Tye-Shiea "Nikki" Howard

• Investigate complex fraud and dispute cases to mitigate financial loss exposure and identify potential financial crime risk indicators
• Analyze customer transaction behavior and merchant activity to support dispute resolution, chargeback classification, and suspicious activity identification
• Apply regulatory requirements including Regulation Z and card network rules across 40+ reason codes while supporting compliance and risk-based case decisioning
• Document detailed investigative findings supporting regulatory compliance, audit readiness, and risk mitigation
• Perform detailed activity reviews to identify abnormal transaction behavior and potential suspicious activity patterns

• Monitored customer transactions to detect fraud indicators including account takeover, theft, and transaction manipulation
• Partnered with financial institutions and customers to validate suspicious activity
• Maintained quality and compliance standards while managing high volume case workload

• Resolved complex customer issues requiring transaction research and policy interpretation
• Developed investigative questioning techniques to identify root cause transaction issues

• Reviewed claims filed by cardholders and performed chargebacks for disputed transactions
• Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions
• Reached out to customers, via mail, after completed sales to evaluate dispute claims and determine immediate service requirements

• Contacted payers to check claim status, submit corrected claims, file appeals, resolve payer issues and maintained denials reports, not worked reports, and other tasks
• Contacted patients/guardians to obtain important information pertinent to the processing of their claims
• Worked very closely with Provider Enrollment department and Accounts Receivable department to ensure that claims are being processed internally without complications

• Processed necessary documents to ensure that all physicians are enrolled in government programs and are participating in company-approved managed care organizations
• Organized and maintained physician files; maintained credentialing reports and updated Provider Enrollment database
• Conducted written and oral follow-ups to determine application status; created and maintained application files for government agencies as well as managed care organizations