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Fraud Reporting

1 month ago

Orlando, United States Zelis Healthcare Full time

Location and Workplace Flexibility We 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. Position Overview The Fraud Reporting & Insights Analyst is a crucial member of the Zelis Payments Payee Identification and Network Security (PINS) team, reporting directly to the Senior Director of PINS. This role collaborates with the Fraud team to provide analytical and data-driven insights that shape the Fraud program. The primary responsibilities include supporting fraud detection and prevention efforts, developing rules, generating reports, and minimizing losses due to fraud by analyzing both third-party and first-party data. This role serves as part of investigations, review, and resolution of suspicious activity. Leveraging your expertise in fraud analytics, you will develop and scale metrics for the fraud team, continuously evolving and automating fraud analytics to keep pace with the changing fraud landscape and growing business needs. Key Responsibilities Analyze fraud history and current reporting capabilities to enhance and develop new fraud prevention controls Use SQL, Snowflake, and other tools to generate daily fraud reports and provide suspicious activity data to investigators Collaborate with Zelis' enterprise data science team to create sophisticated fraud modeling and reporting algorithms for proactive detection and analysis Lead the development and implementation of advanced analytics, gathering and reporting data from various internal and external sources Automate insights with visualization tools like PowerBI, including KPI metrics, performance dashboards, and other business insights Report trends and summarize outcomes to executive stakeholders Assist the Risk and Controls department with compliance and risk-related tasks Required Qualifications Bachelor's degree in business and/or Computer Science 5+ years working experience within Fraud/Risk/Compliance Microsoft SQL Studio, Snowflake , and Python experience Fraud Analytics experience Preferred Qualifications Experience with PowerBI, Tableau, or other data visualization tools Experience using J upyter Jira and Confluence Healthcare Payments Industry experience Certified Fraud Examiner #LI-RZ1 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 Belonging At 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 Opportunity Zelis 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 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 TalentAcquisition@zelis.com SCAM 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