Senior Fraud Risk Analyst & Internal Audit Advisor

Blue Shield of CA; Oakland (CA); Hybrid; USD 110,000 - 170,000; 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 fraud detection activities, and business advisory efforts focused on preventing, identifying, and remediating fraud risk across the enterprise.

You will partner with auditors, compliance, business leaders, data analytics teams, legal, HR, finance, claims, procurement and technology to identify fraud scenarios, evaluate controls, and develop

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, evaluate control design and operating effectiveness.
• Advise on anti-fraud control enhancements, and develop practical detection strategies across the enterprise.
• Support internal audits, proactive fraud detection activities, and business advisory efforts.
• Collaborate with auditors, compliance partners, business leaders, data analytics, legal, HR, finance, claims, procurement, and technology stakeholders.

Skills

Fraud risk

Audit testing

Data analytics

Root cause analysis

Professional skepticism

Communication skills

Internal controls

Audit standards

SQL

Python

Education

Bachelor's degree

Tools

SQL

Python

Excel

Tableau

Power BI

Job description

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 focused on preventing, identifying, and remediating fraud risk across the enterprise.

You will partner with auditors, compliance, business leaders, data analytics teams, legal, HR, finance, claims, procurement and technology to identify fraud scenarios, evaluate controls, and develop