Fraud Investigation Analyst
Fraud Investigation Analyst
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1 Vacancy
Job Description
At Zelis we Get Stuff Done. So lets get to it!
A Little About Us
Zelis is modernizing the healthcare financial experience for all by providing a connected platform that bridges the gaps and aligns interests across payers providers and healthcare consumers. This platform serves more than 750 payers including the top 5 national health plans BCBS insurers regional health plans TPAs and selfinsured employers and millions of healthcare providers and consumers. Zelis sees across the system to identify optimize and solve problems holistically with technology built by healthcare expertsdriving real measurable results for clients.
A Little About You
You bring a unique blend of personality and professional expertise to your work inspiring others with your passion and dedication. Your career is a testament to your diverse experiences community involvement and the valuable lessons youve learned along the way. You are more than just your resume; you are a reflection of your achievements the knowledge youve gained and the personal interests that shape who you are.
Position Overview
The Fraud Investigation Analyst Enterprise Fraud will contribute significantly to safeguarding Zelis against fraudulent activities by conducting comprehensive reviews of all internal and external fraud monitoring alerts performing fraud investigations and thoroughly documenting all 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 within Zelis 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 Zelis 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 wrongdoing and a fervent curiosity to investigate in order to support Enterprise Fraud in prevention detection reporting and monetary recovery related to financial fraud and healthcare fraud waste and abuse.
What Youll Do
Perform 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 all Zelis business units and functions.
Initiate fraud investigations and handle all aspects including detailed documentation analysis research summaries and case management within the appropriate tracking systems to ensure information is accurate and timely.
Examine public record databases opensource records statements invoices correspondence device data and other records pertaining to the transactions events financial crimes or other incidents under investigation.
Develop working relationships and communicate with federal state and local officials and other organizations and individuals related 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 uptodate 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. Known Fraud Data Negative List.)
On limited occasions conduct investigations after hours or on weekends for escalated or highpriority Fraud events.
What Youll Bring to Zelis
Bachelors degree is required preferably in Criminal Justice Finance Accounting or Business Administration.
4 years of experience related to fraud prevention financial services risk management or compliance preferably in the healthcare industry.
Professional industry certification as a Certified Fraud Examiner (CFE) Accredited Health Care Fraud Investigator (AHFI) Health Care AntiFraud Associate (HCAFA) Certified Financial Crimes Investigator (CFCI) or Certified Financial Crime Specialist (CFCS) preferred.
Proficient knowledge of Microsoft Excel Word PowerPoint and case management or case review applications.
Strong logical analytical and critical thinking skills paired 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 followthrough 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 all levels.
Ability to multitask adapt quickly to changing priorities and operate effectively across geographic and functional boundaries to meet tight deadlines.
Location and Workplace Flexibility
We have offices in Atlanta GA Boston MA Morristown NJ Plano TX St. Louis MO St. Petersburg FL and Hyderabad India. We foster a hybrid and remote friendly culture and all our employees work locations are based on the needs of the position and determined by the Leadership team. Inoffice work and activities if applicable vary based on the work and team objectives in accordance with Company policies.
Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.
We welcome applicants from all backgrounds and encourage you to apply even if you dont meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.
Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process please email .
Disclaimer
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race color religion sex gender identity national origin disability status protected veteran status or any other characteristic protected by law.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities duties and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities duties and skills from time to time.
Required Experience:
IC
Employment Type
Full-Time
