Analyst I - Fraud Mitigation

Date: Sep 23, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7717 

 

Position Summary/Position

 

Under the direction of the Accounting Manager, the Fraud Mitigation Analyst is responsible to act as the subject matter expert for Vendor/Provider fraud mitigation and prevention and to maintain the integrity of the data in Vendor Master. This position will ensure that all appropriate safeguards are up-to-date and being adhered to. The Fraud Mitigation Analyst will remain vigilant in seeking ongoing fraud identification and mitigation techniques and passing that information on to the accounting team and relevant IEHP business units.
The Fraud Mitigation Analyst will ensure internal controls/safeguards currently in place are consistently adhered to and will recommend changes, updates, and/or revisions to leadership as they are identified.

Major Functions (Duties and Responsibilities)

 

1. Act as the subject matter expert for fraud identification, mitigation, and prevention in the Accounting Department. 
2. Vigilantly seek fraud identification, mitigation, and prevention resources.  
3. Ensure the established internal controls and safeguards in place are being continually adhered to based on current fraud trends and resource recommendations. 
4. Identify and initiate improvements to current operational processes and procedures using LEAN principles.
5. Ensure Team Members are continually educated in fraud mitigation/prevention.
6. Ensure Team Members are adhering to established procedures and protocols to reduce the risk to IEHP and its Providers.
7. Report any indication of failure to follow approved processes to Finance leadership immediately. (See FIN/ACCT 23-Fraud Policy & FIN/ACCT 21-Vendor Financial Risk Management Policy).
8. Process TIN verifications to ensure IRS regulations are being followed.
9. Create and maintain vendor information in Oracle for all active vendors. (Active vendors are those paid in the last 18  months).
10. Ensure the established vendor maintenance policy regarding vendor deactivation and updating of W9’s annually is consistently followed.
11. Add and update Vendor/Provider financial information in both the Oracle and MediTrac systems as needed.
12. Establish and execute plans to meet tight deadlines, multi-task, and work under pressure while maintaining strong attention to detail and ensuring data integrity.
13. Establish strong working relationships with business units throughout IEHP. Work collaboratively to resolve issues, expedite requests, and provide high-quality customer service.
14. Prepare year end 1099’s by required federal deadlines for all software systems used.
15. Analyze information, provide data,  and run reports and metrics as requested.
16. Participate in initiatives and special projects as required.
17. Effectively communicate metrics to the accounting team and senior leadership.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Leading: Self

Experience Qualifications

 

Minimum three (3) years of experience in accounts payable/receivable, or vendor maintenance and ERP System experience required.

Preferred Experience

 

Oracle Fusion experience a plus. Previous healthcare experience preferred.

Education Qualifications

 

Bachelor’s degree from an accredited institution required.

Preferred Education

Professional Certification

 

One of the following certifications is required: 
1.    Institute of Financial Operations & Leadership (IFOL) certification CFPS-Vendor Masterfile Fraud Prevention Specialist 
2.    National Automated Clearing House Association (NACHA) certification-AAP-Accredited ACH Professional
3.    APRP-Accredited Payments Risk Professional


Other similar certifications may also be considered to meet this requirement. Pre-approval by Finance leadership is required.


Certifications must remain current and have been obtained within 12 months of the TMs hire date. As relevant certifications are identified, this position should work to obtain them to ensure that skillset remains up to date.

Professional Licenses

Drivers License Required

Yes, must have a valid California Driver's License.

Knowledge Requirement

 

Knowledge of available fraud education resources, best practices, and currently identified trends.

Skills Requirement

 

Intermediate Microsoft Office skills

Abilities Requirement

 

Must  be able to develop productive working relationships with Team Members both in and out of the accounting department as well as IEHP Vendors and Providers. Must be able to work independently, with little direction, prioritize tasks, and take strong initiative to meet established deadlines consistently. Strong attention to detail. Communicate effectively at all organizational levels (oral and written).
The position requires an energetic, hands-on individual who can embrace organizational change and work collaboratively with others.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

Standard-No unique working conditions.  

Work Model Location

Hybrid

Physical Requirements

Pushing/Pulling - 0 lbs-24 lbs - FREQUENTLY
Gross Manipulation - FREQUENTLY
Keyboarding: Traditional - CONSTANTLY
Keyboarding: 10-Key - CONSTANTLY
Use of computer mouse - CONSTANTLY
Carry/Lift 1-10 lbs - FREQUENTLY
Extension of the neck - CONSTANTLY
Flexion of the neck - CONSTANTLY
Twisting of the neck - CONSTANTLY
Bending - FREQUENTLY
Hearing: One-on-One - CONSTANTLY
Hearing: In a group - CONSTANTLY
Hearing: Over the Telephone/Cell Phone - FREQUENTLY
Hearing: Conference Speakers/Video Calls/Radio Calls - CONSTANTLY
Hearing: Other sounds - FREQUENTLY
Use hands/fingers to handle or feel - CONSTANTLY
Fine manipulation - CONSTANTLY
Simple Grasp - CONSTANTLY
Side to side motion of the wrist - CONSTANTLY
Turning/rotation of wrist or hand - CONSTANTLY
Communicate: Information/ideas verbally - CONSTANTLY
Communicate: Verbally engage with customer base - CONSTANTLY
Near Visual Acuity - CONSTANTLY
Peripheral Vision - CONSTANTLY
Alternate Sit/Stand or Walk at Will - CONSTANTLY
Sitting - CONSTANTLY
Indoors - CONSTANTLY
Lighting - CONSTANTLY
Perform complex and varied tasks - CONSTANTLY
Develop and maintain positive work relationships - CONSTANTLY
Adaptability: rate of change in work location - CONSTANTLY
Adaptability: rate of change in work tasks - CONSTANTLY
Regular contacts: co-workers, supervisor - CONSTANTLY
Regular contacts: recurring clients - CONSTANTLY
Other contacts: public exchange - CONSTANTLY
Other contacts:one-time clients - CONSTANTLY
Decision-making - FREQUENTLY
Work review - FREQUENTLY
Rapid Pace of work - FREQUENTLY
Control of work pace - FREQUENTLY
Problem Solving - CONSTANTLY
Memory - CONSTANTLY
Understand and follow direction - CONSTANTLY
Regular and reliable attendance - CONSTANTLY

A reasonable salary expectation is between $61,422.40  - $78,312.00, based upon experience and internal equity.

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 7,000 and a team of more than 2,500 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles