Carrier Operations Fraud Analyst

Independence Pet Group•Scottsdale, AZ

17h•Remote

About The Position

Independence Pet Holdings is seeking a Carrier Operations Fraud Analyst who will report to the Director, Carrier Operations. The Carrier Operations Fraud Analyst is responsible for managing and overseeing the Special Investigations Unit (SIU) program for IAIC and IPIC, ensuring compliance with state regulations and filed fraud plan. This role leads fraud investigations, coordinates reporting and required audits, and develops processes to detect and prevent fraudulent activity. The analyst collaborates with internal teams, administrators, and state regulators to maintain program integrity, drive continuous improvement, and support operational compliance.

Requirements

Bachelor’s degree in Business, Insurance, Criminal Justice, or related field preferred.
Minimum of 3 years of experience in insurance operations, fraud investigation, or compliance.
Strong understanding of insurance operations, regulatory standards, and compliance requirements.
Experience with state fraud reporting, audits, and fraud investigation.
Familiarity working with state investigators highly desirable.
Strong understanding of operations, insurance fraud detection, SIU requirements, and regulatory compliance.
Excellent investigative and analytical skills with attention to detail.
Strong organizational and project management abilities.
Ability to interpret and apply state regulations related to fraud and SIU programs.
Proficiency in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint).
Strong written and verbal communication skills; ability to present complex fraud cases clearly.

Nice To Haves

Claims and claims data analysis experience is a plus.
Experience developing workflows, processes, and training programs preferred.

Responsibilities

Lead fraud investigations of referrals; report referrals to regulatory bodies and assist state investigators with requests.
Manage annual SIU reporting requirements for the IPH carriers; submit reports to state regulatory bodies.
Collaborate with administrators to proactively detect fraud, analyze trends, and escalate emerging concerns.
Oversee SIU program operations, collaborate with Director of Carrier Operations and administrators to evaluate processes, workflows, and key risk indicators (KRIs).
Collaborate with DOI law enforcement on fraud investigations and case development.
Create and maintain monthly fraud reporting for carrier leadership.
Facilitate SIU Committee meetings; prepare agendas, present fraud referrals
Facilitate fraud meetings internally and with administrators; prepare agendas, share trends, schemes, and fraud activity.
Ensure completion of DOI-mandated annual fraud training for all SIU employees; manage distribution, follow-ups, certificate collection, and maintain logs for state submission.
Audit administrators and carrier employees annually to confirm fraud training adherence; work with HR and management to resolve gaps.
Maintain and update carrier fraud training programs to meet state requirements, coordinate scheduling and delivery with HR.
Build and maintain fraud-related workflows and handoffs between carrier and administrators.
Develop and maintain process documentation, procedures, and carrier guidelines; provide to states as needed.
Maintain and update fraud plans and organizational charts for carriers; ensure annual review and filing with states.
Create and manage documentation and logs for referrals and investigations.
Create notices and cancellation letters for policyholders and other required parties.
Conduct administrator audits to validate adherence to fraud processes, filed fraud plan and state requirements.
Collaborate with leadership to identify process improvements and drive efficiencies across fraud detection and reporting.
Provide backup support to other areas in the Carrier Operations department.
Performs other duties and responsibilities as assigned.