Fraud Operations Manager

Job Summary

A company is looking for a Manager I, Fraud - Healthcare & Incentives.

Key Responsibilities

• Establish and refine Standard Operating Procedures (SOPs) for fraud risk management
• Ensure compliance with healthcare benefits regulations and manage fraud case handling
• Leverage data analysis to optimize fraud detection and prevention strategies

Required Qualifications

• 5+ years of experience in fraud prevention or risk management
• Experience with healthcare benefits fraud operations (FSA, HSA, WSA preferred)
• Strong knowledge of case management workflows and fraud risk controls
• Proficiency in data analysis tools such as Excel or SQL
• Experience with HIPAA and IRS regulatory frameworks