.
  • Coordinated with senior specialist to compose appeal responses.
  • Responded to attorney inquiries and litigation notices.
  • Developed appeals functions, policies and procedures and documentation.
  • Organized and managed appeals caseloads, prioritizing high-priority cases for timely resolution.

Provider Services Representative

Ally Align Health
05.2018 - 02.2019
  • Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns.
  • Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
  • Streamlined operations by managing a high volume of incoming calls for medical providers seeking information or assistance.
  • Acted as a liaison between providers and company leadership, effectively communicating concerns and feedback to facilitate continuous improvement initiatives.
  • Increased efficiency by accurately entering provider data into company systems and databases.
  • Improved communication between providers and insurance companies, leading to better understanding of policy coverage and claim status.
  • Educated providers on billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.
  • Served as a reliable resource for both internal staff and external partners, offering guidance on best practices in managing provider relationships.
  • Fostered strong relationships with healthcare providers, leading to higher retention rates.
  • Coordinated with cross-functional teams to ensure seamless provider onboarding experience.
  • Reduced errors in billing and claims submissions by implementing stringent quality control measures.
  • Delivered prompt service to prioritize customer needs.

Appeals Specialist

Universal Health Services
09.2017 - 05.2018
  • Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
  • Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
  • Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
  • Consistently met or exceeded performance metrics, demonstrating a strong understanding of the claims review process and an unwavering commitment to achieving positive results for clients.
  • Created, composed and maintained appeal response templates.
  • Developed appeals functions, policies and procedures and documentation.
  • Maintained strict confidentiality of patient information in accordance with HIPAA regulations.
  • Generated, posted and attached information to claim files.
  • Collected premiums and issued accurate receipts.
  • Checked documentation for accuracy and validity on updated systems.

Appeals and Grievances Coordinator

Anthem
09.2014 - 09.2017
  • Processed and finalized appeals and grievances within agreed-upon turnaround time.
  • Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
  • Submitted verbal and written notification to members and providers.
  • Promoted collaboration among cross-functional teams by facilitating regular meetings to discuss ongoing cases, share insights, and develop coordinated action plans.
  • Contributed to the continuous improvement of departmental operations by regularly reviewing performance data, identifying trends, and recommending targeted action plans.
  • Expedited resolution times by proactively communicating with members, providers, and other stakeholders throughout the grievance process.
  • Enhanced internal processes for handling complaints by developing standardized guidelines and documentation templates.
  • Provided exceptional customer service when interacting with individuals involved in each appeal or grievance situation, demonstrating empathy and professionalism at all times.
  • Maintained strict confidentiality of sensitive member information while adhering to HIPAA regulations during case investigations.
  • Participated in labor-management meetings to discuss labor issues.
  • Negotiated collective bargaining agreements.
  • Assessed impact of union proposals on company or government operations.

Loan Collector

SunTrust
03.2014 - 04.2015
  • Reduced loan delinquency with consistent follow-ups and personalized payment plan negotiations.
  • Provided support to other team members, sharing best practices for effective loan collections and delinquency prevention.
  • Contributed to ongoing process improvement initiatives within the department, suggesting innovative ideas for enhanced performance outcomes.
  • Enhanced department efficiency, streamlining processes and optimizing workflow for faster loan recovery.
  • Participated in training opportunities to stay current on industry best practices and regulatory changes affecting collections efforts.
  • Improved borrower satisfaction by effectively addressing inquiries and resolving issues in a timely manner.
  • Maintained high volume of calls and met demands of busy and productive group.
  • Worked in call center environment handling manual and automatically dialed outbound calls.
  • Regularly monitored accounts to identify overdue balances and potential areas of risk.
  • Maintained consistently high success rate of collecting on overdue accounts.
  • Identified and contacted customers with overdue accounts to address payment status.
  • Documented customer payment interactions and account statuses for future reference.
  • Negotiated payment plans with customers to prevent accounts from entering collections.
  • Responded to customer inquiries and provided detailed account information.
  • Collaborated with other departments to verify customer compliance with payment plans.
  • Worked with customer to create debt repayment plan based on current financial condition.
  • Developed and documented collection procedures and policies to comply with government regulations.
  • Generated and distributed monthly customer statements.
  • Analyzed customer financial records to determine appropriate payment plan.

