Fraud Analyst
Fraud Analyst
Posted on :
11-04-2025
Employer Active
1 Vacancy
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Job Description
Maintain or exceed established standards for customer service and resolves
complex issues with little or no supervision or direction;
Analyse data from multiple sources to identify discrepancies and what if any
remedies can eliminate suspicion and maintain compliance;
Work with peers and Managed Services leadership to communicate fraud trends
and share best practices ideas and information;
Review queued transactions and independently determine if the reviewed
transactions are fraudulent or legitimate;
Investigate anomalies in underwriting that could potentially include fraud;
Write reports and document evidence findings and recommendations;
Perform manual fraud review to detect fraudulent transactions;
Independently resolve problems that require in depth investigation and/or
research;
Conduct followup research on fraudulent transactions;
Issue Show cause notice to hospital or diagnostic centre wherever required.
Requirements
Previous fraud prevention investigation or retail fraud prevention experience is
a plus;
Demonstrated experience and/or strong working knowledge of Microsoft Word
Excel and Outlook;
Strong desire to build a career in the fraud industry;
Must be able to work in shift timing including weekends and holidays;
Excellent organizational analytical and critical thinking skills;
Ability to meet deadlines and prioritise deliverables;
Strong innovative problemsolving capabilities;
Must have understanding of technical and financial aspects of the health
insurance industry;
Strong oral and written communication skills;
Must have knowledge of provider facility payment methodology claims
processing systems and coding and billing proficiency;
Selfstarter with the ability to work under pressure independently and as part of
a team;
Ability to think strategically and act proactively to create strong trust and
confidence with business units.
Required Experience:
IC
Employment Type
Full-Time
Department / Functional Area
Key Skills
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