Senior Compliance & Fraud Investigative Analyst

Join Us in the Central Fraud Hub as a Senior Compliance & Fraud Investigative Analyst

Are you ready to take on a high-impact role where your work makes a real difference? As a Senior Compliance & Fraud Investigative Analyst on the Vendor Evaluation Team, you will evaluate vendor contractual compliance, quality of service, billing accuracy, and resource optimization across claims, vendor types, and Lines of Business. You will also participate in team calibrations, results analysis, report development, and presentations to support continuous improvement.

In this role, you’ll:

• Drive meaningful change by planning and executing both proactive and reactive audits on contracted vendors.
• Collaborate and strengthen business partnerships by working closely with Analytics, Vendor Controls & Invoicing, Procurement, and LOB partners to enhance vendor partnerships and accountability.
• Leverage advanced tools and technology, including AI/GPT (with governance and human oversight) to enhance efficiency and accuracy.
• Engage with stakeholders and business parters, preparing clear and reporting out fact-based audit reports to drive impactful outcomes.
• Shape the future of vendor partnerships by supporting accurate and timely actions that secure financial recoveries, strengthens contracts, and addresses gaps with vendor and claim processes.

Responsibilities

• Under limited direction, conducts quality and performance audits of vendor claims files. Analyzes all aspects of claims handled by a particular vendor as outlined in their contract from SLA’s to billing and internal workflows.
• Could potentially review vendors from multiple claims lines of business that span across Personal Lines and Small Commercial claims.
• Review cross-line of business vendor files
• Determine compliance with claims handling standards, policies and procedures as determined by calibration and vendor contracts. Make recommendations on contract improvement opportunities to Vendor LOB owners.
• Under limited direction, analyzes results and develops the necessary detail from audits conducted to assist the QI team in identifying the trends from an audit, which, if corrected, would drive improvement.
• Accurately tracks and inputs audit findings into database.
• Participate in calibration with review team and the analysis of overall results.
• Under limited direction, assists in the preparation and leads presentation of results, conclusions, and recommendations to field leadership
• Assists with driving continuous improvements by providing feedback on audit process and tool changes that will result in a better product being delivered to the line of business.
• Performs other duties as assigned.