Fraud Detection Analyst, Senior

Blue Shield of California • Oakland, CA

10d

About The Position

Your Role The Internal Audit Services team oversees the insider threat detection and security intelligence program at Blue Shield of California. The Senior Developer Consultant will report to the Director of this program as a full-time employee. The individual in this position will partner closely with other team members in designing and deploying AI-powered fraud detection systems that safeguard our health insurance operations using the latest in software development techniques. You will work closely with auditors, data scientists, and compliance experts to build scalable, secure, and an intelligent fraud analytics infrastructure. 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 Your Work In this role, you will:

Requirements

• Requires a Bachelor’s degree in Computer Science, Data Science, or related field or equivalent experience
• Requires a minimum of 5 years of prior professional experience in Python development, preferably in fraud detection or audit analytics
• Hands-on experience training and deploying AI/ML models (OpenAI, LLaMA, HuggingFace, etc.)
• Strong understanding of CI/CD practices and containerization (Docker, GitHub Actions, Azure DevOps)

Nice To Haves

• Experience with internal audit, compliance, or fraud investigations is a strong plus

Responsibilities

• Design and implement Python-based fraud detection algorithms targeting internal fraud schemes (e.g., fictitious employees, kickbacks, claims abuse, financial reporting fraud)
• Train and deploy AI models using frameworks such as OpenAI, LLaMA, and others to perform text analysis using natural language processing, transaction analysis using claims data, and risk analysis for internal controls
• Build and maintain CI/CD pipelines for fraud analytics in a secure Linux environment
• Collaborate with IT, Talent Acquisition, Finance, and Claims teams to identify fraud use cases and automate detection workflows
• Manage data lakes, one-off files, and live connections to production data system from various claims, HR, finance and audit systems
• Develop dashboards and reporting tools using Tableau or similar platforms to visualize fraud detection results
• Ensure compliance with healthcare regulations, audit standards, and internal governance policies

What This Job Offers

• Job Type: Full-time
• Career Level: Senior