Payments Risk Analyst

Overview of PositionChange Healthcare facilitates more than $150B in Payments to healthcare providers annually. It is imperative that we maintain secure payments processing to ensure providers receive reimbursements for the lifesaving work they do. It is our goal to prevent payers, providers, and Change Healthcare from becoming victims of the growing Payments Fraud epidemic and help drive down the overall costs of Health Care. As a Risk Analyst, the incumbent will support enrollment teams by reviewing transactional data, decision risk alerts, and ensure compliance with regulatory and operational policies. The Risk Analyst will support adherence to the Payments Risk policies, and conduct analysis used to further develop the risk program and drive enhancements in the security of our payments solutions.

What will be my duties and responsibilities in this job?

  • Conduct detailed monitoring of enrollment and payments operations activities to detect and prevent payments risks through transactional activity reviews. Clear alerts, restrict accounts, and initiate remediation efforts. Ensure compliance with operational policies and applicable regulatory requirements

  • Conduct in depth enrollment analysis utilizing internal and external systems, sources, and procedures to identify outliers and trends to prevent and/or identify fraud and continuously improve fraud strategy and controls. Conduct high-risk review for indicators of fraud, communicate with providers

  • Conduct preliminary investigation of suspicious payment activity, misapplied payments, and suspected fraudulent activity, identifies/reports gaps in controls, and prepares internal reports

  • Deep dive into individual fraud events to perform root cause analysis and breakdowns in controls to identify fraud strategy and control improvements

What are the requirements needed for this position?

  • Minimum 3 years of experience in fintech or financial services risk and fraud prevention and/or investigation

  • Industry Certification in fraud examination, financial investigations, payment industry and/or bank fraud

  • Healthcare claims process knowledge or investigations experience

What other skills/experience would be helpful to have?

  • Bachelors degree preferred

  • Advanced data analysis skills using Microsoft Excel and common industry data analytic, database, and open-source information systems.

  • SQL experience a plus

  • Stays up-to-date on industry trends and fraud detection and mitigation techniques

  • Maintain Discretion and Confidentiality with sensitive information

  • Strong analytical skills, with the ability to recognize and analyze emerging trends

  • Strong analytical skills, with the ability to recognize and analyze emerging trends

  • Excellent written and verbal communication skills with the ability to prepare internal communications relevant to investigation findings

  • Identify and drive forward the use of best practices, industry standards and innovative methodologies

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Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

COVID Vaccination Requirements

We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcares Privacy Notice to California Job Applicants Regarding the Collection of Personal Information (https://www.changehealthcare.com/privacy-notice/privacy-notice-to-california-job-applicants) .

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.

Posted
06/21/2022
Salary Range
$61,000.00 - $85,000.00
per Year
Salary range estimated by
salary estimation provided by zippia
Location
Atlanta, GA, 30383, US