GENERAL PURPOSE

Operating within the core values and operating principles of the organization, the Fraud Analyst will work cross-functionally with all departments to combat fraudulent activities and cultivate a best in class fraud prevention and reporting program. This individual will lead AAA Life’s fraud monitoring and detection efforts and serve as the main point of contact for fraud investigations and reporting.

POSITION RESPONSIBILITIES

• Leverage external and internal performance data insights to develop a best in class fraud prevention program that will create value for AAA Life and its customers.

• Monitor fraud across our network and serve as a point of contact for fraud investigations and remediation.

• Deep dive into individual fraud events to perform root cause analyses, and combine the insights with a data driven approach to develop fraud defenses.

• Partner with product internal business partners to execute fraud policies and investigations.

• Implement fraud risk metric monitoring by researching/ resolving risk events and developing levers that mitigate risk factors.

• Research emerging fraud trends by pulling data from our data warehouse and utilizing insurance and financial services industry resources.

• Assist with the development of our fraud monitoring strategy and identify any potential gaps.

• Assist with evaluation and development of new external or internal features/signals to improve our fraud detection capabilities.

• Review suspicious activity/exception alerts to identify fraudulent or suspicious transactions and protect AAA Life from any loss.

• Accurately and thoroughly document alert and case comments and all investigative steps, in compliance with department procedures and standards.

• Accurately identify and submit timely Suspicious Activity Reports (SARs) and Management Notifications.

• Interact with business units, customers and outside agencies to communicate fraud situations and recommend action steps.

• Take appropriate action steps to protect AAA Life’s assets and reputation and minimize losses.

• Investigate potential crimes, and ensure compliance with applicable regulatory requirements.

• Utilize sound judgment and knowledge of financial crime investigative tools/techniques to establish an investigative plan; initiate investigation by gathering facts and evidence; and prepare confidential investigative reports.

Required Skills Required Experience

• Five years of life insurance or financial services industry experience preferred.
• Bachelor's Degree desirable; degree in related discipline, such as criminal justice, risk management, business, or law highly desirable
• A combination of education and relevant, successful work experience can be substituted for a degree. Prior work experience in security, investigations, risk management, law enforcement or similar areas a plus.
• Membership in an investigative association, such as CFE or CFCI, a plus
• Certification(s) such as Certified Fraud Examiner, Financial Crimes Investigator, or Certified Anti-Money Laundering Specialist strongly preferred.
• Experience or training in interviewing techniques, testifying in front of tribunals, and report writing.
• Experience using data analytics or conducting process control reviews.
• Strong organizational, communication, and collaborative skills.
• Strong Windows-based PC skills required. Ability to assimilate new information and incorporate it into future actions a must.
• Highly motivated learner focused on progressing through a career in fraud and security risk management.

PATIENT REPRESENTATIVE COMPETENCIES

GENERAL

• Customer Service
• Professionalism/Integrity/Responsibility
• Teamwork/Lean Process Improvement
• Game Changer/Initiative
• Dependability/Punctuality
• Interpersonal Relationships/Communication
• Judgment/Decision Making/Problem Solving
• Quality/Quantity
• Safety/Housekeeping
• Organizational Skills/Time Management

DEPARTMENT SPECIFIC

• Follows reception process for all check in duties.
• Follows appointment preparation process for all scheduled appointments including eligibility verification, referral/authorization/managed care processes.
• Follows process for all demographic data entry.
• Follows appointment process for scheduling to include system reports (cancel/reschedule), Live Chat, and appointment request mailbox.
• Follow check out processes for appointments, referrals, tasking, communications, managed care and failsafe.
• Follows insurance process for all insurance data.
• Follows cashier process for collections, retail sales, and batching.
• Follows patient financial counselor process for billing inquiries and concerns.
• Follows all processes for reconciliation of internal communications.
• Follows HIPAA guidelines.

Wilmington Health is an Equal Opportunity Employer committed to providing equal opportunities to all applicants and employees. We are committed to treating everyone equally and with respect regardless of race, age, sex, religion, national origin, citizenship, marital status, veteran’s status, sexual preference, disability, genetic information or any other class protected under state or federal law. 

ADA PHYSICAL DEMANDS:

Rarely (Less than .5 hrs/day) Occasionally (0.6 – 2.5 hrs/day) Frequently (2.6 – 5.5 hrs/day) Continuously (5.6 – 8.0 hrs/day) Position Dependent (prn)

PHYSICAL DEMAND

REQUIRED?

FREQUENCY

Standing

Position Dependent

Sitting

Continuously

Walking

Position Dependent

Kneeling/Crouching

Rarely

Lifting

Rarely