Claims Representative

Anthem
05.2013 - 09.2014
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Followed up with customers on unresolved issues.
  • Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
  • Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
  • Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
  • Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
  • Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
  • Trained new Claims Representatives on company policies, procedures, and software systems, improving overall team productivity.
  • Investigated and resolved complex claims, ensuring adherence to policy guidelines and regulatory compliance.
  • Coordinated with healthcare providers to verify treatment plans and expenses.
  • Reviewed and updated claim processing guidelines, ensuring alignment with industry standards.
  • Calculated adjustments, premiums and refunds.
  • Posted payments to accounts and maintained records.
  • Modified, updated and processed existing policies.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.

Retail Banker

Woodforest Bank
03.2012 - 11.2013
  • Strengthened client portfolio by identifying needs and recommending suitable financial products or services.
  • Followed through on risk and compliance processes and policies to safeguard customer assets, maintain privacy and act in best interest.
  • Kept current with financial services marketplace and legal and regulatory environment to uphold highest ethical requirements of industry.
  • Complied with regulatory, legal and ethical requirements to protect bank assets.
  • Maintained high levels of cash handling accuracy, ensuring proper documentation and adherence to compliance requirements.
  • Offered clients advice and guidance on digital and self-serve options to make banking easy, simple and fast.
  • Mentored junior staff, fostering teamwork, collaboration, and professional growth within the branch.
  • Identified opportunities for cross-selling financial products, resulting in higher revenue generation.
  • Welcomed customers warmly to meet banking service and transactional needs with seamless execution.
  • Increased customer satisfaction by providing personalized banking solutions and exceptional customer service.
  • Engaged customers in needs-based conversations to identify opportunities and address banking plans and credit card needs.
  • Identified and reported suspicious patterns of activity to reduce money laundering.
  • Improved teller accuracy by conducting regular audits and emphasizing the importance of attention to detail.
  • Developed strong relationships with clients, creating lasting connections that contributed to business growth.
  • Processed applications for new accounts.
  • Arranged monies received in cash boxes and coin dispensers according to denomination.
  • Assisted customers with banking needs and inquiries.
  • Educated customers on online banking and mobile banking applications.
  • Counted, verified and handled bank deposits and armored car transactions.
  • Handled various accounting transactions.
  • Trained new hires on customer service policies and procedures.
  • Monitored and verified suspicious activity on customer accounts.
  • Calculated fees due, interest and change for customer transactions.
  • Performed account maintenance by closing out accounts and changing customer addresses.

Education

Bachelor of Science - Computer Information Systems

DeVry University
Naperville, IL
12.2007

Skills

  • Fraud prevention
  • Regulatory knowledge
  • Anti-Fraud Systems
  • Transaction monitoring
  • Investigation techniques
  • Suspicious Activity Reporting
  • Verbal and written communication
  • Telephone and email etiquette
  • Report Preparation

Timeline

Fraud Specialist II

Capital One
05.2022 - 09.2024

Loan Application Processor

Capital One
08.2020 - 12.2021

Appeals Coordinator

Magellan Complete Care of Virginia
10.2019 - 02.2020

Provider Services Representative

Ally Align Health
05.2018 - 02.2019

Appeals Specialist

Universal Health Services
09.2017 - 05.2018

Appeals and Grievances Coordinator

Anthem
09.2014 - 09.2017

Loan Collector

SunTrust
03.2014 - 04.2015

Claims Representative

Anthem
05.2013 - 09.2014

Retail Banker

Woodforest Bank
03.2012 - 11.2013

Bachelor of Science - Computer Information Systems

DeVry University

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Tivona Whiting