Senior Investigations Analyst

Company :

Highmark Health

Job Description :

JOB SUMMARY

This role serves a critical function within Enterprise Incident Management, leading the coordination and execution of enterprise-wide response activities for large-scale incidents that require engagement across multiple business and operational areas. The position also conducts and supports internal investigations related to employee misconduct, including fraud, theft, privacy and security violations, and other breaches of enterprise policies and the Code of Conduct.

Responsibilities include ensuring investigations are performed consistently and in accordance with organizational standards, as well as conducting fraud-related audits and forensic reviews.

ESSENTIAL RESPONSIBILITIES

• Reviews risk assessment results to perform investigations into potential and existing threats. Responsible for the investigation of reports of real or potential instances of non-compliance and/or fraud in accordance with established standards/policies. Reviews and interprets information provided and assist with performing qualitative and quantitative impact assessments.

• Collaborates on engagement initiation and planning activities for fraud-related audits and monitoring activities within Highmark Health Enterprise; including approving audit programs to support the audit objectives of identified audits.

• Facilitates collaboration efforts with Senior Risk Partners, Risk Operations and Internal Audit team members to facilitate the execution of internal investigations and fraud related audits based on reports or identified fraud risks.

• Defines when additional information gathering and risk assessments is necessary to formulate conclusions; ensuring documentation to support investigative conclusions is sufficient and in accordance with department standards.

• Uses appropriate fraud investigation tools, applications, and systems to continually enhance fraud detection strategies and to identify trends.

• Analyzes assessment results against physical, technical, and administrative safeguards and company-specific contractual requirements in the evaluation of risk.

• Provides consultation in development of assurance plans (e.g., on-site audit, contract review, financials assessment) to address relevant risk areas and to ensure proper controls are implemented.

• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Accounting, Finance, Business Administration, Information Systems or related field

Substitutions

• 6 years of related and progressive experience in lieu of Bachelor's degree

Preferred

• Master's Degree in Fraud and Forensics

EXPERIENCE

Required

• 5 years in Accounting, Finance, Audit, Information Systems or related field

To Include:

• 3 years of conducting internal ethics, fraud, privacy and security investigations

Preferred

• 1 years in Operational and/or IT auditing OR Privacy/Information security

LICENSES or CERTIFICATIONS

Required

• None

Preferred (any of the following)

• Certified Public Accountant (CPA)
• Certified Internal Auditor (CIA)
• Certified Fraud Examiner (CFA)
• Certified Information Systems Auditor (CISA)
• Certified Information Privacy Professional (CIPP)

SKILLS

• Excellent written and verbal communication skills. Ability to appropriate package information and tailor message to respective audiences.

• Broad understanding of fraud/privacy/security risks, business issues, key metrics and organizational linkages.

• Excellent analytical skills with a demonstrated ability to identify unusual trends/circumstances and solve problems.

• Working knowledge of standard investigative procedures/protocols

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer:
The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement:
This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy…