Fraud Examiners, Investigators and Analysts

**Why USAA?**

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.

**The Opportunity**

As a dedicated **, Fraud Prevention and Detection Specialist Intermediate-C** **onsumer Loan** you will within defined guidelines and framework, apply basic analytical skills on high risk financial and non-financial transactions to detect and prevent fraudulent activities for a wide range of enterprise financial products and services. Reviews and responds to suspected fraudulent service requests, queues, and transaction records to identify potentially fraudulent transactions or accounts. Identifies problems and issues by performing relevant research using the appropriate tools and by following established procedures.

We offer a flexible work environment that requires an individual to be **in the office 4 days per week** **.** This position can be based in one of the following locations: San Antonio, TX, Phoenix, AZ, or Tampa Crosstown, FL. Relocation assistance is **not** available for this position.

**Work Schedule:** **T** **uesday-Sa** **turday or Sunday-Thursday 7am-8 pm CS** **T**

**What** **you'll** **do:**

+ Demonstrates a variety of fraud management tools and systems and applies proficient knowledge to identify and investigate suspicious financial and non-financial activity on a wide range of products and services.

+ Effectively initiates contact with members to review suspicious activity; and if vital, take appropriate actions to mitigate the risk and protect the member's assets.

+ Possesses multi product, system, and/or process knowledge and effectively uses it to prevent, detect and mitigate fraudulent activity across multiple products and services.

+ Effectively applies appropriate tools and procedures to report confirmed fraud and associated trends.

+ Applies foundational knowledge of the business, its products, and processes and provides improvement opportunities and recommended solutions to improve the effectiveness or efficiency of fraud prevention and detection.

+ Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

**What you have:**

+ High School Diploma or General Equivalency Diploma required.

+ 1 year of fraud prevention/detection experience in a financial services environment.

+ Experience working with Fraud Case Management Tools/Systems.

+ Working knowledge of bank operations, fraudulent review, and regulations that relate to funds availability, check kiting and check fraud.

+ General knowledge of REG CC, REG E, or REG Z Certificates and Designations Association of Certified Fraud Examiners (ACFE) preferred fraudulent activities for a wide range of enterprise financial products and services.

+ Strong attention to detail and high concern for data privacy and accuracy.

+ Customer service orientation with developed analytical and problem-solving skills.

+ Developing knowledge of Microsoft Office products.

+ Knowledge of federal laws, rules, and regulations to include Reg CC, Reg E

**What sets you apart:**

+ 2 years’ experience Consumer Loan fraud prevention/detection and identifying fraud type.

+ Experience with the following types of fraud; ID Theft, First Party fraud and Account Takeover. (text)

+ 2 years’ customer service experience in a financial institution.

+ Have a Certificate and Designations Association of Certified Fraud Examiners.

**Compensation range:** The salary range for this position is: $43,680 - $53,450 **.**

**USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). **

**Compensation:** USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

**Benefits:** At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on USAAjobs.com

_Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting._

_USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran._

**If you are an existing USAA employee, please use the internal career site in OneSource to apply.**

**Please do not type your first and last name in all caps.**

**_Find your purpose. Join our mission._**

USAA is unlike any other financial services organization. The mission of the association is to facilitate the financial security of its members, associates and their families through provision of a full range of highly competitive financial products and services; in so doing, USAA seeks to be the provider of choice for the military community. We do this by upholding the highest standards and ensuring that our corporate business activities and individual employee conduct reflect good judgment and common sense, and are consistent with our core values of service, loyalty, honesty and integrity.

USAA attributes its long-standing success to its most valuable resource: our 35,000 employees. They are the heart and soul of our member-service culture. When you join us, you'll become part of a thriving community committed to going above for those who have gone beyond: the men and women of the U.S. military, their associates and their families. In order to play a role on our team, you don't have to be connected to the military yourself – you just need to share our passion for serving our more than 13 million members.

USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

California applicants, please review our HR CCPA - Notice at Collection (https://statmcstg.usaa.com/mcontent/static\_assets/Media/enterprise\_hr\_cpra\_notice\_at\_collection.pdf) here.

USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

**JOB DESCRIPTION**

**Job Summary**

The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely turn around. This position ensures adherence to state and federal policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment recovery.

**KNOWLEDGE/SKILLS/ABILITIES**

+ Reviews post pay claims with corresponding medical records to determine accuracy of claims payments.

