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Fraud, Compliance, Investigations

Location:
Baltimore, MD
Salary:
$52,000 - $78,000
Posted:
October 11, 2019

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Resume:

Betty Bates

Baltimore, MD *****

adakio@r.postjobfree.com

443-***-****

Work Experience

Fraud Compliance Manager

Government of the District of Columbia - Department of Insurance - Washington, DC February 2000 to January 2016

Washington, DC

Fraud Compliance Manager

Government of the District of Columbia (DISB) - Washington, DC February 2000 to January 2016

Worked 40 hours weekly;

- Created and managed the day-to-day operations of the newly-created Compliance and Enforcement Division, the regulatory fraud investigative, compliance and enforcement sector of the Fraud Bureau:

* Performed Managerial Duties: - Ensured the enforcement and implementation of the DC Fraud and Compliance Laws, by conducting investigations of allegations of fraudulent activities, misconduct, waste, abuse and mismanagement in DC of financial services industries; - Used best practices, while collaborating and

consulting investigations with other sister regulatory departments and with the Philadelphia, PA, regional office of US HHS, Medicare & Medicaid Services, Medicare Advantage Integrity Program, as well as, participated in its quarterly updated

telephonic conference calls; - Handled highly-profiled and- sensitive referrals, in detail; - Managed and monitored inter-bureau projects; - Assigned, reviewed, monitored and analyzed the work of staff, who prepared comphensive reports of findings, along with referring supporting documents to forward to legals sector for consideration to take enforcement or corrective action, against the alleged perpetrator, as warranted; - Appeared to testify, at Administrative Hearings held, as warranted; and - Maintained and

monitored databases of workflow of assignments and enforcement, including monitoring corrective actions/consent orders;

* Performed Administrative Duties: - Assisted the Fraud Director/Associate Commissioner in developing the mission and vision statements, strategic planning, Standard Operations Procedures (SOPs), - Reviewed and maintained updated compliance documents, formulated budgeting; and - Compiled and submitted all weekly and monthly reporting documents to Senior/Executive Management and the same regarding annually

statistical reports, timely, etc;

* Performed Leadership Duties: - Organized, planned, coordinated, assigned and directed work plans and workflow of staff; and - Manahed several inter-bureau projects;

* Performed Human Resources Duties: - interviewed, hired, coached, trained, appraised work of staff of experienced investigators, etc.; and

* Other Duties: - Scrunched numbers from annual compliance reporting statistical reports in which insurers are mandated to submit; - Annually updated DIBS's website; - Community Consumer Chief Fraud Investigator

Fraud Bureau - Columbia, WA

October 1995 to February 2000

Government of the District of Columbia - Washington, DC October 1995 to February 2000

Worked 40 hours weekly

Supervised the daily operations of the Fraud Division, which was the criminal investigative sector of the Fraud Bureau.

Performed Duties:. Please refer to the above #1 Position duties. Chief Compliance Officer

Government of the District of Columbia - Columbia, WA October 1994 to October 1995

Worked 40 hours weekly

Created and supervised the daily operations of the newly-created Compliance/Market Conduct Division of the then newly-created Fraud Bureau, which was the regulatory review of the market place practices sector of the Fraud Bureau:

* Performed Primary Duties: Managed while conducting on-site review of the operations of insurers, HMOs, Dental Plans and all entities, licensed in the District of Columbia; i.e., experience in reviewing health insurance claims, fraud, underwriting, licensing, advertising, etc.; - Extensive travel throughout the Continental USA; and

- * Other Duties Performed: Please refer to the duties in the above #1 Position. Education

Master's in Human Resources in Human Resources

Marshall University - Huntington, WV

August 1976 to May 1982

Bachelor's in Management & Accounting in planning

West Virginia State University - Institute, WV

August 1968 to August 1972

Certifications and Licenses

Certified Public Manager (CPM)

August 2003 to Present

13-month intensive classroom and independent studies, reading and research.



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