Fraud Manager, PINS

At Zelis, we Get Stuff Done. So, let's get to it!

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients.

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

The Fraud Manager, Payee Identification and Network Security will report to the Sr. Director that leads Zelis Payments' Fraud and Identity Verification organization (known within Zelis as PINS).

As the Fraud Manager, you will be responsible for overseeing fraud detection strategies, leading complex investigations, and enhancing fraud mitigation frameworks to protect the integrity of our payments and provider network.

This role will manage a team that investigate suspicious activity and authenticate users on the Zelis payments network by ensuring that these resources are effectively prioritizing their work, removing roadblocks, and maintaining protocols and standard operating procedures.

This leader will be highly analytical and proficient in database queries / analysis and can be hands-on in network monitoring activity. Additionally, you must be a skilled communicator with an executive presence, who is able to lead conversations with clients and summarize the teams' activities to leadership.

• Lead the design and implementation of fraud prevention strategies for payment transaction, ACH enrollment, and provider verification.

• Oversee fraud investigations, root cause analyses, and escalations, ensuring timely and accurate resolution to mitigate loss.

• Steps in to resolve elevated issues brought forth by the PINS team; for example, escalations brought by the client services team, requests from partner banks or vendor partners.

• Analyze fraud patterns and operational data to identify emerging threats, recommend mitigations, working with relevant teams to support change.

• Effectively oversees the day-to-day operations and activities of the Fraud team; manages productivity and prioritization, helps overcome roadblocks, and monitors progress against team goals and effectively holds frequent 1-on-1's.

• Cultivate a team of Fraud Analysts and Investigators, providing informal feedback on an ongoing basis and formal feedback in the annual performance review process to identify and develop talent.

• Writes and maintains PINS-related Policies and Standard Operating Procedures (SOPs), including protocols to investigate suspicious activities; ensures Payments policies and SOPs are aligned with Enterprise Fraud.

• Ensures alignment across stakeholders for PINS functions (e.g., robust communications process throughout the investigation of a Suspicious Activity, periodic readouts on performance of the Zelis Payments network).

• A strong sense of accountability and the ability to while working collaboratively across multiple departments supporting projects and initiatives driven by adjacent teams (e.g., Product, IT, Payment Operations, Legal) to enhance fraud prevention processes.

• Ability to influence others as well as being able to communicate effectively to all stakeholders involved in fraud and suspicious activity events including Legal, Compliance, IT, Product and effected parties (outside stakeholders).

• Support the development of metrics, reporting and Key Risk Indicators through dashboards, visualizations as well as supporting the development and integration of automations to improve manual processes, improve operating processes and reduce/eliminate gaps.

• 6+ Years of experience in fraud prevention, investigations, or risk management - preferably in payments, fintech, or healthcare.

• Proven expertise in fraud detection tools, behavioral analytics, and case management systems.

• Experience developing fraud rule logic and collaborating with product, engineering, and analytics teams.

• Knowledge of the principles, processes, procedures, and trends of fraud and fraud prevention.

• Proven track record of success in leading teams. For example, increased leadership responsibility of departments, people and projects.

• Strong analytical skills and ability to interpret large data sets to drive insights and decision-making.

• Exceptional communication and stakeholder managements skills; able to influence across levels presenting findings to executive…