Fraud Detection Analyst, Senior

Blue Shield of California; California; Hybrid; USD 103,000 - 154,000; Full time

Job summary

Blue Shield of California is seeking an Internal Audit Fraud Advisor to serve as a fraud subject matter expert supporting internal audits, proactive detection activities, and business advisory efforts focused on preventing and remediating fraud risk across the enterprise.

You will partner with auditors, compliance, business leaders, data analytics, and other stakeholders to identify fraud risk, evaluate controls, and develop practical detection strategies that protect members, providers,

Qualifications

• Bachelor’s degree and 5+ years in internal audit, compliance, investigations, fraud risk management, or related field.
• Subject matter expertise in fraud risk, prevention, detection, control design, and audit testing.
• Ability to communicate fraud risk concepts clearly to audit teams, business partners, and leadership.
• Experience with data analysis, analytics tools, and cross-functional collaboration.

Responsibilities

• Provide fraud SME support during planning, walkthroughs, risk assessments, testing, root cause analysis, and reporting.
• Identify fraud risk considerations within audits of processes, systems, and third-party relationships.
• Perform proactive fraud detection using data analysis, pattern identification, anomaly review, and monitoring.
• Develop fraud scenarios, indicators, and detection logic for audit programs and dashboards.
• Advise on anti-fraud practices, control improvements, and monitoring approaches.
• Collaborate with audits, compliance, legal, HR, finance, IT, and leadership to assess risks and actions.
• Prepare workpapers, summaries, and executive-ready insights linking fraud risks to controls.

Skills

fraud risk

fraud prevention

fraud detection

control design

audit testing

investigation support

data analysis

communication

Education

Bachelor’s degree in Accounting/Finance/Business Administration/Criminal Justice/Data Analytics/Information Systems/Health Care Administration or related field

CFE certification preferred; CIA CPA CISA CAMS CHC or other credentials a plus

Tools

SQL

Python

Excel

Tableau

Power BI

Job description

Your Role

The Internal Audit Services team provides independent assurance, advisory insight, and fraud expertise to help Blue Shield of California strengthen governance, risk management, and internal controls. The Internal Audit Fraud Advisor will serve as a fraud subject matter expert supporting internal audits, proactive fraud detection activities, and business advisory efforts focused on preventing, identifying, and remediating fraud risk across the enterprise.

Job Description

Your Role

The Internal Audit Services team provides independent assurance, advisory insight, and fraud expertise to help Blue Shield of California strengthen governance, risk management, and internal controls. The Internal Audit Fraud Advisor will serve as a fraud subject matter expert supporting internal audits, proactive fraud detection activities, and business advisory efforts focused on preventing, identifying, and remediating fraud risk across the enterprise.

In this role, you will partner closely with auditors, compliance partners, business leaders, data analytics teams, legal, human resources, finance, claims, procurement, and technology stakeholders to identify fraud risk scenarios, evaluate control design and operating effectiveness, advise on anti-fraud control enhancements, and develop practical detection strategies that protect the company, members, providers, employees, and other stakeholders.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

In this role, you will:

• Support internal audit engagements by providing fraud subject matter expertise during planning, walkthroughs, risk assessments, control evaluation, testing, root cause analysis, and reporting
• Identify fraud risk considerations within audits of business processes, systems, third-party relationships, financial activities, claims operations, procurement, expense reimbursement, vendor management, and other enterprise functions
• Perform proactive fraud detection activities using data analysis, pattern identification, anomaly review, control-break analysis, and targeted monitoring to identify potential fraud, waste, abuse, misconduct, policy violations, or control weaknesses
• Develop and document fraud scenarios, indicators, typologies, detection logic, and control points that can be incorporated into audit programs, monitoring routines, dashboards, and business-owned controls
• Advise business units on anti-fraud practices, control improvements, prevention strategies, process changes, documentation expectations, and sustainable monitoring approaches
• Collaborate with Internal Audit, Compliance, Legal, HR, Finance, IT, and business leaders to assess fraud risks, triage observations, recommend corrective actions, and support management action plans
• Prepare clear, well-supported workpapers, summaries, recommendations, and executive-ready insights that connect fraud risks to controls, business impacts, and practical remediation opportunities
• Monitor emerging fraud schemes, regulatory expectations, industry trends, and internal risk signals to continuously improve fraud risk coverage and advisory support
• Maintain confidentiality, professional skepticism, independence, and sound judgment when handling sensitive fraud indicators, investigations support, personnel matters, and privileged or confidential information
• Support continuous improvement of Internal Audit fraud capabilities, including fraud risk assessment methodology, detection playbooks, control libraries, data-driven testing approaches, and knowledge sharing across audit teams

Qualifications

Your Knowledge and Experience

• Requires a Bachelor’s degree in Accounting, Finance, Business Administration, Criminal Justice, Data Analytics, Information Systems, Health Care Administration, or a related field; equivalent experience may be considered
• Requires a minimum of 5 years of professional experience in internal audit, compliance, investigations, fraud risk management, forensic accounting, enterprise risk management, or a related field; health care, insurance, financial services, or other highly regulated industry experience preferred
• Subject matter expertise in fraud risk, fraud prevention, fraud detection, control design, audit testing, investigation support, and root cause analysis
• Certified Fraud Examiner (CFE) certification preferred; CIA, CPA, CISA, CAMS, CHC, or other relevant audit, compliance, risk, investigations, or analytics credentials are a plus
• Demonstrated ability to evaluate business processes, identify fraud vulnerabilities, assess internal controls, and recommend practical control improvements that are business-aligned and sustainable
• Experience performing or supporting fraud risk assessments, audit planning, control testing, issue validation, data analysis, fraud analytics, or investigative case support
• Strong analytical skills, professional skepticism, attention to detail, and ability to connect disparate information into clear risk themes, hypotheses, and actionable findings
• Ability to communicate fraud risk concepts clearly to audit teams, business partners, and leadership through concise workpapers, reports, presentations, and advisory discussions
• Working knowledge of relevant audit standards, compliance expectations, ethics requirements, internal control frameworks, and fraud risk management leading practices
• Experience with data tools, reporting platforms, case management systems, audit management systems, SQL, Python, Excel, Tableau, Power BI, or similar analytics tools is preferred

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About Us

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

JOB INFO

Job Identification : 20261426

Job Category : Finance and Accounting

Posting Date : 2026-10-27T16:16:28+00:00

Job Schedule : Full time

Locations :

Oakland, CA, United States

CA, United States

Long Beach, CA, United States

El Dorado Hills, CA, United States

Rancho Cordova, CA, United States

San Diego, CA, United States

Woodland Hills, CA, United States

Pay Range for California : $102,740.00 to $154,220.00

Pay Range for Bay Area : $115,816.00 to $173,848.00

Note : Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

Role can be filled by a candidate requiring sponsorship : No