Fraud Detection Analyst, Senior

Blue Shield of California•Oakland, CA

4h•$102,740 - $173,848•Hybrid

About The Position

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 Fraud Detection Analyst serves 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. The role partners with auditors, compliance partners, business leaders, data analytics teams, legal, human resources, finance, claims, procurement, and technology stakeholders. It identifies fraud risk scenarios, evaluates control design and operating effectiveness, advises on anti-fraud control enhancements, and develops practical detection strategies to protect the company, members, providers, employees, and other stakeholders. This is a hybrid role. Most teams work in the office two days each week. Employees who live more than 50 miles from an office location work with their manager to determine in-office time based on business needs. The position is based in physical offices and involves work from home office/deskwork; activity is sedentary for most of the workday.

Requirements

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.
At least 5 years of professional experience in internal audit, compliance, investigations, fraud risk management, forensic accounting, enterprise risk management, or a related field.
Subject matter expertise in fraud risk, fraud prevention, fraud detection, control design, audit testing, investigation support, and root cause analysis.
Ability to evaluate business processes, identify fraud vulnerabilities, assess internal controls, and recommend practical, business-aligned, sustainable control improvements.
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.

Nice To Haves

Experience in health care, insurance, financial services, or another highly regulated industry.
Certified Fraud Examiner (CFE) certification; CIA, CPA, CISA, CAMS, CHC, or other relevant audit, compliance, risk, investigations, or analytics credentials are also a plus.
Experience with data tools, reporting platforms, case management systems, audit management systems, SQL, Python, Excel, Tableau, Power BI, or similar analytics tools.

Responsibilities

Support internal audit engagements with fraud subject matter expertise during planning, walkthroughs, risk assessments, control evaluation, testing, root cause analysis, and reporting.
Identify fraud risk considerations within audits of business processes, systems, third-party relationships, financial activities, claims operations, procurement, expense reimbursement, vendor management, and other enterprise functions.
Perform proactive fraud detection using data analysis, pattern identification, anomaly review, control-break analysis, and targeted monitoring to identify potential fraud, waste, abuse, misconduct, policy violations, or control weaknesses.
Develop and document fraud scenarios, indicators, typologies, detection logic, and control points for audit programs, monitoring routines, dashboards, and business-owned controls.
Advise business units on anti-fraud practices, control improvements, prevention strategies, process changes, documentation expectations, and sustainable monitoring approaches.
Collaborate with Internal Audit, Compliance, Legal, HR, Finance, IT, and business leaders to assess fraud risks, triage observations, recommend corrective actions, and support management action plans.
Prepare clear, well-supported workpapers, summaries, recommendations, and executive-ready insights connecting fraud risks to controls, business impacts, and practical remediation opportunities.
Monitor emerging fraud schemes, regulatory expectations, industry trends, and internal risk signals to improve fraud risk coverage and advisory support.
Maintain confidentiality, professional skepticism, independence, and sound judgment when handling sensitive fraud indicators, investigation support, personnel matters, and privileged or confidential information.
Support continuous improvement of Internal Audit fraud capabilities, including fraud risk assessment methodology, detection playbooks, control libraries, data-driven testing approaches, and knowledge sharing across audit teams.