Fraud Detection Analyst, Senior

Blue Shield of CA; San Diego (CA); Hybrid; USD 140,000 - 190,000; Full time

Benefits offered by this job

Hybrid work model

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 fraud detection activities, and business advisory efforts across the enterprise.

You will partner with auditors, compliance, business leaders, data analytics, legal, HR, finance, claims, procurement, and technology to identify fraud risks, evaluate controls, and recommend practical improvements that protect members, providers, employees, and

Qualifications

• 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 credentials are a plus
• Demonstrated ability to evaluate business processes, identify fraud vulnerabilities, assess internal controls, and recommend practical control improvements
• Experience with data tools, reporting platforms, case management systems, SQL, Python, Excel, Tableau, Power BI or similar analytics tools is preferred

Responsibilities

• Identify fraud risk scenarios and evaluate control design and operating effectiveness
• Advise on anti-fraud control enhancements and develop practical detection strategies
• Collaborate with auditors, compliance, business leaders, data analytics, and technology stakeholders
• Support proactive fraud detection activities and remediation across the enterprise

Skills

Analytical skills

Professional skepticism

Attention to detail

Clear communication

Risk assessment

Education

Bachelor's degree in Accounting/Finance/Business Administration

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.

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.

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.