Fraud Specialist Resume Samples

Description :

1. Responsible for reviewing account activity and performed a variety of operational tasks for a moderately complex process or function.
2. Determined the legitimacy of transactions, accountable for entire process from receipt of claim to resolution and closure following all compliance guidelines.
3. Trained new-hires in various aspects such as developing communication skills, handling difficult customers, and educated employees on how to use call center software systems required to assist clients and Partners for both U.S and Canada.
4. Made outbound calls and responded to inbound calls in order to gather pertinent information in a fast-paced, high-volume call center.
5. Successfully assisted callers and negotiated a mutually agreeable solution by patiently providing alternatives to reconcile the customer's needs with the company's objectives.
6. Analyzed and improved departmental operations and procedures resulting in increased productivity.
7. Hosted a weekly conference call with sales managers and production staff addressing issues of concern and ideas for improving service and accentuating the positive results achieved.

Experience

7-10 Years

Level

Management

Education

Business

Description :

1. Conducted fraud investigations of Medicare Parts A, B and DME billing.
2. Utilized data analysis, interviews, surveillance and review of medical and financial documentation to substantiate the accuracy, completeness and appropriateness of billing, documentation and the medical necessity of services per Federal and State regulations and Contractor guidance.
3. Referred substantiated allegations to the OIG and FBI for further development and prosecution.
4. Coordinated investigations between assigned law enforcement and the Contractor, assisted in conducting physical and data surveillance, served as a witness during prosecution and utilized behavioral interviewing techniques during investigations.
5. Coordinated the hearings and appeals process for the Fraud Unit, preparing cases for appeal at the Fair Hearing Officer and Administrative Law Judge levels.
6. Reviewed all correspondence and referral documents for legal sufficiency.
7. Provided training to the healthcare community through seminars on contractor activties and the appropriate application of Medicare standards.

Experience

2-5 Years

Level

Junior

Education

MBA In Accounting

Description :

1. Ensured loss avoidance and regulatory compliance in Preventive Loss Department for a $41 billion dollar company operating in several states.
2. Analyzed and improved performance of all risk products, reported market trends and emerging issues, and developed new business strategies.
3. Accountable for two risk products, which identified suspicious repetitive returned items and identified suspicious monetary transactions.
4. Responsible for updating each system as products and services changed, adhering to any compliance standards for each system, and reporting and investigating suspicious activity related to these systems.
5. Identified and referred SAR reportable issues to Corporate Security.
6. Completed monthly loss reports detailing potential risks, losses, and avoidances.
7. Assisted with the identification and subsequent closing of AML suspect accounts.
8. Reviewed customer identity theft claims and/or affidavits of loss to determine if the customer would be reimbursed according to UCC guidelines.

Experience

10+ Years

Level

Senior

Education

Bachelor Of Science

Description :

1. Reviewed daily reports to monitor possible fraudulent banking activities.
2. Processed levies & garnishments for federal and state agencies, following each states specific guidelines.
3. Processed charged off accounts and reported to appropriate collection services.
4. Conducted and assisted on fraudulent investigations to protect the bank and its customers when suspicious activity was deemed probable fraud.
5. Assisted branch personnel with inquiries regarding suspicious and possible fraudulent banking activities and took the appropriate steps to protect all parties involved.
6. Customer Service Representative Provided outstanding customer service while processing a wide variety of financial transactions accurately and efficiently.
7. Identified other possible financial product needs for the banking customers and referred them to the appropriate party to further enhance customer relationships.
8. Assisted customers with questions and concerns regarding their financial accounts.

Experience

7-10 Years

Level

Management

Education

Education

Description :

1. Provided the highest level of customer satisfaction during periods of extreme customer frustration and concern.
2. Responded to inbound phone calls regarding processing applications and fraud activity on card holder's accounts.
3. Consistently demonstrated an understanding of basic fraudulent principles, as they related to decreasing fraud, cutting costs, and improving overall organizational effectiveness.
4. Successfully resolved fraudulent activity affecting cardholders' accounts, including charges/payments and financial transactions.
5. Processed item-level transactions including exchanges, returns, payments, and credit card orders.
6. Extended guidance to less experienced staff; and, maintained complete and accurate documentation of all telephone and personal interactions.
7. Functioned continually as the dependable team member who could identify and reduce fraud to protect cardholder accounts and minimize the risk to collegial financial institutions.

