Fraud Manager, PINS - Saint Petersburg

Job summary

At Zelis, we Get Stuff Done. So, let's get to it. Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

Responsibilities

• Lead the design and implementation of fraud prevention strategies for payment transaction, ACH enrollment, and provider verification.
• Oversee fraud investigations, root cause analyses, and escalations, ensuring timely and accurate resolution to mitigate loss.
• Steps in to resolve elevated issues brought forth by the PINS team; for example, escalations brought by the client services team, requests from partner banks or vendor partners.
• Analyze fraud patterns and operational data to identify emerging threats, recommend mitigations, working with relevant teams to support change.
• Effectively oversee the day-to-day operations and activities of the Fraud team; manages productivity and prioritization, helps overcome roadblocks, and monitors progress against team goals and effectively holds frequent 1-on-1's.
• Cultivate a team of Fraud Analysts and Investigators, providing informal feedback on an ongoing basis and formal feedback in the annual performance review process to identify and develop talent.
• Writes and maintains PINS-related Policies and Standard Operating Procedures (SOPs), including protocols to investigate suspicious activities; ensures Payments policies and SOPs are aligned with Enterprise Fraud.
• Ensures alignment across stakeholders for PINS functions (e.g., robust communications process throughout the investigation of a Suspicious Activity, periodic readouts on performance of the Zelis Payments network).
• A strong sense of accountability and the ability to while working collaboratively across multiple departments supporting projects and initiatives driven by adjacent teams (e.g., Product, IT, Payment Operations, Legal) to enhance fraud prevention processes.
• Ability to influence others as well as being able to communicate effectively to all stakeholders involved in fraud and suspicious activity events including Legal, Compliance, IT, Product and effected parties (outside stakeholders).
• Support the development of metrics, reporting and Key Risk Indicators through dashboards, visualizations as well as supporting the development and integration of automations to improve manual processes, improve operating processes and reduce/eliminate gaps.

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