Company :

Highmark Health

Job Description :

JOB SUMMARY

This job conducts and supports internal investigations resulting from evidence of employee malfeasance, including but not limited to, fraud, theft, privacy and security violations, or other violations of enterprise policies including the code of conduct. Duties include ensuring that all investigations are completed consistently and in accordance with policy, as well as conducting fraud related audits and forensic reviews.

ESSENTIAL RESPONSIBILITIES

• Leads the review of risk assessment results to perform investigations into potential and existing threats. Responsible for the investigation of reports of real or potential instances of non-compliance and/or fraud in accordance with established standards/policies. Will lead the review and interpretation of information provided and assist with performing qualitative and quantitative impact assessments.

• Leads engagement initiation and planning activities for fraud-related audits and monitoring activities within Highmark Health Enterprise; including approving audit programs to support the audit objectives of identified audits.

• Effectively leads collaboration efforts with Senior Risk Partners, Risk Operations and Internal Audit team members to facilitate the execution of internal investigations and fraud related audits based on reports or identified fraud risks.

• Defines when additional information gathering and risk assessments is necessary to formulate conclusions; ensuring documentation to support investigative conclusions is sufficient and in accordance with department standards.

• Identifies and uses appropriate fraud investigation tools, applications, and systems to continually enhance fraud detection strategies and to identify trends.

• Analyzes assessment results against physical, technical, and administrative safeguards and company-specific contractual requirements in the evaluation of risk.

• Provides consultation in development of assurance plans (e.g., on-site audit, contract review, financials assessment) to address relevant risk areas and to ensure proper controls are implemented.

• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Accounting, Finance, Business Administration, Information Systems or related field

Substitutions

• 6 years of related and progressive experience in lieu of Bachelor's degree

Preferred

• Master's Degree in Fraud & Forensics

EXPERIENCE

Required

• 7 years in Accounting, Finance, Audit, Information Systems or related field

To Include

• 5 years conducting internal ethics, fraud, privacy and security investigations

Preferred

• 3 years in Operations and/or IT Auditing OR

• 3 years with Privacy/Information security

LICENSES or CERTIFICATIONS

Required

• None

Preferred (any of the following)

• Certified Public Accountant (CPA)

• Certified Internal Auditor (CIA)

• Certified Fraud Examiner (CFE)

• Certified Information Systems Auditor (CISA)

• Certified Information Privacy Professional (CIPP)

SKILLS

• Excellent written and verbal communication skills. Ability to appropriate package information and tailor message to respective audiences.

• Broad understanding of fraud/privacy/security risks, business issues, key metrics and organizational linkages.

• Excellent analytical skills with a demonstrated ability to identify unusual trends/circumstances and solve problems.

• Working knowledge of standard investigative procedures/protocols

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$78,900.00

Pay Range Maximum:

$146,000.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J251230