The Fraud Investigator is charged with the following responsibilities: To identify, review, and investigate fraud activity, claims/cases, and risk exposures from various delivery channels. Review transactional activities, internal/external inquiries, and perform investigations to protect the client and its members’ financials and assets, and control and mitigate potential fraud loss. Ensure adherence to applicable federal and state laws, rules, and regulations. Work is performed under close supervision. Responsibilities include investigating various types of transactions/activities/cases (e.g., ID Theft and Synthetic ID, Check Fraud, Account Takeover fraud), responding to inquiries via various communication venues, communicating with internal and external customers on fraud and security issues, collecting evidence and related documentation while maintaining chain of evidence, reviewing data to substantiate or disqualify loss claims, researching public record databases, creating detailed investigation reports, preparing and maintaining data for analysis, detecting fraud trends and recommending preventive measures, monitoring timelines to meet service level agreements and regulatory requirements, collaborating with other business units to understand processes and identify fraud risks, identifying risk exposure and recommending control actions, determining if suspicious activities are due to processing errors, supporting fraud detection and prevention projects, driving continuous process improvement, and maintaining knowledge of applicable laws and policies. Other duties as assigned. Critical skills include familiarity with federal and state laws (e.g., Bank Secrecy Act, USA Patriot Act, OFAC regulations), fraud trends, member/customer service experience, analytical techniques for fraud and identity theft, ability to determine intent, identify red flags, assimilate and analyze information, exercise good judgment, organizational and time management skills, investigative and problem-solving skills, effective communication, and proficiency with word processing and spreadsheet software.
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