PROFESSIONAL SUMMARY

SKILLS

WORK HISTORY

REGINALD GAITHER

UNION CITY, GA 30291

786-***-**** aduwgq@r.postjobfree.com

Seasoned Risk specialist with 10 years of comprehensive experience identifying and analyzing areas of potential risk, risk-prevention, investigation, & anti-money laundering. Methodical and meticulous professional polished in projecting potential losses and making recommendations to limit loss. Excellent quantitative and critical thinking abilities paired with basic knowledge of SQL and Tableau.

Fraud Case Mgmt. /Inventory Control Reports

KYC/EDD

Data Mining/Analysis

Share Point/ SAP

Pivot Tables & Vlookup

SQL

Microsoft Suite

Proficient in Accertify, Tableau, Interceptis,

Transunion, & Salesforce

PURCHASING POWER

Risk Rules Analyst Remote October 2019 - Current Monitor real-time queues and identify and disposition high-risk transactions within the business portfolio.

Observe customer transactions to identify fraudulent activity such as account takeover, friendly fraud, theft, counterfeit, and similar other risks. Determine existing fraud trends by analyzing queries within the account and transactional databases.

Create rules within the internal reporting systems to combat false positive alerts. Investigate fraud claims and make decisions regarding their validity based on available internal policies and 3rd party data and by defined SOPs.

Resolve customer issues within the scope of existing service-level agreements. Involved in creating Tableau dashboards as needed for the team to monitor KPI trends and anomalies.

Create ad hoc analysis and reporting requests as they pertained to team resolutions and dispositions.

Create a Risk policy and procedures handbook.

Conduct all aspects of a compliance review, including scoping, sampling, research, control testing, root cause analysis, and preparation of the final report. Developed short-term goals and long-term strategic plans to improve risk control and mitigation. SUNTRUST BANK

Consultant Atlanta, GA April 2019 - August 2019 Contractual Anti-Money Laundering (AML), Worked with IT in creating an automation process for Negative Media searches and transactional reviews from internal systems and uploading them to the associated Actimize alert.

The created automation removed time-intensive manual processes and lead to a projected time savings of 5-10 minutes per alert.

Created and maintain both Retail and Private Wealth Management (PWM) Client On-Boarding

(COB) procedures including Periodic Review Procedures and Business As Usual (BAU) alert review procedures.

Conducted Enhanced Due Diligence (EDD) and Know Your Customer (KYC) reviews on backlog alerts to bring all customer profile information and risk ratings up to date. Manually conducted Periodic Reviews utilizing data provided by Reporting Team. Worked with Fraud Investigative Unit (FIU) partners to handle Client Overrides for clients whose risk rating is being falsely calculated due to system Tech and system issues. Reviewed client profiles, conduct transactional activity reviews, and work high-risk activity reports for two teams consisting of Private Wealth Management and Retail Client On-Boarding. SAFEGAURD SERVICES

Contractual Medicare Fraud Investigator January 2018 - January 2019 Used data analytics to find questionable patterns and/or discrepancies within submitted Medicare/Medicaid claims to prevent Fraud, Waste, and Abuse (FWA) of the Medicare Trust Fund. Reviewed information contained in standard claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potentially fraudulent or abusive billing practices or vulnerabilities in Medicare policies and initiate appropriate action Reviewed submitted claims data to ensure that CPT codes are appropriate based on the physician's plan of care.

Made potential fraud determinations by utilizing a variety of sources such as internal guidelines, Medicare provider manuals, Medicare regulations, and the Social Security Act. Used investigative techniques to select appropriate beneficiaries to interview as it relates to assigned cases and draft well-interview reports and findings. Conducted physician interviews to validate 3rd party allegations and to ensure Center for Medicare Service (CMS) guidelines are followed and drafted interview reports and findings. Conducted background checks, association checks, and review enrollment documents on all physicians, physician groups, and owners to ensure all National Provider Identifiers (NPI) are active as required by Medicare guidelines; that there are no conflicts or interest in ownership; and that no felonies are present.

