Fraud Investigation Analyst

Position Overview

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 open-source 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 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. Known Fraud Data Negative List.)

• On limited occasions conduct investigations after hours or on weekends for escalated or high-priority 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 Anti-Fraud 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 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 all levels.

• Ability to multi-task adapt quickly to changing priorities and operate effectively across geographic and functional boundaries to meet tight deadlines.

Base Salary Range

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors including experience education qualifications as well as job-related and industry-related knowledge and skills etc. Base pay is just one part of our Total Rewards package which may also include discretionary bonus plans commissions or other incentives depending on the role.

Zelis 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.

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

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.