Senior Investigations Analyst

Job description

Company :

nHighmark Health

nJob Description :

nJOB SUMMARY

nThis 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.

nESSENTIAL RESPONSIBILITIES

nnnReviews 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.

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nnCollaborates 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.

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nnFacilitates 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.

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nnDefines 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.

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

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

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nnProvides 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.

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nnOther duties as assigned or requested.

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n nEDUCATION

nRequired

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

n nSubstitutions

nn6 years of related and progressive experience in lieu of Bachelor's degree

n nPreferred

nnMaster's Degree in Fraud and Forensics

n nEXPERIENCE

nRequired

nn5 years in Accounting, Finance, Audit, Information Systems or related field

n nTo Include:

nn3 years of conducting internal ethics, fraud, privacy and security investigations

n nPreferred

nn1 years in Operational and/or IT auditing OR Privacy/Information security

n nLICENSES or CERTIFICATIONS

nRequired

nnNone

n nPreferred (any of the following)

nnnCertified Public Accountant (CPA)

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nnCertified Internal Auditor (CIA)

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nnCertified Fraud Examiner (CFA)

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nnCertified Information Systems Auditor (CISA)

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nnCertified Information Privacy Professional ​(CIPP)

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n nSKILLS

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

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

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

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nnWorking knowledge of standard investigative procedures/protocols

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n nLanguage (Other than English):

nNone

nTravel Requirement:

n0% - 25%

nPHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

nPosition Type

nOffice-based

nTeaches / trains others regularly

nOccasionally

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

nRarely

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

nNever

nPhysical work site required

nYes

nLifting: up to 10 pounds

nConstantly

nLifting: 10 to 25 pounds

nOccasionally

nLifting: 25 to 50 pounds

nRarely

nDisclaimer: 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.

nCompliance 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.

nAs 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 Policies and Practices and Information Security Policy.

nFurthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

nPay Range Minimum:

n$68,400.00

nPay Range Maximum:

n$105,900.00

nBase pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

nHighmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

nCalifornia Consumer Privacy Act Employees, Contractors, and Applicants Notice (

nReq ID: J

Worksite address

augusta, ME, 04338, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.