RONDA TURNBOW 817-***-****

Lubbock, Texas ***** ad3kjv@r.postjobfree.com

OBJECTIVE:

Experienced professional with demonstrated history spanning twenty-five years working in the insurance industry (A&H and P&C). Strong insurance background specific to fraud, waste and abuse invesƟgaƟons, contract and regulatory compliance, underwriƟng, claims processing, account management roles, grievance and fraud invesƟgaƟons and resoluƟon. AƩended AISIU conferences targeƟng fraud, waste, and abuse. I hope to conƟnue to enhance my analyƟcal, project oversight, and business process improvement skills, as well as my SIU invesƟgaƟonal skills. I strive to stay current on the latest fraud trends.

PROFESSIONAL EXPERIENCE:

STATE NATIONAL COMPANIES June 2022 – CURRENT

AnƟ-Fraud / SIU Compliance Analyst – Compliance Department Research and analyze unique requirements resulƟng from new clients, new products, or changes in insurance regulaƟons. Develop, enhance, distribute, and maintain detailed processes necessary for the Company and internal/external customers to remain compliant with new regulatory compliance requirements. Develop and communicate Company expectaƟons to internal and external customers relaƟve to anƟ-fraud / SIU areas of responsibility. Meet statutory reporƟng obligaƟons relaƟve to anƟ-fraud / SIU acƟviƟes. Monitor new anƟ-fraud / SIU laws or promulgated regulaƟons. Maintain relaƟonships with various state insurance departments and other regulatory bureaus/enƟƟes. Facilitate regular meeƟngs with our Managing General Agents to ensure compliance with all state and federal regulatory requirements. AudiƟng of client’s anƟ-fraud pracƟces to maintain compliance with state and federal regulatory requirements for fraud, waste, and abuse. Failure to pass with an acceptable audit score leads to the implementaƟon of a correcƟve acƟon compliance plan (CACP). STATE OF TEXAS – TEXAS WORKFORCE COMMISSION July 2018 – June 2022 Auditor – TWC Fort Worth Tax Department

Performed complex senior level account examinaƟon work. Work involved planning, developing, and recommending techniques and procedures for conducƟng audits, examinaƟons, and invesƟgaƟons of financial accounƟng records. Supervised the work of others. Worked under limited supervision, with considerable laƟtude for the use of iniƟaƟve and independent judgment. Prepared audit reports containing detailed findings of financial documents and recommended course of acƟon. Failure to pass with an acceptable audit score led to the implementaƟon of a correcƟve acƟon plan

(CAP).

HEALTHMARKETS, INC. June 2017 – July 2018

Fraud InvesƟgator II – Special InvesƟgaƟons Unit

Served as an invesƟgator in our Supplemental lines of business. In this role, I detected fraud, waste, and abuse through invesƟgaƟons of various media and internal systems. Managed large caseload work with heavy medical record reviews and interviewing fraud vicƟms. I created and supported cases related to suspected fraud for internal handling and working with all levels of management in various departments as well as preparing for hand off to law enforcement or other regulatory bodies for civil and/or criminal invesƟgaƟons/prosecuƟons. I rouƟnely parƟcipated in the educaƟon, learning and development relaƟng to targeƟng and detecƟng insurance Fraud, Waste and Abuse Industry. Researched, analyzed, and invesƟgated referred allegaƟons pertaining to producer or agent fraud. Maintained a rapport with law enforcement and industry agencies such as Department(s) of Insurance (DOI). Prepared invesƟgaƟve reports holding detailed findings to determine course of acƟon.

ATLAS PREMIER SERVICES August 2009 – June 2017

Director

Oversight and management of invesƟgators. In this role I also Interviewed witnesses and claimants to obtain recorded statements as it related to workers compensaƟon or accidental death invesƟgaƟons. Gathered documentaƟon, such as medical records, and police reports. Performed on-site scene invesƟgaƟons, including photography. Documented invesƟgaƟve acƟviƟes and prepared reports of findings. Referred findings to claims adjuster for seƩlement. RONDA TURNBOW PAGE TWO

HEALTHMARKETS September 2001 – 2009

Business Analyst – Claims Department

Analyzed and documented the claims market environment, processes, and systems of businesses. Planned and monitored reporƟng and defined business requirements for the claims department. Served as the intermediary between business and IT, assessing whether the IT soluƟon is suitable for the business. Assisted in wriƟng system coding and rouƟng rules to claims automaƟon in compliance with Department(s) of Insurance. Internal Auditor – Compliance AudiƟng Department

Reviewed records to verify that the organizaƟon was performing in compliance with internal and external rules and regulaƟons. Gave recommendaƟons to department heads when found to be non-compliant. Scheduled future audits to monitor progress of non-compliant business departments. Made sure the organizaƟon operated within local, state, and federal laws, and followed procedures and regulaƟons. Failure to successfully pass with an acceptable audit score resulted in a correcƟve acƟon plan (CAP). Subject maƩer expert (SME) for upper management. Consumer Affairs Supervisor – Consumer Affairs Department As consumer affairs supervisor my goal was to provide exemplary customer service to insureds who developed issues with the company’s products or services. In responding to consumer, BeƩer Business Bureaus, and Department of Insurance(s) complaints, I monitored eight consumer affairs invesƟgators and eight consumer affairs telephone representaƟves to provide accurate informaƟon and prompt soluƟons to quesƟons, inquiries, complaints, or problems that arose during the invesƟgaƟon. Subject maƩer expert (SME) for upper management. Compliance InvesƟgator – Corporate Compliance Regulatory Affairs Conducted interviews with claimants/complainants and gathered evidence as it related to their complaint allegaƟons. Focused on compliance, rules, and regulaƟons as it related to our lines of business. Performed deep-dive invesƟgaƟons on brokers/agents with high complaint raƟos. Subject maƩer expert (SME) for upper management. Consumer Affairs Senior InvesƟgator

Conducted and supervised complex and sensiƟve administraƟve, civil, and criminal invesƟgaƟons related to alleged violaƟons against the company internally and within respected department(s) of insurance, as well as criminal acƟvity. Aided in oversight of invesƟgators duƟes and responsibiliƟes in the accomplishment of their assignments. Met frequently with Compliance Departments and Business units regarding invesƟgaƟons and trends idenƟfied. Consumer Affairs InvesƟgator

As an invesƟgator I conducted complex and sensiƟve administraƟve, civil, and criminal invesƟgaƟons related to alleged violaƟons against the company internally and within respected department(s) of insurance, as well as criminal acƟvity. TOOLS and TECHNOLOGY

MicrosoŌ office products Fraud detecƟon soŌware

Suspicious AcƟvity ReporƟng System (SARS) and iSight Case Management plaƞorm LexisNexis and Westlaw QuickBooks, Advanced Micro SoluƟons, and Mcleod Payroll SoŌware Surveillance equipment Desktop/Laptop Computers Digital photography

KEY COMPETENCIES

Monitoring/InstrucƟng OperaƟon and Quality Control Analysis Reading Comprehension Persuasion and NegoƟaƟon Social PercepƟveness Time and Personnel Management CriƟcal Thinking Judgement and Decision-Making Complex Problem Solving Independent worker Advanced WriƩen/Verbal CommunicaƟon Skills