+ Review of applicable policies, CPT guidelines, and provider contracts.

+ Devise clinical summary post review.

+ Communicate and participate in meetings related to cases.

+ Critical thinking, problem solving and analytical skills.

+ Ability to prioritize and manage multiple tasks.

+ Proven ability to work in a team setting.

+ Excellent oral and written communication skills and presentation skills.

**JOB QUALIFICATIONS**

**Required Education**

High School Diploma / GED (or higher)

**Required Experience**

+ 3+ years CPT coding experience (surgical, hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location

+ Thorough knowledge of PC based software including Microsoft Word (edit/save documents) and Microsoft Excel (edit/save spreadsheets, sort/filter)

**Required License, Certification, Association**

Licensed registered nurse (RN), Licensed practical nurse (LPN) and/or Certified Coder (CPC, CCS, and/or CPMA)

**Preferred Education**

Bachelor's degree (or higher)

**Preferred Experience**

+ 2+ years of experience working in the group health business preferred, particularly within claims processing or operations.

+ A demonstrated working knowledge of Local, State & Federal laws and regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.)

+ Experience with UNET, Comet, Macess/CSP, or other similar claims processing systems.

+ Demonstrated ability to use MS Excel/Access platforms working with large quantities of data to answer questions or identify trends and patterns, and the ability to present those findings.

**Preferred License, Certification, Association**

+ AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred

+ Certified Fraud Examiner and/or AHFI professional designations preferred

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.82 - $51.06 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**JOB DESCRIPTION**

**Job Summary**

The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely turn around. This position ensures adherence to state and federal policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment recovery.

**KNOWLEDGE/SKILLS/ABILITIES**

+ Reviews post pay claims with corresponding medical records to determine accuracy of claims payments.

+ Review of applicable policies, CPT guidelines, and provider contracts.

+ Devise clinical summary post review.

+ Communicate and participate in meetings related to cases.

+ Critical thinking, problem solving and analytical skills.

+ Ability to prioritize and manage multiple tasks.

+ Proven ability to work in a team setting.

+ Excellent oral and written communication skills and presentation skills.

**JOB QUALIFICATIONS**

**Required Education**

High School Diploma / GED (or higher)

**Required Experience**

+ 3+ years CPT coding experience (surgical, hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location

+ Thorough knowledge of PC based software including Microsoft Word (edit/save documents) and Microsoft Excel (edit/save spreadsheets, sort/filter)

**Required License, Certification, Association**

Licensed registered nurse (RN), Licensed practical nurse (LPN) and/or Certified Coder (CPC, CCS, and/or CPMA)

**Preferred Education**

Bachelor's degree (or higher)

**Preferred Experience**

+ 2+ years of experience working in the group health business preferred, particularly within claims processing or operations.

+ A demonstrated working knowledge of Local, State & Federal laws and regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.)

+ Experience with UNET, Comet, Macess/CSP, or other similar claims processing systems.

+ Demonstrated ability to use MS Excel/Access platforms working with large quantities of data to answer questions or identify trends and patterns, and the ability to present those findings.

**Preferred License, Certification, Association**

+ AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred

+ Certified Fraud Examiner and/or AHFI professional designations preferred

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.82 - $51.06 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**JOB DESCRIPTION**

**Job Summary**

The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely turn around. This position ensures adherence to state and federal policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment recovery.

**KNOWLEDGE/SKILLS/ABILITIES**

+ Reviews post pay claims with corresponding medical records to determine accuracy of claims payments.

+ Review of applicable policies, CPT guidelines, and provider contracts.

+ Devise clinical summary post review.

+ Communicate and participate in meetings related to cases.

+ Critical thinking, problem solving and analytical skills.

+ Ability to prioritize and manage multiple tasks.

+ Proven ability to work in a team setting.

+ Excellent oral and written communication skills and presentation skills.

**JOB QUALIFICATIONS**

**Required Education**

High School Diploma / GED (or higher)

**Required Experience**

+ 3+ years CPT coding experience (surgical, hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location

+ Thorough knowledge of PC based software including Microsoft Word (edit/save documents) and Microsoft Excel (edit/save spreadsheets, sort/filter)

**Required License, Certification, Association**

Licensed registered nurse (RN), Licensed practical nurse (LPN) and/or Certified Coder (CPC, CCS, and/or CPMA)

**Preferred Education**

Bachelor's degree (or higher)

**Preferred Experience**

+ 2+ years of experience working in the group health business preferred, particularly within claims processing or operations.

