Martinez, California, United States
A well respected SIU investigative background with over 26 years experience as an investigator and insurance fraud expert. Success over the years has been achieved through my ability to network and build strong relationships with insurance companies, law enforcement, district attorneys, and regulatory agencies. This has resulted in effective, coordinated effort to investigate and prosecute fraudulent Medical, Property, and Casualty insurance cases. Over the past 18 years, I have been in the role of investigating organized activity and complex staged accident rings in the Western States. Specialties: Major Case/Complex Investigations, Analytics, Fraud awareness training. During the course of my insurance career, I have also handled the following: CAT Claims (Hurricane, Loma Preita Earthquake, Oakland Hills fire, Hail/Wind (Claims and SIU capacity) Complex Medical Investigations Complex Casualty and Litigated claims Auto Property claims to include Fire and Theft Arson (Home and Auto) Slip and Fall/Dog bite claims Life claims I have created Powerpoint training for Claims/SIU for the following areas: *Microsoft Visio *Conducting Medical Clinic Investigations *Small Claims Court Rules and Procedures *Staged Auto Accident Investigations Presenter at the annual Northern California Fraud Investigators Association conference (1997 and 1998)
Investigation of 1st and 3rd party Property/Casualty claims, including special projects involving complex medical claims/staged accident rings SIU Fraud Prevention training to claims partners Vendor management; initiate and monitor assignments to outside vendors as part of claim investigation SIU investigations handled through the process of prosecution and restitution, including testifying in court proceedings
Tasked with developing 1st and 3rd Party property and casualty cases where fraud indicators are present, often involving collusive activity by multiple parties and/or organized crime. Specialized in Staged Auto Accident Ring and Complex Medical case investigations. Developed large network of local and state resources to include: NICB contacts, DOI, local District Attorneys and DA Investigators, Police departments, Mediators/Arbitrators, Medical Experts Excellent interview and EUO techniques. Ability to deal with conflict resolution while remaining composed and professional. Excellent written and verbal communication skills.
Investigated complex litigated BI and PD cases where indicators of fraud and inconsistencies were established. Developed Major Case position as first investigator in Northern California. Conducted complex fraud investigations throughout Northern and Central California. Initiated, investigated, and managed staged accident investigations utilizing Pre-Text policies and involving law enforcement agencies. "Phantom Menace" case which was prosecuted in Alameda County, is best example.
First investigator assigned to an SIU position for State Farm in Northern California. Investigated 1st and 3rd party property/casualty and residential /commercial arson claims. Assisted in creating framework, investigative guidelines, and reporting documents for Major Case unit in Northern California. Created training materials and conducted training for new and experienced SIU investigators in California pertaining to: Flow Charting, Analytics, Medical Clinic Inspections and reports, Visio, and Staged Accident Investigations.