Summary
Overview
Work History
Skills
Timeline
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Ginger Walker

Pea Ridge,AR

Summary


Professional with robust background in fraud detection and prevention. Skilled in analyzing data, conducting thorough investigations, and utilizing advanced tools to uncover fraudulent activities. Strong focus on teamwork and achieving outcomes, adapting seamlessly to evolving demands. Known for integrity, critical thinking, and effective communication.

Overview

20
20
years of professional experience

Work History

FRAUD INVESTIGATOR

Wal-Mart
06.2022 - Current
  • Conducted prompt and thorough investigations involving insurance claims, claim suppression and ethical policy violations
  • Summarized all key information regarding investigation into detailed report for delivery to client and to assist in identifying process gaps.
  • Interviewed witnesses thoroughly, asking appropriate questions to ascertain critical details about each case and locate key indicators of fraud or suppression.
  • Produced detailed reports of fraud investigations and presented findings to senior management, legal team, and human resource partners.
  • Partnered with risk manager to develop training for all incoming case managers and staff.
  • Focused on claim suppression to identify key indicators to identify suppression behaviors utilizing analytics.
  • Actively participated in key remediation efforts in regard to claim suppression within the supply chain

WORKERS COMPENSATION MANAGER

Claims Management, Inc. (Wal-Mart)
10.2014 - 06.2022
  • Oversight of workers compensation claims and trends for various state programs, with supervision of 7-14 case managers per team.
  • Training and development of outside counsel to ensure litigation was resolved timely and effectively within outside counsel guidelines to achieve goals set for litigation management.
  • Organize and conduct settlement/mediation conferences to mitigate legal expenses and control active litigation metrics.
  • Participate in interviewing and candidate selection for open case manager positions and to fill outside counsel openings.
  • Strategic planning to ensure goals are set appropriately to encourage positive business outcomes as a result of meeting production goals.
  • Created rewards and recognition programs for acknowledging employees' achievements.

WORKERS COMPENSATION CASE MANAGER

Claims Management, Inc. (Wal-Mart)
08.2005 - 01.2014
  • Investigation of work injuries including catastrophic claims.
  • Analysis of complex medical records to analyz treatment and determine the causal relationship to the reported mechanism of injury.
  • Develop and maintain a working relationship with physicians, legal representatives, and facility management.
  • Set appropriate reserves and issue payments to satisfactorily resolve claims
  • Ensure compliance with state regulations
  • Mentoring and development of less experienced adjusters
  • Research into goals, performance to assist team leader with establishing and meeting production goals
  • States managed: VA / AL
  • Complied with established internal controls and policies.
  • Analyzed information gathered by investigations to report findings and recommendations.
  • Collected and tracked evidence in support of legal processes.
  • Directed claims negotiations within allowable limit of $[Amount] and supported successful litigations for advanced issues.
  • Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
  • Substantiated legitimate claims and denied unjustified claims.

Skills

  • Anomaly Detection
  • Dispute Resolution
  • Critical Thinking
  • Fraud Investigations
  • Policy Compliance
  • Fraud Prevention and Detection
  • Loss Mitigation
  • Internal Fraud Recognition and Prevention
  • Witness Interview Skills
  • Case Management
  • Case Analyzation
  • Surveillance and Evidence Gathering
  • Partnering and relationships
  • Detection models
  • Ethical standards

Timeline

FRAUD INVESTIGATOR

Wal-Mart
06.2022 - Current

WORKERS COMPENSATION MANAGER

Claims Management, Inc. (Wal-Mart)
10.2014 - 06.2022

WORKERS COMPENSATION CASE MANAGER

Claims Management, Inc. (Wal-Mart)
08.2005 - 01.2014

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Ginger Walker