Customer Service Insurance

Kristen Shaffer, FCLS

**** * ****** ******, ****** CA 91724

***************@*****.*** • 401-***-****

Professional Experience

CNA – brea, ca

Major Case Investigator, 10/1/2015 – present

Investigation of suspected fraudulent medical providers and organized crime rings – all lines. Responsibilities include claim file review, medical report review, medical billing review/ICD-9 codes, in-depth backgrounds, data analytics, statement taking, witness interviews, implementing appropriate tax TIN blocks and Investigative Alerts, accident scene investigations, report writing, clinic inspections and scene evaluations. Collaborate with local and Federal law enforcement, reporting to appropriate governing agencies. Evaluate claims from initial report to final disposition.

AIG – Santa Ana, CA

Senior Special Investigator, 1/2014 – 10/1/2015

Senior Special Investigator. Investigate suspected fraudulent claims / Major Case investigations– all lines, work with local law enforcement, extensive customer relations, review and interpretation of legal docs, tax liens, judgments, in person witness statements, scene investigations, and recorded statements. Conduct new hire SIU training, worker compensation adjuster training and home office pilot training modules, community outreach coordinator.

I.C.S. Claims – Westborough, MA

Property Claims Supervisor/ Lead Special Investigations Investigator, 12/2011 – 12/2013

Serve dual role spearheading special investigations and as multi-line adjuster and Property Claims Supervisor to 15+ Claims Investigators. Manage implementation and compliance for coverage review, interpretation of languages, and explanation of technicalities. Exercise skills and competencies in statement taking, witness interview, accident scene investigations, report writing, and scene evaluations. Collaborate with local and Federal law enforcement, reporting to appropriate governing agencies. Evaluate claims from initial report to final disposition. Assess value of claim and negotiate settlement or issue denial of claim document with supporting notes and rationale, in compliance with established decision-making processes.

Guide Post Solutions – New York, NY

Independent Contractor, Temporary Contract position

Associated with international securities and investigation firm as Special Investigations Unit Specialist. Developed and addressed methodologies for proper investigative procedures and effective investigatory techniques, emphasizing adherence to legal and industry regulations. Enforced local / federal regulations, Medicare rules, and Medicaid policies. Trained employees and senior level management on SIU Operations Procedures and Investigative Techniques.

JS Investigations – Slidell, LA

Senior Special Investigations Unit Manager, 12/2010 – 9/2011 (contract position)

Oversaw team of 65+ private investigators performing due diligence into BP oil spill loss of income claims, large organized crimes investigations. Act as a subject matter expert on insurance fraud. Represent firm at industry conferences and present to attorney panels on use of JS for workers’ compensation claims and insurance defense cases. Communicated directly with senior claims managers regarding investigative strategies and conclusions on cases. Tracked workflow and reports in Excel spreadsheets, approved timesheets, and managed confidential claims database.

CHUBB INSURANCE COMPANY – Phoenix, AZ

Senior SIU Examiner, 11/2005 - 8/2009

Positioned as Lead SIU Investigator for major residential and commercial property. Managed 22 inside adjusters, outside independent adjusters, contractors, and experts in more than 30 states. Responsible for determining origin and cause of damage to structures, vehicles, and other insured collateral. Handled field testing and witness interviews. Collected both onsite and field evidence and data as part of claim ownership. Compiled detailed and extensive oral and written investigative reports.

AMERICAN FAMILY INSURANCE – Phoenix, AZ

Office Manager / Agent, 6/1995 – 8/2004

Supported business operations and customer service, managing 4 agents and 6 staff; Responded to client inquiries on insurance contacts and updated insurance member files. Developed quotes for all lines of coverage and issued new policies. Key Achievements:

•Conducted hands-on inspection of property to ensure accuracy of underwriting.

•Skilled use of ITV program to evaluate rebuild costs of property.

Training

~ FCLS Designation (currently working towards my SCLA designation)

~ Licensed Property and Casualty Producer / Adjuster in AZ & TX

~ National Insurance Crime Bureau Specialized Track Certification

~ Fluent in American Sign-Language

Applications: Word, Excel, PowerPoint, Outlook, Access, Scout, Xactimate, XactAnalyis, Claim Vision, File Trac

Affiliation: Association of Certified Fraud Examiners; IASIU; SCLA

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