+ A demonstrated working knowledge of Local, State & Federal laws and regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.)

+ Experience with UNET, Comet, Macess/CSP, or other similar claims processing systems.

+ Demonstrated ability to use MS Excel/Access platforms working with large quantities of data to answer questions or identify trends and patterns, and the ability to present those findings.

**Preferred License, Certification, Association**

+ AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred

+ Certified Fraud Examiner and/or AHFI professional designations preferred

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.82 - $51.06 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**JOB DESCRIPTION**

**Job Summary**

The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely turn around. This position ensures adherence to state and federal policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment recovery.

**KNOWLEDGE/SKILLS/ABILITIES**

+ Reviews post pay claims with corresponding medical records to determine accuracy of claims payments.

+ Review of applicable policies, CPT guidelines, and provider contracts.

+ Devise clinical summary post review.

+ Communicate and participate in meetings related to cases.

+ Critical thinking, problem solving and analytical skills.

+ Ability to prioritize and manage multiple tasks.

+ Proven ability to work in a team setting.

+ Excellent oral and written communication skills and presentation skills.

**JOB QUALIFICATIONS**

**Required Education**

High School Diploma / GED (or higher)

**Required Experience**

+ 3+ years CPT coding experience (surgical, hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location

+ Thorough knowledge of PC based software including Microsoft Word (edit/save documents) and Microsoft Excel (edit/save spreadsheets, sort/filter)

**Required License, Certification, Association**

Licensed registered nurse (RN), Licensed practical nurse (LPN) and/or Certified Coder (CPC, CCS, and/or CPMA)

**Preferred Education**

Bachelor's degree (or higher)

**Preferred Experience**

+ 2+ years of experience working in the group health business preferred, particularly within claims processing or operations.

+ A demonstrated working knowledge of Local, State & Federal laws and regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.)

+ Experience with UNET, Comet, Macess/CSP, or other similar claims processing systems.

+ Demonstrated ability to use MS Excel/Access platforms working with large quantities of data to answer questions or identify trends and patterns, and the ability to present those findings.

**Preferred License, Certification, Association**

+ AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred

+ Certified Fraud Examiner and/or AHFI professional designations preferred

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.82 - $51.06 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**JOB DESCRIPTION**

**Job Summary**

The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely turn around. This position ensures adherence to state and federal policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment recovery.

**KNOWLEDGE/SKILLS/ABILITIES**

+ Reviews post pay claims with corresponding medical records to determine accuracy of claims payments.

+ Review of applicable policies, CPT guidelines, and provider contracts.

+ Devise clinical summary post review.

+ Communicate and participate in meetings related to cases.

+ Critical thinking, problem solving and analytical skills.

+ Ability to prioritize and manage multiple tasks.

+ Proven ability to work in a team setting.

+ Excellent oral and written communication skills and presentation skills.

**JOB QUALIFICATIONS**

**Required Education**

High School Diploma / GED (or higher)

**Required Experience**

+ 3+ years CPT coding experience (surgical, hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location

+ Thorough knowledge of PC based software including Microsoft Word (edit/save documents) and Microsoft Excel (edit/save spreadsheets, sort/filter)

**Required License, Certification, Association**

Licensed registered nurse (RN), Licensed practical nurse (LPN) and/or Certified Coder (CPC, CCS, and/or CPMA)

**Preferred Education**

Bachelor's degree (or higher)

**Preferred Experience**

+ 2+ years of experience working in the group health business preferred, particularly within claims processing or operations.

+ A demonstrated working knowledge of Local, State & Federal laws and regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.)

+ Experience with UNET, Comet, Macess/CSP, or other similar claims processing systems.

+ Demonstrated ability to use MS Excel/Access platforms working with large quantities of data to answer questions or identify trends and patterns, and the ability to present those findings.

**Preferred License, Certification, Association**

+ AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred

+ Certified Fraud Examiner and/or AHFI professional designations preferred

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.82 - $51.06 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**About this role:**

Wells Fargo is seeking a Product Manager who will be responsible for defining and executing strategies to combat internal fraud within our organization. Utilizing the Agile methodology and Scrum framework, they will lead cross-functional teams to develop solutions that align with our business objectives, regulatory requirements, and customer needs. This role will be accountable for helping our Enterprise Internal Fraud team with leading safeguards against internal fraud within our institution, fostering a culture of transparency and trust. Our innovative fraud detection product will leverage advanced data & analytics and case management workflow solutions to proactively identify suspicious activities, empowering our employees to uphold the integrity of our operations.

