Healthcare Fraud Investigator Resume

Samantha Gray

North Highlands CA 95660

(916) 987-6543

[email protected]

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Job Objective

To be given an opportunity to work as a Healthcare Fraud Investigator to put my years of training and experience to work for good of company.

Summary of Qualifications:

  • Remarkable experience with fraud/abuse detection and claims data analysis
  • Wide knowledge of law enforcement involved in healthcare and Medicaid fraud abuse detection
  • Proficient in Excel and data analysis
  • Excellent verbal and written communication skills
  • Ability to differentiate between fraud, abuse and overutilization

Work Experience:

Healthcare Fraud Investigator, August 2005 – Present

UnitedHealth Group, Devine, TX

  • Developed Federal, State and local law enforcement programs to reduce fraud and assault in relation to health plans.
  • Performed investigations, audits, evaluations and inspections regarding the delivery of and payment for health care.
  • Assisted the implementation of the civil, criminal and administrative statutes applicable to health care.
  • Provided industry assistance, including suggested opinions, safe harbors and specific fraud alerts regarding to fraudulent health care practices.

Education

Bachelor’s Degree in Criminal Justice, West Valley College, Saratoga, CA