Fraud and Risk Specialist

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

A Little About Us

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.

At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.

A Little About You

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.

Position Overview

What you'll do:

Investigation & Case Management:

• Monitor and investigate suspicious activity to identify and mitigate financial and cyber-enabled threats, including account takeover, phishing, malware, ransomware, and identity compromise

• Conduct comprehensive case investigations, including:

• Deep-dive analysis of data from detection tools, device fingerprinting systems, behavioral analytics, and internal/external reporting sources

• Correlation of fraud signals with cybersecurity indicators (e.g., IP anomalies, device spoofing, unusual login patterns)

• Validation of suspicious activity using internal systems, third-party tools, and threat intelligence sources

• Analysis of transaction activity to identify indicators of fraud such as unauthorized payments, account takeover-related disbursements, anomalous transaction patterns, and potential money movement risks

• Produce clear, concise, and well-documented investigative reports summarizing findings, evidence, risk assessments, and recommended actions

Client & Stakeholder Communication

• Communicate confidently with clients via email and phone regarding unusual or confirmed fraudulent/cyber activity, including gathering details and providing updates

• Maintain strict confidentiality and integrity of sensitive information throughout investigations

• Collaborate with internal and external partners to complete investigations, document processes, and identify opportunities for improvement Process Improvement & Strategy

• Identify gaps in fraud and cybersecurity controls, systems, and policies; recommend enhancements to mitigate emerging threats

• Support PINS and key stakeholder groups including Enterprise Fraud, Information Security (Infosec), Compliance, Payment Operations, and Treasury to support investigations and risk mitigation efforts

• Assist in the development and refinement of fraud and cyber detection strategies, including rules, alerts, and monitoring frameworks

What you'll bring to Zelis:

• Bachelor's degree

• 3+ years of experience as a Fraud Analyst, Fraud Investigator, or in a combined Fraud/Cybersecurity role

• Industry experience in financial institutions, fintech, or payments companies required; healthcare payments experience preferred

• Strong knowledge of fraud schemes, cyber threats (e.g., phishing, malware, ransomware), and prevention/detection methodologies

• Familiarity with device fingerprinting, behavioral analytics, and digital identity verification technologies

• Experience leveraging fraud detection tools, case management systems, and threat intelligence platforms

• Strong investigative report writing skills, with the ability to clearly document complex findings and present actionable insights

• Analytical and detail-oriented mindset with strong problem-solving capabilities

• Ability to challenge the status quo and contribute to continuous improvement of fraud and cybersecurity strategies

• Foundational knowledge of SQL (Snowflake, Microsoft SSMS), a plus

• Certified Fraud Examiner (CFE), or similar certifications are a plus

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.