Lead Investigations Analyst

Company :

Highmark Health

Job Description : 

JOB SUMMARY

This job conducts and supports internal investigations resulting from evidence of employee malfeasance, including but not limited to, fraud, theft, privacy and security violations, or other violations of enterprise policies including the code of conduct. Duties include ensuring that all investigations are completed consistently and in accordance with policy, as well as conducting fraud related audits and forensic reviews.             

ESSENTIAL RESPONSIBILITIES

• Leads the review of 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. Will lead the review and interpretation of information provided and assist with performing qualitative and quantitative impact assessments.

• Leads 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.

• Effectively leads 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.

• Identifies and 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 & Forensics

EXPERIENCE

Required

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

To Include

• 5 years conducting internal ethics, fraud, privacy and security investigations

Preferred

• 3 years in Operations and/or IT Auditing OR

• 3 years with Privacy/Information security

LICENSES or CERTIFICATIONS

Required

• None

Preferred (any of the following)

• Certified Public Accountant (CPA)

• Certified Internal Auditor (CIA)

• Certified Fraud Examiner (CFE)

• 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

Frequently

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

Rarely

Works primarily out-of-the office selling