Fraud Detection Analyst, Senior

Your Role

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 Internal Audit Fraud Advisor will 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.

In this role, you will partner closely with auditors, compliance partners, business leaders, data analytics teams, legal, human resources, finance, claims, procurement, and technology stakeholders to identify fraud risk scenarios, evaluate control design and operating effectiveness, advise on anti-fraud control enhancements, and develop practical detection strategies that protect the company, members, providers, employees, and other stakeholders.

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.

Your Work

In this role, you will:

Support internal audit engagements by providing 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 activities 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 that can be incorporated into 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 that connect fraud risks to controls, business impacts, and practical remediation opportunities

Monitor emerging fraud schemes, regulatory expectations, industry trends, and internal risk signals to continuously improve fraud risk coverage and advisory support

Maintain confidentiality, professional skepticism, independence, and sound judgment when handling sensitive fraud indicators, investigations 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

Your Knowledge and Experience

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 audit, compliance, risk, investigations, or analytics credentials are a plus

Demonstrated ability to evaluate business processes, identify fraud vulnerabilities, assess internal controls, and recommend practical control improvements that are business-aligned and sustainable

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

Experience with data tools, reporting platforms, case management systems, audit management systems, SQL, Python, Excel, Tableau, Power BI, or similar analytics tools is preferred

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.