Carrier Operations Fraud Analyst in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Carrier Operations Fraud Analyst in the United States.

This role plays a key part in safeguarding the integrity of insurance operations by leading fraud detection, investigation, and reporting activities within a regulated environment. You will oversee Special Investigations Unit (SIU) processes, ensuring compliance with state regulations and internal fraud prevention standards. Working closely with internal teams, administrators, and regulatory bodies, you will help identify fraud trends, strengthen controls, and improve operational processes. The position combines investigative analysis, regulatory coordination, and cross-functional collaboration in a highly detail-oriented environment. You will also contribute to the continuous improvement of fraud detection systems and reporting frameworks across carrier operations. This is a remote role offering the opportunity to directly impact compliance, risk mitigation, and program integrity at scale.

• Lead fraud investigations, including case referrals, escalation, documentation, and coordination with regulatory agencies and state investigators.
• Manage Special Investigations Unit (SIU) reporting obligations, including preparation and submission of annual regulatory reports.
• Analyze fraud trends and collaborate with administrators to proactively detect and mitigate emerging risks.
• Oversee SIU program operations, ensuring alignment with fraud plans, workflows, and key risk indicators.
• Facilitate SIU and fraud committee meetings, preparing agendas, presenting cases, and communicating insights to leadership.
• Conduct audits of internal teams and external administrators to ensure compliance with fraud policies and regulatory requirements.
• Maintain fraud documentation, training records, workflows, and state filings, ensuring accuracy and compliance.

• Bachelor’s degree in Business, Insurance, Criminal Justice, or related field preferred.
• Minimum 3+ years of experience in insurance operations, fraud investigation, compliance, or SIU-related functions.
• Strong understanding of insurance regulations, fraud detection processes, and compliance frameworks.
• Experience with fraud reporting, investigations, audits, and interaction with state regulators or investigators.
• Strong analytical and investigative skills with high attention to detail and accuracy.
• Ability to interpret regulations and translate them into operational processes and workflows.
• Excellent communication skills with the ability to present complex findings clearly.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook).

• Comprehensive medical, dental, and vision insurance coverage.
• Fully paid short-term and long-term disability and basic life insurance.
• 12 weeks of fully paid parental leave.
• Health Savings Account (HSA) and Flexible Spending Accounts (FSA).
• Retirement savings plan and financial wellness support.
• Paid time off, paid holidays, and company wellness day.
• Volunteer paid time off and pet-friendly culture with group pet insurance options.
• Career development opportunities, on-the-job training, and skills advancement programs.