Fraud Analyst

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 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.

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 [email protected]

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