**In this role, you will:**

+ Defining and articulate the product vision and strategy to align with organizational goals, focusing on reducing internal fraud risks.

+ Collaborate with product designers to ensure solutions meet business and customer needs with a focus on usability and desirability.

+ Engage in research to anticipate market trends, customer needs, and prioritize product features accordingly

+ Manage product budgets to address priorities, ensuring optimal resource allocation for maximum value.

+ Utilize Agile practices to drive product development, ensuring timely delivery and continuous improvement.

+ Lead the product team in developing solutions that enhance our internal fraud detection capabilities while maintaining cost efficiency.

+ Ensure compliance with regulatory and policy requirements, managing risk through product design.

+ Foster a culture of innovation, proactive problem-solving, and customer-centric product development.

+ Maintain strong partnerships across other teams to ensure seamless integration and execution of product strategies.

+ Continuously monitor and adjust product roadmaps to reflect changes in fraud patterns, technology, and business needs

**Required Qualifications:**

+ 6+ years of Product Management, product development, strategic planning, process management, change delivery, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education

+ 3+ years of management or leadership experience

**Desired Qualifications:**

+ 6 + years of Website or Application Design experience

+ Experience with human-centered design principles and strong risk management leadership skills.

+ Proficiency in Agile methodology and frameworks like Kanban and Scrum, along with experience in tools like Confluence and JIRA.

+ Strong dependency management skills and ability to communicate effectively at all organizational levels.

+ Proven track record in driving organizational change and influencing within a matrixed environment.

+ Recognized as a thought leader in product management with a focus on fraud prevention.

**Job Expectations:**

· Ability travel 10% of the time

· Hybrid role, 3 days in the office, 2 remote

**Posting End Date:**

22 Jun 2025

**_*Job posting may come down early due to volume of applicants._**

**We Value Equal Opportunity**

Wells Fargo is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other legally protected characteristic.

Employees support our focus on building strong customer relationships balanced with a strong risk mitigating and compliance-driven culture which firmly establishes those disciplines as critical to the success of our customers and company. They are accountable for execution of all applicable risk programs (Credit, Market, Financial Crimes, Operational, Regulatory Compliance), which includes effectively following and adhering to applicable Wells Fargo policies and procedures, appropriately fulfilling risk and compliance obligations, timely and effective escalation and remediation of issues, and making sound risk decisions. There is emphasis on proactive monitoring, governance, risk identification and escalation, as well as making sound risk decisions commensurate with the business unit’s risk appetite and all risk and compliance program requirements.

Candidates applying to job openings posted in Canada: Applications for employment are encouraged from all qualified candidates, including women, persons with disabilities, aboriginal peoples and visible minorities. Accommodation for applicants with disabilities is available upon request in connection with the recruitment process.

**Applicants with Disabilities**

To request a medical accommodation during the application or interview process, visit Disability Inclusion at Wells Fargo (https://www.wellsfargojobs.com/en/diversity/disability-inclusion/) .

**Drug and Alcohol Policy**

Wells Fargo maintains a drug free workplace. Please see our Drug and Alcohol Policy (https://www.wellsfargojobs.com/en/wells-fargo-drug-and-alcohol-policy) to learn more.

**Wells Fargo Recruitment and Hiring Requirements:**

a. Third-Party recordings are prohibited unless authorized by Wells Fargo.

b. Wells Fargo requires you to directly represent your own experiences during the recruiting and hiring process.

**Req Number:** R-452748

Description

The Special Projects & Investigations team is looking for an experienced, motivated industry specialist with background in risk, digital fraud, compliance, or cyber investigations who also have advanced data analysis skills (SQL, Python, Machine Learning, Data Science). This role will manage critical and high impact projects and scale their findings through technology and analytics to interpret risks across Amazon’s entire business segment or apply other industry experience to develop feasible, systematic solutions to endemic problems.

