Jared W. Email and Phone Number

- Work with direct reports to identify new schemes of fraud, waste, and abuse through data analysis. - Develop innovative approaches to improve on the identification of fraud, waste, and abuse - Utilize advanced analytics including machine learning and work with various large data sources to improve the detection of fraud waste and abuse. - Utilize data mining and quantitative analysis to support analytic projects - Develop reports that support the business needs for specific areas for detecting and validating potential fraud, waste, and abuse to improve program effectiveness. - Generate fraud referrals for investigation, prepayment review or to another business area. - Develop innovative improvements that mitigate risks for fraud and recommend improvements to management. - Proactively contribute to meetings and training sessions including occasionally preparing and delivering PowerPoint presentations as needed. - Improve written documentation regarding data analysis. - Facilitate and oversee team in the creation of reports required to support investigation and compliance work. - Diversity Equity Inclusion & Behavior (DEIB) Committee Member

- Consult with internal stakeholders to identify and prioritize opportunities to implement data science solutions to business problems at an advanced level. - Product owner of specific projects to meet the needs of the business. - Create presentations that provide recommendations to senior leadership. - Recommend modeling techniques to data scientist - Improve methodologies and efficiency on existing solutions - Develop business intelligence solutions and dashboards based on the problems and goals of business partners. - Work with multiple clients and create solutions for business cases

- Research and ad hoc report development to identify fraud, waste and abuse schemes and trends.- Staying up do date with new and emerging fraud, waste and abuse schemes and trends through training sessions and industry resources.- Review the clinical & payment policies to determine the impact of the schemes on the business.- Create and document requirements and work with data science business partners to create business rules that use claim data to auto generate Fraud, Waste or Abuse leads for investigation. - Stay up to date with coding changes to ensure that existing business rules are being updated as well.- Analyze and present key findings to internal customers to provide recommendations based on the findings.- Create VBA macros for each business rule to create efficiency and consistency within referral process.- Utilize SAS enterprise guide create process flows which automate and generate weekly reports to be reviewed for newly flagged providers. - Utilize Power BI to present metrics through visualizations on a quarterly basis. - Conduct Excel and Power BI trainings for the Special Investigations Unit.

- Collaborate with BSI, Audit Operations, the OSA’s IT Department and other stakeholders to identify data trends and analysis requirements for reports projects.- Monitor and review electronic account and transaction data for suspicious activity and possible public assistance or provider fraud.- Identify and document existing trends and patterns in Medicaid claim data, Electronic Benefits Transfer (EBT) card transactional data, as well as a variety of other transactional and operational data sets- Identify and assess new possible risks and concepts that could occur regarding provider fraud - Utilize SQL Server Management Studio and SQL Developer to identify anomalies within the data- Create stored procedures in SQL so prior concepts can be tested in the future - Apply quality assurance best practices for data mining/analysis services- Utilize BI tools such as Cognos, Qlik Sense and Power BI to visually present findings- Consult with management on a weekly basis to present updates and make recommendations on how to proceed with investigation. - Create referrals to be presented to federal partners and audit operations - Interview recipients or providers that are being investigated - Work on multiple projects simultaneously - Work in an Scrum framework - Train new staff on projects

- Analyzed irregularities with subjects that have allegations against them for committing public assistance fraud.- Obtained evidence that will support allegation such as if subject was on assistance at the time.- Escalated case to senior examiners if it meets the criteria of public assistance fraud.- Met regularly with Assistant Director regarding investigations.- Trained new staff on projects - Prepared reports, evidence, and correspondence concerning investigations of public assistance fraud to provide required information and makes appropriate recommendations concerning investigations.- Utilized different data warehouses for investigations.

- Analyzed case details to identify methodology of each fraud scheme, assess existing preventive controls, identify control gaps, recommend and implement mitigation strategies.- Contributed to Key Performance Indicators, prevention results, and fraud loss management reports.- Maintained the case management system for tracking fraud cases and relevant information.- Monitored the performance of the rules to ensure that agreed risk levels and positive customer experience are maintained.- Examined account transactions such as check deposits to verify their validity. - Documented results of actions taken to support fraud trending and reporting.- Analyzed loss experienced based on monthly/quarterly/annual losses for trending.- Provided support to Field Investigators, senior analysts, and Loss Prevention Team Managers.- Complied with all applicable federal regulations in decision process.- Utilized Microsoft Excel and Access for Data Analysis for discovering outliers - Demonstrated proficiency of applicable systems, tools, policies and procedures, and bank regulations.- Assisted in new ways to mitigate losses.

- Researched and analyzed high risk transactions across all payment channels with a sense of urgency in a fast paced environment. - Identified fraud patterns and communicated observations to analysts and management. - Collaborated with internal and external customers to make decisions on transactions and perform appropriate actions required to mitigate losses. - Facilitated special projects as the lead role.