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Pilot Catastrophe Inc - Siu Investigator Resume Example

Layla Ross
XXXXX XXXXXXX XXXXXX XXXX , Mobile , AL 36695 | (H) XXXXXXXXXXXX | XXXXXXXXXXXXXXXXXXXXXXX
Professional Summary
  • Highly trained Respiratory Therapist & Registered Nurse with strong clinical abilities and a successful career in an acute care facility. Proactive and organized with passionate commitment to first-rate patient care. 
  • Competent and supportive Case Manager with 1 year of experience in
    patient / client advocacy. Possesses excellent interviewing skills, dogged determination, and
    unrelenting ethical integrity.
  • Seasoned insurance fraud investigator with more than years of experience in a fast-paced market claims office. Excellent communication and computer skills. Track record of achieving exceptional results in insurance claims handling and fraud investigation
Skills
  • Critical Thinking
  • Judgment and Decision Making
  • Complex Problem Solving
  • Time Management
  • Negotiation
  • Computers and Electronics
Experience
SIU Investigator 08/2008 to Present
Pilot Catastrophe Inc. Mobile, AL
  • Conduct verbal consultations with claims adjusters to discuss suspected fraudulent claim activity and assist in the identification of industry accepted red flags. 
  • Identify and articulate red flags, suspected fraudulent activity, material misrepresentation and other indicators of insurance fraud.
  • Educate claims staff via in service training and verbal consultations to promote awareness of insurance fraud, industry accepted red flags, the SIU process and investigative best practices.
  • Make sound investigative recommendations to claims staff that will assist in the identification and investigation of insurance fraud and promote claims savings.
  • Coordinate investigations of suspected fraudulent activity with adjusters, 3rd party vendors and prosecuting authorities. 
  • Obtain, document and report information related to suspected fraudulent activity, red flags, state mandated reporting, restitution and claims savings.
  • Conduct interviews and obtain recorded statements from a wide variety of individual in varying environments.
  • Obtain supporting documentation including claim documents, expert reports, and other records. 
  • Document all investigative efforts and case related communications in claim file. 
  • Complete expense reports on a weekly basis. 
Nurse Case Manager 07/2007 to 07/2008
Blue Cross of Idaho Meridian, ID
  • Effectively case manages members utilizing a collaborative process. Assess, plan, implement, monitor and evaluate the options and services required to meet an individual's health needs, using communication and available resources to promote quality and cost effective outcomes. 
  • Support the Medical & Quality Management initiative to ensure the delivery of medically necessary and appropriate, cost-effective and timely, quality health care services, through the focused procedural review and authoritative process. 
Staff Nurse - ICU 06/2005 to 07/2008
St. Alphonsus Regional Medical Center Boise, ID
  • Duties include caring for critically injured and sick patients through assessment, planning and treatment of the patients and their families.
  • Other responsibilities include communicating with members of the multi-disciplinary team by collaborating with physicians and ancillary departments to coordinate and provide optimal care to our patients and their families.
  • As a new employee preceptor, I assisted in the professional growth and development of new staff in nursing skills and hospital and unit policies and procedures.
Guest Lecturer 01/2005 to 01/2006
Idaho State University Boise Campus Boise, ID
  • Provided instruction on arterial blood gas interpretation and therapeutic modalities to ISU nursing students.
  • Provided instruction on appropriateness of use during a skills lab on oxygen delivery devices to ISU nursing students.
Respiratory Therapist - Relief Supervisor 05/1998 to 06/2005
St. Alphonsus Regional Medical Center Boise, ID
  • Provided Respiratory Care for all patient populations including ICU, med-surg, and pediatrics, through assessment and delivery of treatments via a multi-disciplinary approach.
  • Supervisory roles included coordinating therapist assignments and responding to emergency calls throughout the hospital.
Respiratory Therapist - Evening Shift Supervisor 05/2000 to 03/2002
St. Luke's Regional Medical center Boise, ID
  • Duties included providing respiratory care and education to patients and their families.
  • Supervisor position duties included assignment of patient care load to therapists within the central RT department as well as assignment of therapist to PICU, NICU and Pediatrics.
  • As supervisor, I was also responsible for ensuring adequate staffing of the central department and critical care units for the oncoming shift.
  • As a senior staff member my duties also involved the mentorship of junior staff members in the assessment, planning and treatment of patients in the ICU, med-surg and pediatric populations.
Education
Bachelor of Science: Nursing May 2005 Idaho State University - Boise, ID
Bachelor of Science: Respiratory Therapy May 1999 Boise State University - Boise, ID
Diploma: May 1993 Alexandria Senior High School - Alexandria, LA
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Resume Details

This is a real resume for a SIU Investigator in Mobile , Alabama with experience working for such companies as Pilot Catastrophe Inc, Blue Cross Of Idaho, St Alphonsus Regional Medical Center. This is one of the hundreds of SIU Investigator resumes available on our site for free. Use these resumes as templates to get help creating the best SIU Investigator resume.

Previous Companies:

  • Pilot Catastrophe Inc
  • Blue Cross of Idaho
  • St Alphonsus Regional Medical Center

Previous Job Positions:

  • SIU Investigator
  • Nurse Case Manager
  • Staff Nurse ICU
  • Guest Lecturer
  • Respiratory Therapist Relief Supervisor

Schools:

  • Idaho State University
  • Boise State University
  • Alexandria Senior High School

Level of Education:

  • Bachelor of Science
  • Diploma

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