Zelis Healthcare, LLC
Fraud Analyst
Zelis Healthcare, LLC, Boston, Massachusetts, us, 02298
Overview:The Fraud Analyst will report to the Manager of the Fraud Team, under the Payee Identification and Network Security (PINS) department. The PINS department encompasses Zelis Payments' Fraud, Risk, and Identity Verification organization and centrally manages Fraud, Onboarding/Verifications, and Account Servicing for Zelis clients, addressing issues related to account takeover, business identification, bank account validation, and more.
The Fraud Analyst conducts all aspects of investigations into suspicious activity, including collecting relevant data in support of case findings, drawing sound conclusions based on assessments and the development of facts, and summarizing findings into an actionable and digestible format. They will leverage both internal and external tools and reporting, as well as their fraud-related experience, to make sound judgements to determine the level of risk and the appropriate actions to take to protect Zelis and its clients. The Fraud Specialist takes proactive measures to prevent losses, analyzes suspicious activity, coordinates responses across all stakeholders, and properly escalates significant cases of risk exposure. This role operates in a dynamic and fast-paced environment which requires effectively leveraging relationships across key business units in the organization, communicating directly with clients, and accepting constant change as a reality of fighting fraud.
In addition, a successful candidate will be passionate about fighting fraud, identifying new trends, and is naturally curious.Role Objectives
:Safeguards Zelis and its clients from
fraud losses and risk exposure through monitoring and
Fraud Investigations.
Takes action
based on sound judgement
and exacting investigative practices
to remediate
any adverse
impacts
to minimize financial and reputational risks.
Collaborates with PINS
leadership
to share best practices
,
identified
trends, and recommendations based on insights.
Ke
y Responsibilities
:Monitor
s
and investigate
s
suspicious
activity to
identify
and control
fraudulent activity
,
such as account
takeover
, theft, and
similar risks.
Accurately
and efficiently complete
s
case investigations which may involve:
Deep dive analysis of data
from various sources such as detection tools, reports
, and
/or
internal and
external
referrals
to evaluate, investigate, and
determine
required actions.
Leverag
e
internal and external data sources to
validate
suspicious activity.
Facilitat
e
client communication
regarding
suspicious activity
to include collection of details
,
providing updates
when
appropriate
, and
closing the loop
.
Ensur
e
confidentiality of all information collected during
investigations.
C
onfidently communicate
s
via outbound communication to clients
through both email and phone contact.
Collaborat
es
with
internal and external partners
to complete
and document
investigation
processes
,
identify
process improvements
, and
help safeguard Zelis and its clients from further risk.
Assist
s
the Fraud team in
identifying
gaps in current systems,
policies
and strategies, and recommend
s
enhancements and process improveme
nts to mitigate emerging risks
.
Supports
PINS team and other key stakeholder groups, including Enterprise Fraud, Infosec, Compliance, Payment Operations, and Treasury
.
Qualifications:Bachelor's degree required
3+
w
orking experience as a Fraud Analyst or Fraud Investigator
Industry experience in
financial institution
, fintech, or payments company
required
;
Healthcare payments industry, preferred
Knowledge of fraud schemes, fraud prevention methods, and fraud detection tools
Creative, natural problem solver, with a team-focused mentality
Strong attention to detail and can question the status quo to further enhance fraud mitigation strategies
Foundational knowledge of
SQL
(Snowflake
, Microsoft
SSMS)
, a plus
Certified Fraud Examiner, a plus
Location and Workplace FlexibilityWe 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 of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We're Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.Commitment to Diversity, Equity,Inclusion, and BelongingAt Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.Equal Employment OpportunityZelis is proud to be an equal opportunity employer. All 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 encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.Accessibility SupportWe 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 TalentAcquisition@zelis.comSCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you're contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.
#J-18808-Ljbffr
The Fraud Analyst conducts all aspects of investigations into suspicious activity, including collecting relevant data in support of case findings, drawing sound conclusions based on assessments and the development of facts, and summarizing findings into an actionable and digestible format. They will leverage both internal and external tools and reporting, as well as their fraud-related experience, to make sound judgements to determine the level of risk and the appropriate actions to take to protect Zelis and its clients. The Fraud Specialist takes proactive measures to prevent losses, analyzes suspicious activity, coordinates responses across all stakeholders, and properly escalates significant cases of risk exposure. This role operates in a dynamic and fast-paced environment which requires effectively leveraging relationships across key business units in the organization, communicating directly with clients, and accepting constant change as a reality of fighting fraud.
In addition, a successful candidate will be passionate about fighting fraud, identifying new trends, and is naturally curious.Role Objectives
:Safeguards Zelis and its clients from
fraud losses and risk exposure through monitoring and
Fraud Investigations.
Takes action
based on sound judgement
and exacting investigative practices
to remediate
any adverse
impacts
to minimize financial and reputational risks.
Collaborates with PINS
leadership
to share best practices
,
identified
trends, and recommendations based on insights.
Ke
y Responsibilities
:Monitor
s
and investigate
s
suspicious
activity to
identify
and control
fraudulent activity
,
such as account
takeover
, theft, and
similar risks.
Accurately
and efficiently complete
s
case investigations which may involve:
Deep dive analysis of data
from various sources such as detection tools, reports
, and
/or
internal and
external
referrals
to evaluate, investigate, and
determine
required actions.
Leverag
e
internal and external data sources to
validate
suspicious activity.
Facilitat
e
client communication
regarding
suspicious activity
to include collection of details
,
providing updates
when
appropriate
, and
closing the loop
.
Ensur
e
confidentiality of all information collected during
investigations.
C
onfidently communicate
s
via outbound communication to clients
through both email and phone contact.
Collaborat
es
with
internal and external partners
to complete
and document
investigation
processes
,
identify
process improvements
, and
help safeguard Zelis and its clients from further risk.
Assist
s
the Fraud team in
identifying
gaps in current systems,
policies
and strategies, and recommend
s
enhancements and process improveme
nts to mitigate emerging risks
.
Supports
PINS team and other key stakeholder groups, including Enterprise Fraud, Infosec, Compliance, Payment Operations, and Treasury
.
Qualifications:Bachelor's degree required
3+
w
orking experience as a Fraud Analyst or Fraud Investigator
Industry experience in
financial institution
, fintech, or payments company
required
;
Healthcare payments industry, preferred
Knowledge of fraud schemes, fraud prevention methods, and fraud detection tools
Creative, natural problem solver, with a team-focused mentality
Strong attention to detail and can question the status quo to further enhance fraud mitigation strategies
Foundational knowledge of
SQL
(Snowflake
, Microsoft
SSMS)
, a plus
Certified Fraud Examiner, a plus
Location and Workplace FlexibilityWe 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 of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We're Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.Commitment to Diversity, Equity,Inclusion, and BelongingAt Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.Equal Employment OpportunityZelis is proud to be an equal opportunity employer. All 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 encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.Accessibility SupportWe 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 TalentAcquisition@zelis.comSCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you're contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.
#J-18808-Ljbffr