Fraud Analyst III

October 14

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Availity

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2000

⚕️ Healthcare Insurance

☁️ SaaS

🔌 API

💰 Secondary Market on 2021-07

Description

• We are seeking a detail-oriented and analytical Fraud Analyst III to join our team. • In this role, you will play a critical part in safeguarding our organization against fraudulent activities. • You will analyze patterns, identify vulnerabilities, and implement strategies to mitigate risks while ensuring compliance with healthcare regulations. • Monitor transactions and user behavior to identify suspicious activities and potential fraud schemes. • Conduct thorough analyses of data to uncover trends, patterns, and anomalies that indicate fraudulent behavior. • Develop sophisticated KPIs to aid in tracking existing risk factors and operational impact. • Prepare comprehensive reports detailing findings, patterns of fraud, and recommendations for prevention strategies. • Lead Incident response efforts for cyberfraud alerts on a 24x7 basis as part of our on-call rotation schedule. • Work closely with cross-functional teams, including Compliance, Legal, and IT, to develop and implement fraud prevention measures. • Ensure adherence to healthcare regulations and standards, maintaining compliance with HIPAA and other relevant laws. • Evaluate existing products, policies and procedures for vulnerabilities, recommending enhancements to mitigate risks.

Requirements

• Bachelor’s degree in Finance, Business, Criminal Justice, Computer Science, or a related field. • 3+ years of experience in fraud analysis, risk management, or a related area, preferably in the healthcare or technology sector. • 3-5 Years of Experience directly relevant to incident response and/or ad hoc research using SQL or Splunk. • 3-5 years of experience using SQL (including variant languages), and demonstrates the ability to interpret, create and modify sophisticated ad-hoc queries during the incident response process. • 1-3 years of experience using Splunk and demonstrate ability to manipulate queries in Splunk’s proprietary Search Processing Language (SPL). • 1-3 years of experience using AWS toolsets to perform ad hoc research. • 1-3 years of experience using PowerBI, Cognos, Splunk, and/or Apptrinsic/Gainsight for reporting. • Strong analytical skills with proficiency in data analysis tools and methodologies including use of the Mitre Att&ck framework for defining fraudster tactics, techniques and procedures. • Familiarity with business and healthcare regulations, compliance standards, and fraud detection techniques including those under the purview of HHS, CMS, FTC, SEC, HITRUST, NIST, and GDPR, including HIPAA, HITECH, and the NPI FINAL RULE. • Excellent communication skills, both verbal and written, with the ability to present complex information clearly. • Adept in investigative communication strategies for interactions with victims and fraudsters. • Detail-oriented with strong problem-solving skills and the ability to work independently. • Certifications such as Certified Fraud Examiner (CFE), Certified Financial Crime Specialist (CFCS), CompTIA Security+. • Experience with cybersecurity and fraud detection software and analytics platforms such as Anomali, Accurint, Plaid, Clear, Maltego, and/or Human Security. • Experience working in a 24x7 operational environment, with geographic disparity. • Experience with customer access administrator toolsets within Availity Essentials or other Availity products and services. • Experience interpreting HIPAA ANSI X12 Electronic Data Interchange formatted transactions at a basic level. • Experience developing and implementing basic automations using PowerShell and/or Python, with the ability to interact with and integrate applicable APIs. • Ability to read, speak and interpret multiple languages to and from English at a business level, including any of the following: Spanish, French, Hindi, Bengali, Urdu, Russian, and/or Mandarin Chinese.