Senior Compliance Analyst - Life & Health Insurance Fraud Investigations - Hybrid

Compliance Investigator

Helps to mitigate legal exposure, insurance and claims fraud risks to the organization by enforcing company policies, procedures and regulatory requirements. Possesses and applies broad knowledge of concepts and principles; performs multiple moderate to complex suspicious claims investigations to determine if fraud can be substantiated and claim payments should be paid or denied.

Responsibilities:

• Independently evaluate complex fraud, misconduct, misrepresentation, unauthorized activity, claims fraud, application fraud, agent misconduct, or other SIU matters.
• Prepare referrals and supporting documentation for law enforcement, fraud bureaus, Departments of Insurance, or other external parties.
• Support SIU regulatory obligations, reporting, regulatory inquiries, fraud referral tracking, and state insurance fraud requirements.
• Independently conduct complex investigations, monitoring, reviews, and analysis involving potential financial crimes, policy violations, or regulatory requirements.
• Analyze complex information and data to identify risks, patterns, anomalies, root causes, trends, and emerging typologies.
• Prepare comprehensive investigative files, conclusions, recommendations, and documentation supporting risk-based decisions and regulatory obligations.
• Recommend improvements to investigative methods, monitoring, controls, workflows, reporting, dashboards, metrics, and overall program effectiveness.
• Support audits, examinations, reporting obligations, management reporting, dashboards, testing, projects, and implementation of new capabilities.
• Collaborate with internal partners to resolve complex matters, communicate findings, and support risk mitigation.
• Guide less experienced analysts on case handling, documentation, investigative approach, quality expectations, and escalation.
• Independently manage workload, meet performance expectations, and proactively support additional team priorities when capacity allows.

Qualifications:

• Bachelor's degree in business, marketing, pre-law or other relevant field, or equivalent education and experience.
• Four years of regulatory, securities, or advertising compliance experience.
• Areas of experience desired may vary based upon assigned compliance functions and may include contract development, claims, underwriting, legal research, fraud or anti-money laundering investigations and/or communications.
• Securities and some advertising industry positions require comprehensive knowledge of the securities laws, regulations, rules, and applicable FINRA licensing (Series 7 & 24 or Series 6 & 26, as applicable).
• Written and verbal communication skills.
• Analytical and research skills.
• Proficiency using MS Office tools.

Preferred Qualifications:

• Experience independently conducting complex investigations, reviews, monitoring, risk assessments, and regulatory support.
• Ability to analyze complex information, identify patterns and anomalies, draw supported conclusions, and make sound risk-based recommendations.
• Demonstrated ability to identify trends, root causes, control gaps, and improvement opportunities.
• Strong analytical, investigative, critical thinking, communication, prioritization, and independent judgment skills.
• Knowledge of applicable laws, regulations, policies, procedures, industry guidance.
• Experience supporting AML, Fraud/SIU, sanctions, customer due diligence, transaction monitoring, suspicious activity monitoring, or financial crimes programs.
• Experience supporting audits, examinations, regulatory inquiries, reporting obligations, testing, control enhancements, or process improvements.
• Experience using case management systems, databases, reporting tools, or risk identification systems.
• Insurance, securities, banking, or financial services experience; professional certification such as CAMS, CFE, CFCS, ACSS, or similar designation.

Working Conditions:

• Hybrid office environment: 3 days in office (Tues/Wed/Thurs)
• Locations:
  Philadelphia, Baltimore, Cedar Rapids, Denver

Compensation:

• The Salary for this position generally ranges between $75,000 - $85,000 annually. Please note that the salary range is a good faith estimate for this position and actual starting pay is determined by several factors including qualifications, experience, geography, work location designation (in-office, hybrid, remote) and operational needs. Salary may vary above and below the stated amounts, as permitted by applicable law.
• Additionally, this position is typically eligible for an Annual Bonus based on the Company Bonus Plan/Individual Performance and is at the Company's discretion.