Experience

7-10 Years

Level

Management

Education

BA In Human Services

Description :

1. Accountable for the overall control of fraud to protect internal and external customers.
2. Review daily reports keenly analyzing for patterns of fraud such as Kiting, ATM Fraud, and Account Compromise.
3. Routinely identify fraudulent activities and refer to the investigators for further review and action.
4. Provide support to bank employees regarding questions relating to actual, potential or suspicious fraudulent activity.
5. Manage and provide daily controls for the prevention of fraud focused exclusively on eliminating or reducing financial loss to both customer and bank.
6. Perform detail video surveillance upon discovery of fraudulent activity and/or bank robberies.
7. Under the realm of bank security, grant, maintain and issue all security access cards at the employee level for bank personnel.
8. Proficient with several different security access system applications.

Experience

5-7 Years

Level

Executive

Education

BS

Description :

1. Representative of Call Center operations of inbound calls from global cardholder clients.
2. Investigation and escalation of fraudulent debit and credit card transactions.
3. Resolution of lost/stolen debit and credit card activity.
4. Extensive client interaction via phone, voicemail, fax, and e-mail.
5. Escalation of client concerns to internal or external responsible parties.
6. Daily contact including actively supporting our member financial institutions nationwide.
7. Assisting our globally-traveling cardholders to ensure their travel plans were documented to eliminate declined transactions abroad.
8. Fostering a team environment and progressively pursuing positive advancements in our call center environment 24 hours a day throughout the year.

Experience

5-7 Years

Level

Executive

Education

Bachelor Of Arts

Description :

1. Provide support by initiating and maintaining system case files via BBVA Compass internal case management system.
2. Use Compass internal bank systems to research and document casework and the filing of SAR.
3. Work and assign specific cases that require investigation or SAR filing.
4. Including internal fraud cases and bank robberies.
5. Contact internal and external customers to clarify charges or request additional documentation.
6. Create bank entries and process credits / debits to resolve casework using internal general ledger account.
7. Maintain working relationship and open line of communication with various members of law enforcement on specific cases.
8. Conduct new hire training on internal and external fraud prevention.

Experience

2-5 Years

Level

Junior

Education

Criminal Justice

Description :

1. Worked directly with cardholders to resolve fraud and billing dispute claims.
2. Monitored exception reports to mitigate credit losses, and provide TSYS-related administrative support.
3. Responded to dispute/fraud related customer inquiries (oral or written) Researched exception activity and take appropriate action to reduce credit losses.
4. Researched, resolved, documented and responded to disputed purchases and fraud claims.
5. Tracked all sales draft retrieval requests.
6. Coordinated with law enforcement as applicable regarding fraud claims.
7. Processed chargebacks and representments according to Association rules.
8. Performed all duties in compliance with appropriate regulations.

Experience

2-5 Years

Level

Executive

Education

General Education

Description :

1. Investigated fraud-related accounts to prevent Identity Theft.
2. Handled telephone communication with clients, verifying identity for fraud.
3. Contacted banks to verify funds dealing with balance transfers and returned payments.
4. Researched credit bureaus to verify personal information and identity and restriction of suspicious accounts.
5. Presented special projects to the management team, involving spreadsheets and layouts that pertained to monitoring computers for staff efficiency and productivity.
6. Sustained four consecutive passed audits with a score of 100%.
7. Attended meetings with Head Corporate Manager, representing the department and offered feedback for increased production.

Experience

2-5 Years

Level

Executive

Education

Bachelor's In Biology

Description :

1. Prepare reports for all fraud cases to MasterCard International.
2. Help companies and banks improve their capabilities and resources for the alleviation and prevention of fraud.
3. Provided feedbacks for International and local banks about their client's transactions.
4. Monitor and review electronic account and transaction data for suspicious activity and possible fraud.
5. Investigate and resolve irregular transactions reported by end users.
6. Interface with mid- and senior-level managers daily to resolve operation issues.
7. Identify Business areas required high security.
8. Keep detailed records for all fraud activities and prepare recommendation loss mitigation as needed.

Experience

7-10 Years

Level

Consultant

Education

MBA