Fraud Manager, PINS

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.

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

The Fraud Manager, Payee Identification and Network Security will report to the Sr. Director that leads Zelis Payments’ Fraud and Identity Verification organization (known within Zelis as PINS). As the Fraud Manager, you will be responsible for overseeing fraud detection strategies, leading complex investigations, and enhancing fraud mitigation frameworks to protect the integrity of our payments and provider network. This role will manage a team that investigate suspicious activity and authenticate users on the Zelis payments network by ensuring that these resources are effectively prioritizing their work, removing roadblocks, and maintaining protocols and standard operating procedures. This leader will be highly analytical and proficient in database queries / analysis and can be hands-on in network monitoring activity. Additionally, you must be a skilled communicator with an executive presence, who is able to lead conversations with clients and summarize the teams’ activities to leadership.

What You’ll Do

• Lead the design and implementation of fraud prevention strategies for payment transaction, ACH enrollment, and provider verification.
• Oversee fraud investigations, root cause analyses, and escalations, ensuring timely and accurate resolution to mitigate loss.
• Steps in to resolve elevated issues brought forth by the PINS team; for example, escalations brought by the client services team, requests from partner banks or vendor partners.
• Analyze fraud patterns and operational data to identify emerging threats, recommend mitigations, working with relevant teams to support change.
• Effectively oversees the day-to-day operations and activities of the Fraud team; manages productivity and prioritization, helps overcome roadblocks, and monitors progress against team goals and effectively holds frequent 1-on-1’s.
• Cultivate a team of Fraud Analysts and Investigators, providing informal feedback on an ongoing basis and formal feedback in the annual performance review process to identify and develop talent.
• Writes and maintains PINS-related Policies and Standard Operating Procedures (SOPs), including protocols to investigate suspicious activities; ensures Payments policies and SOPs are aligned with Enterprise Fraud.
• Ensures alignment across stakeholders for PINS functions (e.g., robust communications process throughout the investigation of a Suspicious Activity, periodic readouts on performance of the Zelis Payments network).
• A strong sense of accountability and the ability to while working collaboratively across multiple departments supporting projects and initiatives driven by adjacent teams (e.g., Product, IT, Payment Operations, Legal) to enhance fraud prevention processes.
• Ability to influence others as well as being able to communicate effectively to all stakeholders involved in fraud and suspicious activity events including Legal, Compliance, IT, Product and effected parties (outside stakeholders).
• Support the development of metrics, reporting and Key Risk Indicators through dashboards, visualizations as well as supporting the development and integration of automations to improve manual processes, improve operating processes and reduce/eliminate gaps.

What You’ll Bring to Zelis

• 6+ Years of experience in fraud prevention, investigations, or risk management – preferably in payments, fintech, or healthcare.
• Proven expertise in fraud detection tools, behavioral analytics, and case management systems.
• Experience developing fraud rule logic and collaborating with product, engineering, and analytics teams.
• Knowledge of the principles, processes, procedures, and trends of fraud and fraud prevention.
• Proven track record of success in leading teams. For example, increased leadership responsibility of departments, people and projects.
• Strong analytical skills and ability to interpret large data sets to drive insights and decision-making.
• Exceptional communication and stakeholder managements skills; able to influence across levels presenting findings to executive and leadership teams and maintaining composure in high stakes situations.
• Sensitivity to confidentiality, demonstrated ability to adhere to Zelis Payments standards regarding privacy.
• Experience working with behavioral biometrics, device fingerprinting, or other advanced fraud detection technologies.
• Experience scaling fraud operations or building out programs in a fast-growth or start-up environment.
• SQL skills/experience is a plus.
• Relevant certifications a plus (i.e. CFE).

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.

Base Salary Range

$115,000.00 - $153,000.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

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

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.

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.