Tivona Whiting
Square Financial (BLOCK)
Glen Allen,VA
1
Language
13
years of professional experience
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.
Experienced analyst prepared for this role with strong focus on data interpretation, financial modeling, and strategic planning. Known for collaboration and delivering results, adaptable to changing needs, and reliable. Skilled in data visualization, problem-solving, and stakeholder communication. Employers value analytical mindset, teamwork, and consistent performance.
Work History
SFS Escalated Complaints Analyst
1 Year 2 Months- Resolved escalated customer complaints through detailed case review, de-escalation, and policy-aligned solutions.
- Investigated complex service issues to identify patterns and implement effective resolutions.
- Investigated complex service issues using CRM tools, transaction records, and account histories.
- Documented complaint trends and root causes to inform process improvements and enhance service quality.
- Documented complaint trends and root causes to support process improvements and service quality.
- Managed 35–50 complex cases daily, validating documentation, investigating inconsistencies, and ensuring accuracy in findings.
Fraud Specialist III
3 Years 3 Months- Reduced instances of fraud by implementing comprehensive detection and prevention strategies.
- Conducted thorough investigations into suspected fraudulent activities, ensuring timely resolution of cases and safeguarding customer trust.
- Conducted thorough and timely investigations of suspicious activity reports, ensuring compliance with regulatory requirements.
- Identified trends in fraudulent activities through data analysis, informing updates to anti-fraud strategies and enhancing overall detection efforts.
- Coordinated with law enforcement on high-profile fraud cases, aiding in apprehension of perpetrators.
- Notified customers directly about fraudulent activity to ensure timely response. to notify of fraudulent activity and minimize impacts.
- Improved customer trust by promptly addressing and resolving reported instances of fraud.
- Advised senior management on fraud risk management strategies, influencing company-wide policies that strengthened organizational defenses against fraud.
- Collaborated with team members to discuss fraud trends and brainstorm methods to combat this type of crime.
- Advised senior management on fraud risk management strategies, influencing company-wide policies.
- Reduced energy theft incidents through diligent monitoring of usage patterns and prompt investigation of suspicious activity reports.
Loan Application Processor
1 Year 4 Months- 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 the team to create strategies that enhanced 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 the 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.
- Reviewed loan applications for completeness and accuracy and supporting documentation for completeness and accuracy.
- Created training materials for new hires, facilitating consistent onboarding and effective knowledge transfer within the team.
- Reviewed application packets for completeness, accuracy, and policy compliance.
- Verified customer information against supporting documents and internal records.
Appeals Coordinator
4 Months- Served as departmental resource for appeals, providing guidance and expertise.
- Developed and managed appeal response templates to ensure consistency and effectiveness.
- Collaborated with senior specialist to draft comprehensive appeal responses addressing key issues.
- Coordinated with senior specialist to compose appeal responses.
- Acted as a departmental resource on appeals matters.
- Responded to attorney inquiries and litigation notices.
Provider Services Representative
9 Months- Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns.
- Coordinated with internal departments to resolve claims disputes and financial matters for providers, ensuring timely payment.
- 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.
- Enhanced communication between providers and insurance companies, clarifying policy coverage and claim status.
- Served as a reliable resource for both internal staff and external partners, offering guidance on best practices in managing provider relationships.
- Developed strong relationships with healthcare providers, contributing 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.
Appeals Specialist
8 Months- Collaborated with cross-functional teams to gather documentation and evidence, enhancing accuracy and effectiveness of appeals.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under high deadlines or heavy caseloads.
- Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
- 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.
- Developed and organized appeal response templates for efficient processing.
- Developed and implemented appeals functions, policies, and procedures to improve documentation standards and compliance.
- Maintained strict confidentiality of patient information in accordance with HIPAA regulations.
- Compiled and uploaded relevant information to claim files to support processing.
- Reviewed and verified documentation accuracy and validity in updated systems.
Appeals and Grievances Coordinator
3 Years- Processed and finalized appeals and grievances within agreed-upon turnaround time.
- Submitted verbal and written notification to members and providers.
- Facilitated regular meetings with cross-functional teams to discuss ongoing cases, share insights, and create coordinated action plans, enhancing collaboration.
- Reviewed performance data and identified trends to recommend targeted action plans, contributing to continuous improvement of departmental operations.
- Enhanced internal processes for handling complaints by developing standardized guidelines and documentation templates.
- Developed standardized guidelines and documentation templates to enhance internal processes for handling complaints.
- Contributed to the continuous improvement of departmental operations by regularly reviewing performance data, identifying trends, and recommending targeted action plans.
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
- Attended labor-management meetings to discuss workplace issues and employee concerns. to discuss labor issues.
- Facilitated negotiations for collective bargaining agreements to ensure fair labor practices..
- Evaluated the impact of union proposals on company operations and employee relations. on company or government operations.
Claims Representative
1 Year 4 Months- Processed large volumes of claims efficiently in fast-paced environment, ensuring timely resolution.
- Followed up with customers on unresolved claims to enhance communication and satisfaction.
- 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 policies, procedures, and software systems, increasing team effectiveness.
- 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 to claims, premiums, and refunds to ensure accurate financial processing.
- Posted payments to customer accounts and maintained accurate financial records for tracking.
- Modified and updated existing policies to ensure compliance with current regulations.
- Performed administrative tasks including client communication, mail distribution, and document scanning to support operations.
Education
Bachelor of Science - Computer Information Systems
Skills
Fraud prevention
Fraud detection systems
Investigation techniques
Communication strategies
Suspicious Activity Reporting
Regulatory knowledge
Report Preparation
Analytical thinking
Professional communication
Data management
Time management
Case prioritization
Professional etiquette
Languages
English
Native or Bilingual
Timeline
SFS Escalated Complaints Analyst
Square Financial (BLOCK)
08.2025 - 10.2026Read More
Fraud Specialist III
Capital One
05.2022 - 08.2025Read More
Loan Application Processor
Capital One
08.2020 - 12.2021Read More
Appeals Coordinator
Magellan Complete Care of Virginia
10.2019 - 02.2020Read More
Provider Services Representative
Ally Align Health
05.2018 - 02.2019Read More
Appeals Specialist
Universal Health Services
09.2017 - 05.2018Read More
Appeals and Grievances Coordinator
Anthem
09.2014 - 09.2017Read More
Claims Representative
Anthem
05.2013 - 09.2014Read More
DeVry University
Bachelor of Science from Computer Information Systems
Read More