Senior Fraud Detection Analyst - Blue Shield of California
Overview
The Internal Audit Fraud Advisor leads independent assurance initiatives to strengthen governance and mitigate fraud risk across Blue Shield of California. This role drives proactive fraud detection and advisory support through cross-functional collaboration, leveraging advanced analytics and domain expertise. Success is measured by delivering actionable insights that protect members, providers, and stakeholders while fostering a culture of continuous improvement.
What You'll Do11
- 1Support internal audit engagements by providing fraud subject matter expertise during planning walkthroughs risk assessments control evaluation testing root cause analysis and reporting
- 2Identify fraud risk considerations within audits of business processes systems third-party relationships financial activities claims operations procurement expense reimbursement vendor management and other enterprise functions
- 3Perform proactive fraud detection activities using data analysis pattern identification anomaly review control-break analysis and targeted monitoring to uncover potential fraud waste abuse misconduct policy violations or control weaknesses
- 4Develop and document fraud scenarios indicators typologies detection logic and control points for integration into audit programs monitoring routines dashboards and business owned controls
- 5Advise business units on anti-fraud practices control improvements prevention strategies process changes documentation expectations and sustainable monitoring approaches
- 6Collaborate with Internal Audit Compliance Legal HR Finance IT and business leaders to assess fraud risks triage observations recommend corrective actions and support management action plans
- 7Prepare clear well-supported workpapers summaries recommendations and executive-ready insights linking fraud risks to controls business impacts and remediation opportunities
- 8Monitor emerging fraud schemes regulatory expectations industry trends and internal risk signals to enhance fraud risk coverage and advisory support
- 9Maintain confidentiality professional skepticism independence and sound judgment when handling sensitive fraud indicators investigations support and personnel matters
- 10Contribute to continuous improvement of Internal Audit fraud capabilities including fraud risk assessment methodology detection playbooks control libraries data-driven testing approaches and knowledge sharing across audit teams
- 11Perform or support fraud risk assessments audit planning control testing issue validation data analysis fraud analytics or investigative case support
Requirements8
- 1Bachelor’s degree in Accounting Finance Business Administration Criminal Justice Data Analytics Information Systems Health Care Administration or related field with equivalent experience accepted
- 2Minimum 5 years of professional experience in internal audit compliance investigations fraud risk management forensic accounting enterprise risk management or related fields with preference for healthcare insurance or other highly regulated industries
- 3Certified Fraud Examiner CFE certification preferred; credentials such as CIA CPA CISA CAMS CHC or similar audit compliance risk investigation or analytics certifications are a plus
- 4Proven ability to evaluate business processes identify fraud vulnerabilities assess internal controls and recommend practical sustainable control improvements aligned with organizational goals
- 5Strong analytical skills professional skepticism attention to detail and capacity to translate complex information into clear risk themes hypotheses and actionable findings
- 6Experience with data tools reporting platforms case management systems audit management systems SQL Python Excel Tableau Power BI or similar analytics tools is preferred
- 7Hybrid work arrangement requiring two days in office weekly with flexibility for remote work based on business needs
- 8Background check drug screening and adherence to equal employment opportunity principles including protection for veterans disabilities and other classifications
Salary Insight
$91 - $136k per year
Location
Required Skills
Similar open positions
Explore active roles that match your skills and interests.
Blue Shield of California
VerifiedActuarial Analyst Consultant Blue Shield of California
The Actuarial Analyst Consultant leads strategic payment models and value-based care initiatives at Blue Shield of California. This hybrid role requires 6+ years of actuarial experience with expertise in healthcare analytics and provider reimbursement. Responsibilities include shaping enterprise payment strategies and developing scalable solutions. The position offers competitive compensation and opportunities for professional growth within a mission-driven organization.
Blue Shield of California
VerifiedCorporate Security Analyst - Blue Shield of California
Lead the Security Operations Center and Security Fusion Center at Blue Shield of California driving security strategy and incident response. This Consultant-level role reports to the Senior Manager, Security Intelligence shaping security programs across facilities legal and compliance frameworks. You will integrate threat intelligence develop detection strategies and lead cross-functional teams to address workplace violence insider threats and cyber-physical risks.
Blue Shield of California
VerifiedActuarial Analyst Principal Blue Shield of California
Strategic partner shaping payment models and value‑based care initiatives. Directly manages a team of two actuaries while collaborating with senior leadership to deliver measurable impact on affordability and quality. Lead enterprise strategies and drive transformational change.
Forescout Technologies Inc.
VerifiedSenior Workforce Fraud Manager
Senior Workforce Fraud Manager at Forescout Technologies Inc. Dallas Texas onsite payroll shape future of cybersecurity daily cyberattacks threaten hospitals power grids financial systems infrastructure Forescout builds defenses keep civilization running smooth over 25 years Fortune 100 organizations government agencies large enterprises trust Forescout managed cyber risk ensure compliance mitigate threats protect critical infrastructure of modern world
US132 Guidehouse Digital, LLC
VerifiedSenior Staff Fraud Analytics Consultant
Lead Fraud Analytics Consultant at Guidehouse Digital supports fraud analytics operations and technical documentation. This role solves structured problems and contributes to analytics and reporting. Onsite work in Lanham Maryland.
Space Coast Credit Union
VerifiedFraud Management Manager, Banking & Compliance
You will lead SCCU's Fraud Management team, protecting $9 billion in assets across 685,000+ members. You'll own fraud prevention, detection, and investigation, reducing financial losses and ensuring regulatory compliance. You'll manage a team, optimize workflows with automation, and partner with agencies like FBI and Secret Service. This role offers a hybrid schedule and a clear path for career growth in a not-for-profit credit union.