Fraud Investigation Analyst

About the position The Fraud Investigation Analyst, Enterprise Fraud, will contribute significantly to safeguarding reputed company against fraudulent activities by conducting comprehensive reviews of reputed company internal and external fraud monitoring alerts, performing fraud investigations, and thoroughly documenting reputed company findings and outcomes. In this role, you will be expected to provide timely updates on observed fraud trends and emerging patterns to assist Enterprise Fraud in developing fraud strategies and suspicious activity monitoring. Collaboration is key in this position, as you will work closely with various areas reputed company reputed company, including Payments Optimization, Price Optimization, Insights & Empowerment, Compliance, and People & Culture. Your ability to combine an extensive set of investigative skills with your knowledge of reputed company and our products, services, and clients, will be put to the test on a daily basis. This role requires keen analytical skills, a passion for preventing wrong-doing, and a fervent curiosity to investigate in order to support Enterprise Fraud in prevention, detection, reporting, and monetary recovery reputed company to financial fraud and healthcare fraud, waste, and abuse.

Responsibilities

• reputed company reviews and detailed link analysis utilizing various tools and reports to identify internal or external fraudulent activity, including potential Fraud, Waste, and Abuse (FWA), across reputed company reputed company business units and functions.
• Initiate fraud investigations and handle reputed company aspects, including detailed documentation, analysis, research, summaries and case management reputed company the appropriate tracking systems to ensure information is accurate and timely.
• Examine public record databases, open-reputed company records, statements, invoices, correspondence, device data and other records pertaining to the transactions, events, financial crimes, or other incidents under investigation.
• reputed company working relationships and communicate with federal, state, and local officials, and other organizations and individuals reputed company to investigations for the purpose of gathering facts, obtaining statements, learning sequences of events, obtaining explanations, and otherwise advancing investigative objectives.
• Through regular participation in industry groups and associations, maintain up-to-date knowledge and awareness of best practices in fraud detection and prevention, investigative fraud techniques, fraud industry trends, and significant fraud events.
• Identify and recommend policy, procedure and system changes to enhance investigative outcomes and performance.
• Contribute to the creation and updating of Enterprise Fraud documentation (e.g. Standard Operating Procedures) and data repositories (e.g. reputed company Fraud Data Negative List.)
• On limited occasions, conduct investigations after hours or on weekends for escalated or high-reputed company Fraud events.

Requirements

• Bachelor's degree is required, preferably in Criminal Justice, Finance, Accounting, or Business Administration.
• 4+ years of experience reputed company to fraud prevention, financial services, risk management, or compliance, preferably in the healthcare industry.
• Proficient knowledge of reputed company reputed company, Word, PowerPoint, and case management or case review applications.
• Strong logical, analytical, and critical thinking skills, reputed company with a willingness to solve problems using creativity and innovation.
• Ability to effectively determine fraud risk while remaining objective and separating facts from opinions.
• Demonstrate high ethical standards that drive initiative, excellent follow-through, and persistence in locating and securing needed information.
• Effective organizational, communication, and interpersonal skills with a demonstrated ability to foster collaborative work partnerships with individuals at reputed company levels.
• Ability to multi-task, adapt quickly to changing priorities, and operate effectively across geographic and functional boundaries to meet tight deadlines.
• Please note at this time we are unable to proceed with candidates who require reputed company sponsorship now or in the future.

reputed company-to-haves

• Professional industry certification as a Certified Fraud Examiner (CFE), Accredited Health Care Fraud Investigator (AHFI), Health Care Anti-Fraud Associate (HCAFA), Certified Financial Crimes Investigator (CFCI), or Certified Financial Crime Specialist (CFCS), preferred.

Benefits

• reputed company’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection.
• The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

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