The Fraud Analyst is a member of the Security Operations Center s fraud team responsible for the protection and integrity of Availity s online systems. This role works closely with customer facing teams supporting and investigating anomalous customer activity, registrations, and identity verification issues. The team member assists in the collection, researching, and reviewing of cases escalated to the team. The fraud analyst will also participate in the creation and modification of alerts and operational metrics to quickly identify fraudulent or anomalous behavior.
What you will be doing:
- Monitors and processes reporting in reference to ongoing escalations, new customer registrations and identity verification events.
- Monitors alerting and processes security measures in relation to sensitive customer account changes and customer behavior.
- Identifies Areas of Opportunity and coordinates with leadership to ensure appropriate verifications have been processed to meet standards set forth.
- Coordinates with Management regarding potential front-end and back-end enhancements to further integrate anti-fraud measures and anti-fraud research capabilities.
- Refers to run-guides compiled by senior analysts and management for appropriate procedures to handle fraud prevention reviews and fraud investigations.
- Contributes data supporting policy related decisions.
- Contributes to development of presentations for leadership surrounding identified solutions to previously diagnosed fraud vulnerabilities or decisions as assigned by management.
- Will take part in a quarterly uptraining session with a Senior Fraud Analyst (Analyst III) regarding a new tool, process, set of tactics or workflows to meaningfully enhance ability to resolve issues of higher complexity.
The above-cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.
Requirements:
- Bachelor s degree in computer science, Health Information Technology, Criminal Justice may apply but is not required.
- Good understanding and experience of reporting and/or research using at least two of the following platforms or languages: Salesforce Lightning, Splunk, Jira, SQL (including variant dialects and associated platforms), PowerBI, MS Excel, LDAP/Apache Directory Studio, Maltego, Gainsight, Variphy, Accurint by Lexis Nexis, or other similar tools which may be used for Fraud Investigation.
- Familiarity with Open-Source Intelligence (OSINT) tools or resources.
- Strong understanding of tactics used for the commission of fraud, waste and/or abuse by malicious actors from within a web-based platform or via different contact centers including the Call Center, Inbound Emails, Document Submissions, Web-help chat, Web-based Community Support tickets, etc.
- Direct knowledge of healthcare-related standards (HIPAA, HITECH, NPI FINAL RULE, NIST800).
- Direct knowledge regarding Availity Essentials platform role and permission structures.
- Comfort working in a department with several adaptive workflows and technologies, and where change and innovation are frequent.
- Adept with multitasking across numerous tools and linking disparate data sources.
- Strong sense of data logic to identify workflows which may be exploited by malicious actors.
- A high level of discretion is required, due to the sensitive nature of this role.
- Demonstrable skill in detailed factual notation for fraud prevention reviews or fraud investigations.
- Comfort in defining source vulnerabilities exploited by fraud actors.
