What are the responsibilities and job description for the Fraud Analyst III position at AVAILITY?
Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change.
Job Overview
We are seeking a detail-oriented and analytical Cyber Fraud Analyst III to join our SOC Fraud Team. In this role, you will play a critical part in safeguarding our organization against fraudulent activities. You will analyze patterns, identify vulnerabilities, and implement strategies to mitigate risks while ensuring compliance with healthcare regulations.
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Key Responsibilities
Fraud Detection and Prevention
* Monitor transactions and user behavior to identify suspicious activities and potential fraud schemes.
* Leverage advanced analytics tools and fraud detection platforms to proactively detect fraud patterns.
Data Analysis
* Conduct thorough analyses of data to uncover trends, patterns, and anomalies that indicate fraudulent behavior.
* Develop sophisticated KPIs to track risk factors and operational impacts.
* Coordinate with management to propose front-end and back-end enhancements that integrate anti-fraud measures and research capabilities.
Investigative Reporting
* Prepare comprehensive reports detailing findings, patterns of fraud, and recommendations for prevention strategies.
* Lead incident response efforts for cyber fraud alerts on a 24x7 basis as part of an on-call rotation schedule.
Collaboration
* Work closely with cross-functional teams, including Compliance, Legal, and IT, to develop and implement fraud prevention measures.
* Serve as high-level escalation support for the Availity Client Services contact center and their leadership team.
Regulatory Compliance
* Ensure adherence to healthcare regulations and standards, maintaining compliance with HIPAA and other relevant laws.
Risk Assessment
* Evaluate existing products, policies, and procedures for vulnerabilities, recommending enhancements to mitigate risks.
* Interview suspected fraudsters and their victims to provide objective threat analyses.
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Qualifications
Required:
* Bachelor's degree in Finance, Business, Criminal Justice, Computer Science, or a related field.
* 3 years of experience in fraud analysis, risk management, or a related area, preferably in the healthcare or technology sector.
* 3-5 years of experience directly relevant to incident response and/or ad hoc research using SQL or Splunk.
* Proficiency in SQL and the ability to interpret, create, and modify sophisticated ad-hoc queries during incident response.
* 1-3 years of experience using Splunk, with the ability to manipulate queries in Splunk's proprietary Search Processing Language (SPL).
* 1-3 years of experience with AWS toolsets for ad hoc research.
* 1-3 years of experience using PowerBI, Cognos, Splunk, and/or Apptrinsic/Gainsight for reporting.
* Strong analytical skills with expertise in data analysis tools and methodologies, including use of the MITRE ATT&CK framework to define fraudster tactics, techniques, and procedures.
* Familiarity with business and healthcare regulations, compliance standards, and fraud detection techniques under HHS, CMS, FTC, SEC, HITRUST, NIST, GDPR, HIPAA, HITECH, and the NPI Final Rule.
* Excellent verbal and written communication skills to clearly present complex information.
* Skilled in investigative communication strategies for interacting with victims and fraudsters.
* Strong problem-solving skills, detail-oriented, and capable of working independently.
Preferred:
* Certifications such as Certified Fraud Examiner (CFE), Certified Financial Crime Specialist (CFCS), or CompTIA Security .
* Experience with cybersecurity and fraud detection software and analytics platforms, such as Anomali, Accurint, Plaid, Clear, Maltego, and/or Human Security.
* Familiarity with Availity customer access administration toolsets and ANSI X12 EDI transaction formats.
* Experience working in a 24x7 operational environment with geographically dispersed teams.
* Proficiency in developing and implementing basic automations using PowerShell and/or Python, including integrating applicable APIs.
* Ability to speak multiple languages is a plus (e.g., Spanish, French, Hindi, Russian, Mandarin Chinese).
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Why Work at Availity
* Culture: Availity is a certified "Great Place to Work"! We value diversity, inclusion, continuous learning, and a casual work environment.
* Compensation and Benefits: Competitive salary, bonus structure, generous HSA company contribution, and a 401(k) match program vested on day one. Unlimited PTO for salaried associates and a comprehensive wellness program.
* Training and Development: Our Cyber Defense team prioritizes advanced training opportunities and professional development, supporting certifications in fraud detection and cybersecurity.
* Community Involvement: Availity partners with organizations for volunteer opportunities and fundraising campaigns.
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Next Steps in the Process
After you apply, you will receive text/email updates regarding your application status. The interview process includes:
* Resume review
* HR interview
* Automated interview
* Panel interview
Availity is an equal opportunity employer and makes decisions in employment matters without regard to race, religious creed, color, age, sex, sexual orientation, gender identity, gender expression, genetic information, national origin, religion, marital status, medical condition, disability, military service, pregnancy, childbirth and related medical conditions, or any other classification protected by federal, state, and local laws and ordinances.
Availity is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
NOTICE: Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. When required by state law or federal regulation, Availity uses I-9, Employment Eligibility Verification in conjunction with E-Verify to determine employment eligibility. Learn more about E-Verify at http://www.dhs.gov/e-verify.
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