The Customer Trust (CT) organization's mission is to keep Amazon stores safe and trustworthy for our buyers, brands and selling partners, by enabling our selling partners to provide great CX while ensuring bad actors are kept out of our stores. The Special Projects & Investigations (SPI) team protects Amazon’s WW stores store by creating projects and programs focused on the detection of abuse at its earliest point and identifying the root causes, vulnerabilities or exploits to systematically address to prevent future abuse. We search out highly skilled candidates who move fast, have an entrepreneurial spirit to create new solutions, a tenacity to get things done, thrive in an environment of ambiguity and change, and are capable of breaking down and solving complex problems. We value individual expression, respect different opinions, and work together to create a culture where each of us is able to contribute fully. The combination of our unique backgrounds and perspectives strengthens our ability to achieve Amazon's mission of being Earth's most customer-centric company.

We catch bad actors and stop online fraud. It’s fun. It’s hard. It matters. We are passionate about protecting our selling partners and customers from bad actors and want a candidate that shares that passion. Amazon is one of the world’s most trusted companies. Help us keep it that way. To achieve this, the ideal candidate should be passionate about use of advanced data analytics and technology approaches to identify patterns and establish connections to uncover process and technology gaps and prevent fraud across Amazon stores worldwide. Your decisions are not only fundamental to helping protect customers and selling partners but will help maintain the health of Amazon’s catalog and product listings ecosystem.

Key job responsibilities

• Complete risk analyses and manipulate data in complex data sets (SQL, Python, R etc.)

• Use high-level judgment to inform our most complex enforcement decisions

• Identify gaps and risks in Amazon's current mechanisms and policies and recommend solutions to product/policy owning teams.

• Use data and/or technical skills to discover new ways to scale deep dive signals resulting in the identification of many bad actors and sizing the issue

• Owning the complete life cycle of one or more complex problems - from identification through scaling the solutions

• Break problems into manageable pieces, ruthlessly prioritizing, and delivering results in an ambiguous environment

• Conduct large scale deep dives to derive insights about tactics used to conduct abuse on our stores, identifying gaps and risk in Amazon's current mechanisms, systems, and policies

• Write documents for partner teams and executives that identify problems, propose technical solutions, and drive alignment among stakeholders

• Own partnerships with stakeholder teams and guide appropriate trade-offs, clearly communicate goals, roles and responsibilities.

A day in the life

Your day might involve diving deep into data to uncover emerging fraud patterns, collaborating with teams across Amazon to implement protective solutions, or developing new detection methods. You'll balance independent analytical work with team collaboration, sharing insights and supporting colleagues in our shared mission.

About the team

Our team is comprised of practitioners of fraud and abuse, working to understand bad actor ecosystems using threat intelligence analytics and technical skills. We complement specialized industry skills with broad risk experiences, to deliver results - we wear a lot of hats and take ownership of hard to solve problem areas whenever possible. We speak 12 languages, write code in 3 (mostly self-taught, on the job), and celebrate learning and taking risks. We encourage experimentation and curiosity while supporting each other to constantly learn and grow.

Our work is to solve hard puzzles and identify what hasn’t already been discovered - typically with data and always with a lot persistence and curiosity. If you like the sound of that, come join us.

Basic Qualifications

• Bachelor’s or postgraduate degree in Information Security, Computer Science, Data Science/Analytics, Engineering, Mathematics, Statistics or related discipline.

• 3+ years of relevant industry experience in risk or fraud investigations, regulatory compliance, ecommerce, analytics, or security

• Proficient with deriving insights from big data using SQL & experience manipulating/processing data with Python

• Proven ability to deliver complex projects across multiple teams

Preferred Qualifications

• Experience working in e-commerce organizations

• Experience working within fraud, compliance, law enforcement, or intelligence organizations

• Experience with AWS services like Redshift, Neptune or Sagemaker

• Masters degree in or practical experience with data science or machine learning

• Excellent written and verbal communication skills to communicate security and business risk to a broad range of technical and non-technical audiences.

• High level of integrity and discretion to handle confidential information.

• Exceptional ownership and bias for action: willing to move quickly and decisively

• Proven ability to problem solve in large/complex/technical systems

Amazon is an equal opportunity employer and does not discriminate on the basis of protected veteran status, disability, or other legally protected status.

Our inclusive culture empowers Amazonians to deliver the best results for our customers. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process, including support for the interview or onboarding process, please visit https://amazon.jobs/content/en/how-we-hire/accommodations for more information. If the country/region you’re applying in isn’t listed, please contact your Recruiting Partner.

