Her Story
About Erica
I've been working in Special Investigations Units for about 12 years now, moving between auditor and investigator roles throughout my career. I spent 9 years at UnitedHealth, where I worked as an auditor for 8 years and then as an investigator for a year. I've been in my current fraud investigator role since October, after working as an auditor for a year and a half with this company. What gives me an advantage in fraud investigations is that I'm also a coder and a registered health information administrator (RHIA), so my background as an auditor helps me understand what the codes mean, which ones get paid, and which ones are highly abused and have a lot of errors. In my role, I do data analysis to find leads and dig deeper into investigations to catch fraud, waste, or abuse. I contact providers and members, investigate every facet of visits and dates of service, check medical records, write multiple types of letters, and provide education to providers after reviews. I work in the Medicaid market in Wisconsin, so I collaborate with state agencies, present cases to them, and make referrals to law enforcement like the OIG or FBI when we find actual fraud. I'm currently taking a medical writing course at my own pace because I really like to write and I'm actually trying to write a book right now. I'm also thinking about pursuing fraud investigation certification in the next few years.
Her Interview
Ten minutes with Erica
01What do you attribute your success to?
I attribute my success to my relentlessness and perseverance - I'm kind of a headstrong individual who just keeps pushing forward no matter what challenges come my way. Education has been absolutely critical to my success, as I spent 9 years straight in school while dealing with my husband's disability, a mentally ill child at home, and recovering from a car accident that left both my husband and me with chronic pain. Great companies and great management throughout my career have also been instrumental in my growth. My support system and my family have been essential in helping me continue moving forward, especially through incredibly difficult times including the loss of my daughter three and a half years ago and my husband's ongoing health issues. I also credit the new resources available to us today, including new technology and AI, even though I'm still a bit scared to delve too far into it. Really, I think my biggest accomplishment is just getting up every day and being able to push through, because sometimes you just don't have a choice - you're stronger than you think.
02What’s the best career advice you’ve ever received?
The best career advice I've ever received is not to lose my passion. I'm a very passionate person, and there are times that I have been mistaken for being aggressive because when you're speaking with passion or performing with passion, you kind of tend to get a little louder and more excitable. Sometimes it just comes off wrong, especially as a virtual employee, which is a challenge I've faced. But I've learned that maintaining that passion is crucial, even when it might be misunderstood by others. I love working from home and have been doing it a long time, and while some people say they couldn't work from home, I tell them that if you have a lot of work, believe me, you can do it. The key is to hold onto what drives you, even when the way you express it might be misinterpreted.
03What advice would you give to young women entering your industry?
My advice to any women entering this field is to find the best way to join professional associations and don't be afraid to ask questions, ever. There's so much to learn in this field, and you should never be afraid to take courses to expand your knowledge base, because knowledge is power. Even though I'm scared to go deeper into AI right now, I know I'll get there eventually. Most importantly, embrace change. That's so hard for everybody, I think, and some have it worse than others, especially people who've been in the same field and the same role for a long time. But change is good - you can't fix things that you didn't know were broken, and sometimes when you change processes, you discover that a process was broken for a long time. So embrace change, because it leads to improvement and growth.
04What are the biggest challenges or opportunities in your field right now?
In terms of opportunities, getting the fraud investigation certification opens a lot more doors, especially if you're interested in going further up into higher places like the OIG or working for government or state agencies - they usually like you to have that certification. As for challenges, there are so many of them. Sometimes technology itself is a challenge for me, not because I'm technology challenged, but because when I'm sending a provider a medical records request or any other kind of correspondence, sometimes things just don't work. Internet outages, illness, and just life in general can impede our work. Really, life in general is a challenge, period - that's my biggest challenge. There's always something outside of work that affects what we do, and it just seems like when one thing goes wrong, a couple more things go wrong. It rains and pours.
05What values are most important to you in your work and personal life?
Ethics is very important to me - I'm a very honest person, and I appreciate companies and people in their personal and professional lives who provide ethical solutions and work ethically in their day-to-day activities. Obviously as a fraud investigator, I see a lot more than the average bear when it comes to scams and unethical behavior out there. Hard work and dedication are also crucial values for me. Simple courtesy and compassion matter tremendously - I think courtesy is very important because even in just day-to-day conversation, lately it seems like people just don't care and they're rude and they don't want to help anyone else. It's really disheartening and sad to see people being subjected to that kind of treatment, and I hope that it gets better. We need more people who show genuine care and consideration for others in both professional and personal settings.
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