Senior Investigations Analyst

Job summary

The role leads enterprise-wide response activities for large-scale incidents and conducts internal investigations into employee misconduct, fraud, and policy breaches. It also involves performing fraud-related audits, risk assessments, and collaborating with internal teams to ensure organizational standards are met.

Job details

COMPANY : Highmark Health JOB DESCRIPTION : JOB SUMMARY This role serves a critical function within Enterprise Incident Management, leading the coordination and execution of enterprise-wide response activities for large-scale incidents that require engagement across multiple business and operational areas. The position also conducts and supports internal investigations related to employee misconduct, including fraud, theft, privacy and security violations, and other breaches of enterprise policies and the Code of Conduct. Responsibilities include ensuring investigations are performed consistently and in accordance with organizational standards, as well as conducting fraud-related audits and forensic reviews. ESSENTIAL RESPONSIBILITIES * Reviews 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. Reviews and interprets information provided and assist with performing qualitative and quantitative impact assessments. * Collaborates on 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. * Facilitates 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. * 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 and Forensics EXPERIENCE Required * 5 years in Accounting, Finance, Audit, Information Systems or related field To Include: * 3 years of conducting internal ethics, fraud, privacy and security investigations Preferred * 1 years in Operational and/or IT auditing OR Privacy/Information security LICENSES or CERTIFICATIONS Required * None Preferred (any of the following) * Certified Public Accountant (CPA) * Certified Internal Auditor (CIA) * Certified Fraud Examiner (CFA) * 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 Occasionally 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: $68,400.00 Pay Range Maximum: $105,900.00 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 any category protected by applicable federal, state, or local law. California Consumer Privacy Act Employees, Contractors, and Applicants Notice [https://dokumfe7mps0i.cloudfront.net/oms/4391/document/2026/1/doclib_458575_QLVK9_1769448333304228022_1769448333396/1769448333396.pdf]

What you’ll do

The role leads enterprise-wide response activities for large-scale incidents and conducts internal investigations into employee misconduct, fraud, and policy breaches. It also involves performing fraud-related audits, risk assessments, and collaborating with internal teams to ensure organizational standards are met.

Requirements

Candidates must have a Bachelor's degree in Accounting, Finance, Business, or Information Systems, or 6 years of progressive experience. A minimum of 5 years of experience in relevant fields, including 3 years of conducting internal investigations, is required.

Listed skills

• Incident Management · Preferred
• Problem solving · Preferred
• Data analysis · Preferred
• Compliance · Preferred
• Audit · Preferred
• Communication Skills · Preferred
• Financial analysis · Preferred
• Accounting · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Internal investigations
• Fraud detection
• Risk assessment
• Audit
• Forensic reviews
• Compliance
• Data analysis
• Communication skills
• Problem solving
• Information security
• Privacy
• Incident management
• Financial analysis
• Accounting
• Business administration
• Security Investigations
• Certified Information System Auditor (CISA)
• Fraud Investigation
• Accountability
• Internal Investigations
• Certified Information Privacy Professional
• Ethical Standards And Conduct
• California Consumer Privacy Act (CCPA)
• Fraud Detection
• Information Gathering
• Planning
• Analytical Skills
• Auditing
• Business Administration
• Certified Fraud Examiner
• Certified Information Systems Security Professional
• Certified Internal Auditor
• Certified Public Accountant
• Chartered Financial Analyst
• Information Systems
• Data Security
• Digital Forensics
• English Language
• Finance
• Equity Markets
• Sales
• Selling Techniques
• Health Insurance Portability And Accountability Act (HIPAA) Compliance
• Incident Management
• Internal Auditing
• Operations
• Risk Analysis
• Security Policies
• Verbal Communication Skills
• Audit Info System (AIS)

Job areas

• Finance & Accounting
• Security & Safety
• Data & Analytics
• Healthcare
• Management & Leadership
• Investigations Analyst
• Internal Auditor
• Accountants
• Accountants and Auditors

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