Fraud Investigation Analyst Jobs in Florida

Drive process change management, leveraging data to drive insights and improvement by partnering with Operations analytics.

Partner with workforce management to balance cost and capacity to meet established SLAs.

Identify opportunities to reduce fraud risk while delivering better Member experience.

10+ years of relevant fraud or financial crime operations experience managing multiple teams in a large or super regional Financial Institutions.

Investment Securities Fraud experience is a plus.

Lead and coach investigators on productivity while driving accountability and efficacy.

Conduct investigations of potential waste, abuse, and fraud

Document activity on each case and refer issues to the appropriate party

Perform data mining and analysis to detect aberrancies and outliers in claims

Develop new queries and reports to detect potential waste, abuse, and fraud

Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions

Assist with complex allegations of healthcare fraud