Fraud Business Analyst

Applies extensive knowledge the job skills, company policies and procedures to complete complex, specialized assignments/tasks in creative and effective ways. Comprehensive understanding of the general/technical aspects of the job. Works on assignments that are complex in nature and require considerable judgment, initiative, and technical/specialized knowledge to resolve problems and/or develop recommended solutions. Work is completed with minimal supervision and assignments may be completed without established procedures. May determine methods and procedures for new assignments. Typically provides guidance to other non- exempt employees.


  • Actively participates as a key member of the team, possibly in a team lead role.
  • Completes complex tasks and defined processes.
  • Suggests creative solutions.
  • Multiple complex assignments are worked and completed simultaneously with minimal input from leadership.
  • Identifies, prioritizes and resolves most questions and issues independently.
  • Answers questions of peers. Escalates more complex questions or issues appropriately.
  • Interpret and provides recommends for all and contract requirements, business rules and related industry and legal regulations.

Education and Experience

  • High School Diploma or equivalent; may hold 2 year post-high school Degree; may hold Bachelor’s degree.
  • Typically, 3-5 years of working experience in related fields.

Knowledge and Skills

  • Strong office experience and skills, possibly in a lead capacity.
  • Strong healthcare related knowledge.
  • Intermediate to Senior level knowledge of operating systems, and of software skills.
  • Ability to develop and document procedures.
  • Ability to research and resolve inquiries.
  • Ability to read and interpret moderately complex documents such as operating and maintenance instructions, procedure manuals, and government/healthcare guidelines.
  • Ability work on multiple assignments/issues with limited instructions from leadership.
  • Self-motivated with strong time management and organizational skills.
  • Excellent written and verbal communication skills and customer service skills, including professional telephone skills.

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