TONYA QUINNONEZ
Flowery Branch,GA
Summary
Accomplished in leading high-stakes investigations for NYC Bureau of Fraud Investigations, I excel in strategic negotiation and fostering team collaboration. My background showcases a blend of complex problem-solving and effective team leadership, ensuring integrity and compliance across operations. Proven track record in enhancing investigative outcomes and employee development.
Overview
29
29
years of professional experience
Work History
Claims Specialist
State Farm
Dunwoody, GA
06.2023 - Current
- Manage claim files, maintaining compliance with documentation procedures.
- Request and review replacement quotes on personal property loss claims and issuing payments based on reconciled documents.
- Oversee damaged property inventories and process claims efficiently.
- Applies knowledge of state and federal laws, statutes and insurance regulations in claim handling
- Interprets and applies insurance contract provisions
- Utilizes appropriate job aids, knowledge, and tools to process the initial reception of claims.
- Completed damage assessment via phone, including detailed description and measurement for building estimations.
- Requests material samples for evaluation.
- Provided insights to claim management on coverage issues for informed decision-making.
- Transition files for further processing as needed after recognizing subrogation opportunities.
- Recognizes and handles retained salvage and monitors pending salvage sale items.
- Collaborates with internal partners, agents, insurance companies, vendors, contractors, and service providers during investigations.
- Identifies and escalates complex coverage issues to the appropriate claim segment.
Director of Medicaid Investigations Division
NYC Bureau of Fraud Investigations
11.2017 - 07.2021
- Directed and coordinated management and operations of the Medicaid Investigations Division within the Bureau of Fraud Investigation.
- Ensure that established goals and objectives are met in a timely manner.
- Developed corrective action plans to address issues identified in statistical reports.
- Created and executed solutions to mitigate vulnerabilities in the State Department of Health Medicaid Program.
- Supervised investigative staff of over 20 investigators, fostering a climate focused on quality and responsibility.
- Devised plans of action to maintain the BFI's operational integrity.
- Implemented changes for the swift resolution of criminal, eligibility, and discrepant cases.
- Evaluates obstacles to reaching targets and devises corrective measures.
- Develop and schedule training for the staff on issues identified.
- Coordinated and engaged in meetings with relevant organizations for resolving operational issues.
- Facilitated structured case conferences with unit supervisors to enhance staff development and assess quality control measures.
- Ensured alignment of employee understanding with company policies and strategic plans.
- Recognize areas in need of additional training.
- Conduct a quality control review of the unit's major functions.
- Input accurate monetary dispositions into relevant IRIS categories.
- Executed timely resolutions of corrective actions to maintain a positive reflection on the agency.
- Identified and resolved personnel issues with supervisory reporting chain.
- Ensured compliance with Equal Employment Opportunity (EEO), HIPAA, and other agency policies/procedures.
- Promoted professional development for leadership roles.
Assistant Deputy Director
NYC Investigation, Revenue & Enforcement Administration
11.2013 - 11.2017
- Orchestrated daily tasks for Fraud Investigators handling applicant interviews for public assistance.
- Managed oversight for 5 distinct units within the organization.
- Managed comprehensive range of intricate, complex, and specialized investigations.
- Compiled reports with recommended actions for managerial decision-making.
- Delivered structured and ad-hoc training sessions on updated investigative policies.
- Compile statistical data to facilitate investigative findings.
- Supervised execution of performance evaluations and oversight of attendance records.
- Collaborated with municipal, state, and external prosecution bodies.
Assoc. Fraud Investigator- Special Investigations
Investigations Revenue Enforcement Agency
, NY
06.1996 - 11.2013
- Manage a unit of 8 Fraud Investigators
- Supervise and conduct complex investigations
- Conducted special projects such as Domestic Violence case, Commissioner complaint and various pilot projects
- Provide staff training and development, monitor subordinates time and leave and operational activities
- Evaluate and rate staff work performance
- Conducted sensitive field Investigations involving recipients who were referred by the Division of AIDS Services and/or Commissioner Complaints
Education
Police Academy -
NYC Police Academy
06.1992
High School -
John Jay High School of Criminal Justice
06.1987
Skills
- Operations management
- Investigative Experience
- Employee Relations
- Documentation Expertise
- Teamwork and Collaboration
- Problem Resolution
- Strong Verbal and Written Skills
- Effective Objective Planning
- Organized Time Management
- Effective Team Leadership
- Project Planning
- Onboarding and Orientation
- Employee Development
- Complex Problem Solving
- Performance Tracking and Evaluation
- Training and Development
- Negotiation and Conflict Resolution
- Customer Relationship Management
- Coverage assessments
- Strategic Negotiation Management
- Compliance management
- Documentation review
- Claims analysis
- Verbal communication
- Policy and procedure development
Awards
NYC HRA Excellence Program Eagle Award Recipient, 04/01/17
Affiliations
- Basketball Team Parent - Volunteering for events, conduct fundraisers and assist with coordinating team activities
- Event Planner
- Novice Baker
Accomplishments
- Consistently exceeding target goals
- Successfully recouped over $400k in benefits fraudulently obtained
- Proven success in employee development and performance management
- Consistently achieve favorable results through thorough investigation and policy application.
- Spearheaded the annual cultural event to foster workplace inclusivity.
- Implemented successful workflow for staff working from home during pandemic with positive results for the agency
Timeline
Claims Specialist
State Farm
06.2023 - Current
Director of Medicaid Investigations Division
NYC Bureau of Fraud Investigations
11.2017 - 07.2021
Assistant Deputy Director
NYC Investigation, Revenue & Enforcement Administration
11.2013 - 11.2017
Assoc. Fraud Investigator- Special Investigations
Investigations Revenue Enforcement Agency
06.1996 - 11.2013
Police Academy -
NYC Police Academy
High School -
John Jay High School of Criminal Justice