Senior Compliance Analyst – Life & Health Insurance Fraud Investigations

Responsibilities

Independently evaluate complex fraud, misconduct, misrepresentation, unauthorized activity, claims fraud, application fraud, agent misconduct, and other SIU matters.
Prepare referrals and supporting documentation for law enforcement, fraud bureaus, Departments of Insurance, and other external parties.
Support SIU regulatory obligations, reporting, regulatory inquiries, fraud referral tracking, and state insurance fraud requirements.
Conduct complex investigations, monitoring, reviews, and analysis involving potential financial crimes, policy violations, or regulatory requirements.
Analyze information and data to identify risks, patterns, anomalies, root causes, trends, and emerging typologies.
Prepare 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 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.
Manage workload, meet performance expectations, and support additional team priorities.

• 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.
• Experience may include contract development, claims, underwriting, legal research, fraud or anti-money laundering investigations and/or communications.
• Comprehensive knowledge of securities laws, regulations, rules, and applicable FINRA licensing may be required for securities positions.
• Written and verbal communication skills.
• Analytical and research skills.
• Proficiency using MS Office tools.
• 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.
• Knowledge of applicable laws, regulations, policies, procedures, and 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 is preferred.

Demonstrates expertise in conducting complex investigations and analyzing data to identify risks and trends, while ensuring compliance with regulatory obligations and industry standards. Proficient in preparing documentation and recommendations to support risk-based decision-making and improve investigative processes.

• Complex Investigations
• Regulatory Compliance
• Fraud Detection
• Data Analysis
• Risk Assessment

• Analytical Skills
• Research Skills
• Risk-Based Recommendations
• Monitoring
• Fraud Investigations
• Regulatory Support
• Claims Management
• Contract Development
• Policy Analysis
• Financial Crimes Programs

• Written Communication
• Verbal Communication
• Collaboration
• Mentoring

• CAMS
• CFE
• CFCS
• ACSS

• Securities Laws
• Insurance Fraud
• AML
• Financial Services
• Regulatory Inquiries
• Transaction Monitoring
• Customer Due Diligence
• Suspicious Activity Monitoring

• MS Office
• Case Management Systems
• Reporting Tools
• Risk Identification Systems