Performed financial analysis on subjects based on Request for Information (RFIs) forms submitted by law enforcement agencies.

Drafted disposition reports outlining contents of investigative findings, a detailed dollar amount that may be at risk of the Medicare Trust Fund with supporting documentation, and financial analysis.

US BANK

Investigator September 2015 - December 2016

Anti-Money Laundering (AML), Cleared and escalated assigned alerts by investigating and identifying high-risk profiles, transactions, affiliations, and customer locale i.e.: Casinos, Money Service Businesses, Politically Exposed Persons, Cash Vault Services, High Drug Intensity Areas. Worked on Actimize Improvement Team to set alerting parameters and limit the number of false positive alerts

Submitted Suspicious Activity Report (SARs) filings to the Financial Crimes Enforcement Network

(FINCEN) for Law Enforcement review

Analyzed potential risk through investigative techniques, such as open source media reports, Lexis Nexis, Hoovers, surveillance, subpoenas, and internal referrals, and create a Suspicious Activity Report (SARs) filing if warranted.

Created detailed dispositions of risk factors found through case investigations within the Suspicious Activity Reports (SARs) and submit cases to Financial Crimes Enforcement Network

(FinCEN).

Updated new BSA Policies and Procedures about adverse media and newly imposed US sanctions placed against allegedly corrupt Foreign Nationals. BANK OF AMERICA

Contractual Business Analyst II August 2014 - May 2015 Responsible for investigating High-Risk alerts which include, but are not limited to, Politically Exposed Persons, Casinos, Money Service Businesses, and International Accounts. Conducted Enhanced Due Diligence (EDD) and Know Your Customer (KYC) reviews to identify clients and entity profiles that pose greater than normal anti-money laundering risk. Conducted analysis of clients' financial activity, customers' banking profiles, and public records

(including negative news0 to make sound investigative decisions. Led a team of BSA analysts in the successful completion of a priority remediation project for high-risk clients created from the Choice Point acquisition. Reviewed and prepared Suspicious Activity Reports (SARs) for submission to FinCEN and other appropriate law enforcement or regulatory agencies which may include 314b analysis. Dispositioned a minimum of 25 full investigations weekly with all investigative findings and case recommendations.

ALPHA BERKELEY MANAGEMENT LLC

Contractual Business Analyst June 2013 - July 2014 Coordinated the submission of Unified Improvement Plans (UIPs) with school leadership. This includes online system management and adherence to state and federal requirements. Consult with school stakeholders to identify, define, and document business needs, objectives, current operational procedures, input/output requirements, and levels of systems access. Gathered and documented requirements and communicate stakeholders' needs to the development EDUCATION

team.

Maintained project schedule development, established objectives, determining priorities, and monitored progress to plan.

WELLS FARGO

Financial Crimes Specialist 2 Team Lead March 2010 - January 2013 Investigated suspicious or unusual transactions detected through an internal automated alerting system, internal business referrals, and independent investigative techniques and create Suspicious Activity Reports (SARs) if warranted.

Created weekly/monthly excel formatted team reports to provide management with case statutes, investigator rationale, and the case deadline date to ensure the team remained in compliance as listed within the department's quality and procedural guidelines. Assisted management team with various tasks including case reviews, QA corrections, case reassignments, and procedural change write-ups; while also maintaining a full caseload and meeting daily production goals with stellar quality. Created and provided critical thinking & analytical training for new hires on case creation best practices and investigative techniques and data mining/trend analysis. Applied knowledge of AML requirements to the diverse line of businesses that required case review which includes US and international banking services, Wires, Money Services Business, Politically Exposed Persons, OFAC Sanctions, and Retail Broker/Dealer 2. M.B.A Business Intelligence/Analytics

Herzing University

12/2023

BACHELOR OF BUSINESS ADMINISTRATION Marketing concentration Morehouse College

2005

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