Health Systems Analyst

• Review assigned fraud cases involving commercial enrollment, account changes, provider validation, and payment activity across ACH, virtual card, and check workflows in accordance with validation steps and documentation standards.
• Maintain and prioritize assigned case inventory to support timely case progression, targeted backlog priorities, required turnaround times, service expectations, evidence needs, and escalation requirements.
• Gather, compare, and analyze relevant facts from transactional data, enrollment records, payment records, validation checks, external research, platform records, and stakeholder input.
• Conduct outbound calls with providers, customers, clients, payers, and internal business partners to validate enrollment, payment, or account-change information and support case review and follow-up.
• Identify indicators of suspicious activity; document relevant facts, assumptions, and limitations; and escalate suspected fraud, unclear ownership, case delays, or material concerns through established channels.
• Use applicable systems, case management platforms, validation tools, business productivity tools, and reporting resources to monitor case status, support clear workload visibility, update trackers, and maintain organized, accurate, complete, and audit-ready case documentation.
• Prepare clear case summaries, status updates, inventory updates, and trend observations to support program leadership, operational reporting, stakeholder updates, and team operating routines.
• Support preliminary investigation activities by documenting anomalies, payment exceptions, account-change concerns, financial impact, repeat-risk indicators, and follow-up needed to prepare cases for closure, continued review, or escalation.

• Bachelor’s Degree
• 2+ years of experience in fraud operations, commercial payments, transactional review, payment operations, enrollment, banking, loss prevention, audit support, or another high-volume case review environment with established service expectations.
• Experience conducting outbound calls, asking effective questions, gathering facts, validating information, and documenting findings.
• Ability to analyze data, identify anomalies, connect related facts, and summarize case conclusions clearly and accurately.
• Ability to communicate findings professionally and with attention to detail, both verbally and in writing.
• Ability to work independently, manage assigned case inventory, follow defined procedures, meet established service expectations, and maintain accountability in a remote work environment.
• Intermediate proficiency with Microsoft 365 products, including Excel, Word, PowerPoint, Outlook, Teams, and SharePoint.
• Experience using commercial banking, payment, enrollment, identity-validation, case management, monitoring, or research tools to review and verify information.
• Ability to ramp quickly in a fast-paced environment with changing business needs, evolving fraud trends, time-sensitive case work, and operational priorities.

$32 an hour - Full-time, Contract, Pulled from the full job description

• Health insurance
• Vision insurance
• Dental insurance, * Dental insurance
• Health insurance
• Vision insurance