RENIA SHARMAINE LANUZA
Ubiquity Global Services
SAN ANDRES,manila
12
years of professional experience
Detail-oriented Fraud Analyst with a strong background in fraud identification, prevention, and dispute resolution. Proven ability to analyze data, detect anomalies, and streamline processes to minimize financial loss.
Work History
Fraud and Risk Analyst
2 Years 10 Months- Analyzed fraud patterns to identify key risks and enhance detection strategies.
- Collaborated with cross-functional teams to develop risk mitigation frameworks and processes.
- Developed comprehensive reports detailing findings, trends, and recommendations for strategic decision-making.
- Detected fraudulent activities by conducting thorough investigations and analyzing transactional data.
- Reviewed customer accounts for unusual activity or patterns indicative of potential fraud risks, flagging concerns for further investigation.
- Evaluated customer data to identify and prevent fraudulent activities.
- Analyzed large amounts of data to find patterns of fraud and anomalies.
- Contacted customers directly to notify of fraudulent activity and minimize impacts.
- Conducted thorough investigations into suspicious activities, providing actionable insights to management teams.
Chargeback Analyst
6 Years 8 Months- Analyzed chargeback cases to identify trends and potential fraud indicators.
- Developed detailed reports on chargeback activities for stakeholder review and decision-making.
- Trained junior analysts on best practices for chargeback analysis and compliance standards.
- Streamlined the dispute resolution process through effective communication with merchants, banks, and customers.
- Investigated disputed credit or debit card transactions.
- Identified fraud and reported suspected cases to appropriate contact.
- Maintained thorough knowledge of changing industry regulations, ensuring compliance in all chargeback processes.
- Exceeded performance metrics for chargeback resolution timeframes and customer satisfaction scores on a consistent basis.
- Reduced financial losses from chargebacks by closely monitoring transactions and identifying suspicious activity.
- Conducted detailed investigations into complex cases, resulting in successful resolutions for both company and clients.
Client Specialist for Claims Tracking
1 Year 9 Months- Reviewed and processed claims to ensure compliance with company policies and regulatory standards.
- Evaluated documentation for accuracy, identifying discrepancies and reducing claim processing time.
- Analyzed claims data to identify trends, informing adjustments in processing protocols.
- Reduced claim errors by conducting thorough investigations and obtaining all necessary documentation.
- Identified potential fraudulent claims through careful analysis of trends, patterns, and inconsistencies.
- Streamlined the appeals process for denied claims, resulting in faster resolution times for clients.
- Maintained a high level of accuracy and attention to detail when reviewing submitted claims for completeness and correctness, contributing to the overall quality of processed claims.
- Analyzed historical data from past cases when evaluating new incoming claims this helps improve accuracy during decision-making processes.
- Handled complex cases with a keen attention to detail, ensuring proper evaluation and adjudication of each claim.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing deadlines.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Generated, posted and attached information to claim files.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Posted payments to accounts and maintained records.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Calculated adjustments, premiums and refunds.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Medical Service Representative
1 Year 4 Months- Coordinated communication between healthcare providers and patients to streamline service delivery.
- Managed appointment scheduling and confirmations to optimize operational efficiency.
- Reviewed and explained insurance plans to patients to guarantee full understanding of payment policies and procedures.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality of patient information at all times.
- Organized and updated charts with clinic notes, retrieved scans, obtained medical records and verbally confirmed appointments via telephone.
- Verified patient insurance eligibility and entered patient information into system.
- Provided excellent customer service to patients and medical staff.
Secretary's Assistant
5 Months- Organized and maintained comprehensive filing systems for confidential documents.
- Coordinated scheduling and logistics for meetings and appointments, ensuring efficient use of time.
- Managed inventory of office supplies, ensuring availability while adhering to budget constraints.
- Ensured timely completion of reports by proofreading, editing, and submitting documents as requested by the Secretary.
- Maintained a clean and organized workspace that facilitated an optimal working environment for both the Secretary and their colleagues.
- Managed filing system, entered data and completed other clerical tasks.
- Assisted coworkers and staff members with special tasks on a daily basis.
Education
Bachelor of Science - Hospitality Management Major in CLOHS
Skills
Fraud identification
prevention and detection
Fraud and anomaly analysis
Transaction review and monitoring
Dispute resolution
Risk assessment and level determination
Investigation documentation
Case management
Account information review
Loss prevention
Decision-making
Detail-oriented
Multitasking
Self-motivation
Timeline
Fraud and Risk Analyst
Ubiquity Global Services
10.2023 - CurrentRead More
Chargeback Analyst
Ubiquity Global Services
12.2019 - CurrentRead More
Client Specialist for Claims Tracking
Access Healthcare
02.2018 - 11.2019Read More
Medical Service Representative
Global Innov8tion Inc.
10.2016 - 02.2018Read More
Secretary's Assistant
MMS Placement Agency
10.2014 - 03.2015Read More
Lyceum of The Philippines University
Bachelor of Science from Hospitality Management Major in CLOHS
Read More