Our compensation reflects the cost of labor across several US geographic markets. The base pay for this position ranges from $91,800/year in our lowest geographic market up to $196,300/year in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on job-related knowledge, skills, and experience. Amazon is a total compensation company. Dependent on the position offered, equity, sign-on payments, and other forms of compensation may be provided as part of a total compensation package, in addition to a full range of medical, financial, and/or other benefits. For more information, please visit https://www.aboutamazon.com/workplace/employee-benefits . This position will remain posted until filled. Applicants should apply via our internal or external career site.

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

**Position Summary**

The Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends.

Activities include:

- Conduct a comprehensive medical record review to ensure billing is consistent with medical record.

- Provide detailed written summary of medical record review findings.

- Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.

- Review and discuss cases with Medical Directors to validate decisions.

- Assist with investigative research related to coding questions, state and federal policies.

- Identify potential billing errors, abuse, and fraud.

- Identify opportunities for savings related to potential cases which may warrant a prepayment review.

- Maintain appropriate records, files, documentation, etc.

- Ability to travel for meetings and potential to testify

**Required Qualifications**

- AAPC Coding certification - Certified Professional Coder (CPC)

- 3+ years of experience in medical coding or documentation auditing.

- Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements

- Experience with researching coding, state regulations and policies.

- Working experience with Microsoft Excel

**Preferred Qualifications**

- 2 years or more previous experience with Behavioral Health coding/auditing of records

- Licensed Clinical Social Worker (LCSW)

- Licensed Independent Social Worker (LISW)

- Licensed Master Social Worker (LMSW)

- Prior auditing experience

- Excellent analytical skills

- Strong attention to detail and ability to review and interpret data

- Excellent communication skills

**Education**

- GED or equivalent

- AAPC Certified Professional Coder Certification (CPC)

**Anticipated Weekly Hours**

40

**Time Type**

Full time

**Pay Range**

The typical pay range for this role is:

$43,888.00 - $102,081.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

**Great benefits for great people**

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .

+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 07/11/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Data Scientist II - Fraud Prevention and Detection

Charlotte, North Carolina;Plano, Texas; Richmond, Virginia; Fort Worth, Texas; New York, New York; Boston, Massachusetts; Chandler, Arizona; Tampa, Florida; Kennesaw, Georgia; Jacksonville, Florida; Newark, Delaware; Phoenix, Arizona

**Job Description:**

At Bank of America, we are guided by a common purpose to help make financial lives better through the power of every connection. We do this by driving Responsible Growth and delivering for our clients, teammates, communities and shareholders every day.

Being a Great Place to Work is core to how we drive Responsible Growth. This includes our commitment to being an inclusive workplace, attracting and developing exceptional talent, supporting our teammates’ physical, emotional, and financial wellness, recognizing and rewarding performance, and how we make an impact in the communities we serve.

Bank of America is committed to an in-office culture with specific requirements for office-based attendance and which allows for an appropriate level of flexibility for our teammates and businesses based on role-specific considerations.

At Bank of America, you can build a successful career with opportunities to learn, grow, and make an impact. Join us!

**Job Summary:**

This job is responsible for performing more complex analysis aimed at improving portfolio risk, profitability, performance forecasting, and operational performance for consumer products and related divisions, such as credit cards. Key responsibilities include applying knowledge of multiple business and technical-related topics and independently driving strategic improvements, large-scale projects, and initiatives. Job expectations include working with business counterparts within the Line of Business and partner organizations including Risk and Product teams.

Fraud Prevention and Detection is looking for an energetic and inquisitive experienced data scientist to join our team and help us combat financial crime using graph databases. In this role, you will be expected to work on large and complex data scienceprojects. Collaboratingwith internal strategy, technology, product, and policy partners to deploy advanced analytical solutions with the goal of reducing fraud losses, lowering false positive impacts, improving client experience, and ensuring the Bank minimizes its total cost of fraud.

**Responsibilities:**

+ Link Analysis/Graph analytics to find and mitigate densely connected fraud networks.

+ Developing and tuning graph algorithms to maximize detection of fraud.

+ Work with software developers to create/enhance link analysis process for new fraud detection use cases, and assist with the generation, prioritization, and investigation of fraud rings.

+ Coordinate with stakeholders and tech to deliver process end-to-end, be the gate keeper for issue tracking and remediation.

+ Gather business requirements and translate to technical logic for script development, and design, create and monitor daily report/QA metrics for fraud detection process.

