
Susan Rainey Biler Cfe Ahfi
Recognized anti-fraud professional with expertise in Health Care lines in both public and private sectors. Accredited Health Care... | Omaha, Omaha, United States
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Susan Rainey Biler Cfe Ahfi’s Emails su****@we****.com
Susan Rainey Biler Cfe Ahfi’s Phone Numbers 1813290****
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Susan Rainey Biler Cfe Ahfi’s Location Omaha, Omaha, United States
Susan Rainey Biler Cfe Ahfi’s Expertise Recognized anti-fraud professional with expertise in Health Care lines in both public and private sectors. Accredited Health Care Fraud Investigator and Certified Fraud Examiner with proven ability to drive strategic leadership, guidance and tactical direction for all fraud operations. An earned reputation for building successful teams by providing drive, direction, value and cross functional integration. Dramatic success driven metrics generated through substantial process improvements, ROI focus, successful criminal and civil prosecutions and millions of dollars in savings and recoveries to the bottom line. In-depth insurance industry knowledge including anti-fraud analytic methodologies and aberrant billing pattern detection systems. Successful leader of global teams in a dynamic, high-pressure environment, maintaining focus on both the internal and external customer. Fluent in industry legal, regulatory and compliance requirements at both the state and federal level AREAS OF EXPERTISE / EXPERIENCE Business: Operations Management, Budget Planning/Control, Risk Management, Settlement Negotiations, Lean Management, Mentoring, Internal/External committee leadership Investigations: Healthcare FWA, Data Analytics, Internal and Financial, Case Management, SIU Management, Interview / Interrogation, Compliance & Ethics. Case investigation and presentation to federal law enforcement agencies.
Susan Rainey Biler Cfe Ahfi’s Current Industry Anthem
Susan
Rainey Biler Cfe Ahfi’s Prior Industry
Blue Cross Blue Shield Of Nebraska
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Truven Health Analytics An Ibm
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Workers Compensation Center Llcnci Advancemed
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Anthem
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Work Experience

Anthem
SIU Investigator
Sun Sep 01 2019 00:00:00 GMT+0000 (Coordinated Universal Time) — Present
Workers Compensation Center Llcnci Advancemed
Fraud Investigator
Sun Oct 01 2017 00:00:00 GMT+0000 (Coordinated Universal Time) — Tue May 01 2018 00:00:00 GMT+0000 (Coordinated Universal Time)
Truven Health Analytics An Ibm
Client Services Manager
Wed Jun 01 2016 00:00:00 GMT+0000 (Coordinated Universal Time) — Thu Jun 01 2017 00:00:00 GMT+0000 (Coordinated Universal Time)
Blue Cross Blue Shield Of Nebraska
Special Investigations Supervisor
Wed Jan 01 1997 00:00:00 GMT+0000 (Coordinated Universal Time) — Tue Mar 01 2016 00:00:00 GMT+0000 (Coordinated Universal Time)