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Zelis · 1 week ago

Fraud Manager, PINS

St. Petersburg, FL

Full-time

Hybrid

Senior Level

6+ years exp

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. The Fraud Manager will oversee fraud detection strategies, lead complex investigations, and enhance fraud mitigation frameworks to protect the integrity of Zelis' payments and provider network.

FinanceFinTechHealth Care

No H1B

Responsibilities

Lead the design and implementation of fraud prevention strategies for payment transaction, ACH enrollment, and provider verification

Oversee fraud investigations, root cause analyses, and escalations, ensuring timely and accurate resolution to mitigate loss

Steps in to resolve elevated issues brought forth by the PINS team; for example, escalations brought by the client services team, requests from partner banks or vendor partners

Analyze fraud patterns and operational data to identify emerging threats, recommend mitigations, working with relevant teams to support change

Effectively oversees the day-to-day operations and activities of the Fraud team; manages productivity and prioritization, helps overcome roadblocks, and monitors progress against team goals and effectively holds frequent 1-on-1’s

Cultivate a team of Fraud Analysts and Investigators, providing informal feedback on an ongoing basis and formal feedback in the annual performance review process to identify and develop talent

Writes and maintains PINS-related Policies and Standard Operating Procedures (SOPs), including protocols to investigate suspicious activities; ensures Payments policies and SOPs are aligned with Enterprise Fraud

Ensures alignment across stakeholders for PINS functions (e.g., robust communications process throughout the investigation of a Suspicious Activity, periodic readouts on performance of the Zelis Payments network)

A strong sense of accountability and the ability to while working collaboratively across multiple departments supporting projects and initiatives driven by adjacent teams (e.g., Product, IT, Payment Operations, Legal) to enhance fraud prevention processes

Ability to influence others as well as being able to communicate effectively to all stakeholders involved in fraud and suspicious activity events including Legal, Compliance, IT, Product and effected parties (outside stakeholders)

Support the development of metrics, reporting and Key Risk Indicators through dashboards, visualizations as well as supporting the development and integration of automations to improve manual processes, improve operating processes and reduce/eliminate gaps

Qualification

Fraud prevention strategiesFraud detection toolsData analysisTeam leadershipBehavioral analyticsCase management systemsFraud rule logicStakeholder managementSQLCommunication skillsConfidentialityProblem-solvingCollaborationAdaptability

Required

6+ Years of experience in fraud prevention, investigations, or risk management – preferably in payments, fintech, or healthcare

Proven expertise in fraud detection tools, behavioral analytics, and case management systems

Experience developing fraud rule logic and collaborating with product, engineering, and analytics teams

Knowledge of the principles, processes, procedures, and trends of fraud and fraud prevention

Proven track record of success in leading teams. For example, increased leadership responsibility of departments, people and projects

Strong analytical skills and ability to interpret large data sets to drive insights and decision-making

Exceptional communication and stakeholder managements skills; able to influence across levels presenting findings to executive and leadership teams and maintaining composure in high stakes situations

Sensitivity to confidentiality, demonstrated ability to adhere to Zelis Payments standards regarding privacy

Experience working with behavioral biometrics, device fingerprinting, or other advanced fraud detection technologies

Experience scaling fraud operations or building out programs in a fast-growth or start-up environment

SQL skills/experience is a plus

Relevant certifications a plus (i.e. CFE)