+ Document and prepare attestation response for process and fraud strategy with governance team.

+ Identify, track, and recommend opportunities for process improvement.

+ Coach and mentor peers to improve proficiency in a variety of systems and serve as a subject matter expert on multiple business and technical-related topics.

+ Identify business trends based on economic and portfolio conditions and communicate findings to senior management.

+ Support execution of large-scale projects, such as platform conversions or new project integrations by conducting advanced reporting and drawing analytics-based insights.

**Required Qualifications:**

+ 5+ years of experience in data and analytics is required.

+ Must be proficient with SQL and one of SAS, Python, or Java

+ Critical problem-solving skills including selection of data and deployment of solutions.

+ Proven ability to manage projects, exercise thought leadership and work with limited direction on complex problems to achieve project goals while also leading a broader team.

+ Excellent communication and influencing skills.

+ Thrives in fast-paced and highly dynamic environment.

+ Intellectual curiosity and strong urge to figure out the “whys” of a problem and come up with creative solutions.

+ Model development experience leveraging supervised and unsupervised machine learning (regression, tree-based algorithms, neural networks)

+ Expertise handling and manipulating data across its lifecycle in a variety of formats, sizes, and storage technologies to solve a problem (e.g., structured, semi-structured, unstructured; graph; hadoop; kafka)

**Desired Qualifications:**

+ Advanced Quantitative degree (Masters or PhD)

+ 7+ years of experience; work in financial services is very helpful, with preference to fraud, credit, cybersecurity, or other heavily quantitative areas.

+ Understanding of advanced machine learning methodologies including neural networks, ensemble learning like XGB, and other techniques

+ Proficient with H2O or similar advanced analytical tools

**Skills:**

+ Analytical Thinking

+ Business Analytics

+ Data and Trend Analysis

+ Fraud Management

+ Problem Solving

+ Collaboration

+ Innovative Thinking

+ Monitoring, Surveillance, and Testing

+ Presentation Skills

+ Risk Management

+ Data Visualization

+ Interpret Relevant Laws, Rules, and Regulations

+ Issue Management

+ Oral Communications

+ Written Communications

**Shift:**

1st shift (United States of America)

**Hours Per Week:**

40

Bank of America and its affiliates consider for employment and hire qualified candidates without regard to race, religious creed, religion, color, sex, sexual orientation, genetic information, gender, gender identity, gender expression, age, national origin, ancestry, citizenship, protected veteran or disability status or any factor prohibited by law, and as such affirms in policy and practice to support and promote the concept of equal employment opportunity, in accordance with all applicable federal, state, provincial and municipal laws. The company also prohibits discrimination on other bases such as medical condition, marital status or any other factor that is irrelevant to the performance of our teammates.

To view the "Know your Rights" poster, CLICK HERE (https://www.eeoc.gov/sites/default/files/2023-06/22-088\_EEOC\_KnowYourRights6.12.pdf) .

View the LA County Fair Chance Ordinance (https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf) .

Bank of America aims to create a workplace free from the dangers and resulting consequences of illegal and illicit drug use and alcohol abuse. Our Drug-Free Workplace and Alcohol Policy (“Policy”) establishes requirements to prevent the presence or use of illegal or illicit drugs or unauthorized alcohol on Bank of America premises and to provide a safe work environment.

To view Bank of America’s Drug-free Workplace and Alcohol Policy, CLICK HERE .

Bank of America is committed to an in-office culture with specific requirements for office-based attendance and which allows for an appropriate level of flexibility for our teammates and businesses based on role-specific considerations. Should you be offered a role with Bank of America, your hiring manager will provide you with information on the in-office expectations associated with your role. These expectations are subject to change at any time and at the sole discretion of the Company. To the extent you have a disability or sincerely held religious belief for which you believe you need a reasonable accommodation from this requirement, you must seek an accommodation through the Bank’s required accommodation request process before your first day of work.

This communication provides information about certain Bank of America benefits. Receipt of this document does not automatically entitle you to benefits offered by Bank of America. Every effort has been made to ensure the accuracy of this communication. However, if there are discrepancies between this communication and the official plan documents, the plan documents will always govern. Bank of America retains the discretion to interpret the terms or language used in any of its communications according to the provisions contained in the plan documents. Bank of America also reserves the right to amend or terminate any benefit plan in its sole discretion at any time for any reason.