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Company

Availity · 17 hours ago

Fraud Analyst III

United States

Full-time

Remote

Mid Level

3+ years exp

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Growth Opportunities

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Responsibilities

Monitor transactions and user behavior to identify suspicious activities and potential fraud schemes.

Leverage advanced analytics tools and fraud detection platforms to proactively detect fraud patterns.

Conduct thorough analyses of data to uncover trends, patterns, and anomalies that indicate fraudulent behavior.

Develop sophisticated KPIs to track risk factors and operational impacts.

Coordinate with management to propose front-end and back-end enhancements that integrate anti-fraud measures and research capabilities.

Prepare comprehensive reports detailing findings, patterns of fraud, and recommendations for prevention strategies.

Lead incident response efforts for cyber fraud alerts on a 24x7 basis as part of an on-call rotation schedule.

Work closely with cross-functional teams, including Compliance, Legal, and IT, to develop and implement fraud prevention measures.

Serve as high-level escalation support for the Availity Client Services contact center and their leadership team.

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.

Interview suspected fraudsters and their victims to provide objective threat analyses.

Qualification

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Fraud AnalysisRisk ManagementIncident ResponseSQLSplunkAWS ToolsetsPowerBICognosFraud Detection TechniquesData AnalysisMITRE ATT&CK FrameworkCertified Fraud ExaminerCompTIA Security+PythonPowerShellMulti-Language Proficiency

Required

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.

Proficiency in SQL and the ability to interpret, create, and modify sophisticated ad-hoc queries during incident response.

1-3 years of experience using Splunk, with the ability to manipulate queries in Splunk’s proprietary Search Processing Language (SPL).

1-3 years of experience with AWS toolsets for ad hoc research.

1-3 years of experience using PowerBI, Cognos, Splunk, and/or Apptrinsic/Gainsight for reporting.

Strong analytical skills with expertise in data analysis tools and methodologies, including use of the MITRE ATT&CK framework to define fraudster tactics, techniques, and procedures.

Familiarity with business and healthcare regulations, compliance standards, and fraud detection techniques under HHS, CMS, FTC, SEC, HITRUST, NIST, GDPR, HIPAA, HITECH, and the NPI Final Rule.

Excellent verbal and written communication skills to clearly present complex information.

Skilled in investigative communication strategies for interacting with victims and fraudsters.

Strong problem-solving skills, detail-oriented, and capable of working independently.

Preferred

Certifications such as Certified Fraud Examiner (CFE), Certified Financial Crime Specialist (CFCS), or CompTIA Security+.

Experience with cybersecurity and fraud detection software and analytics platforms, such as Anomali, Accurint, Plaid, Clear, Maltego, and/or Human Security.

Familiarity with Availity customer access administration toolsets and ANSI X12 EDI transaction formats.

Experience working in a 24x7 operational environment with geographically dispersed teams.

Proficiency in developing and implementing basic automations using PowerShell and/or Python, including integrating applicable APIs.

Ability to speak multiple languages is a plus (e.g., Spanish, French, Hindi, Russian, Mandarin Chinese).