Utilize data analytics tools to support the design and implementation of claim fraud detection and prevention initiatives.
Compiles, cleans, organizes and analyzes complex data to understand fraud results.
Develop and maintain comprehensive data models to identify fraud patterns and trends.
Pilot technical solutions to enhance both operational and data analysis capabilities for fraud detection and prevention.
Collaborate with internal partners such as IT, Legal, Compliance, and Claims to ensure alignment and effective fraud mitigation solutions.
Design and operate reports to measure the effectiveness and loss cost containment of fraud mitigation tools, processes, and initiatives.
Build automated self-service reports to track referrals, assignments, performance metrics, and outcomes of claim fraud.
Develop a consistent communication strategy to keep all stakeholders informed and engaged.
Develop and maintain strong relationships with key departments to foster a culture of transparency and trust.
Ensure timely and effective communication with all relevant parties during fraud investigations.

3–5 years of experience in data analytics, fraud detection, or claims operations within the insurance or financial services industry.
Proficiency in coding and query languages, including Python and R.
Power BI and SQL required.
Strong experience with data analytics and visualization platforms such as Alteryx, Tableau, and Power BI, with a proven ability to build and maintain automated dashboards and self-service reporting tools.
Familiarity with fraud detection models, anomaly detection techniques, and predictive analytics.
Strong understanding of claims processes, fraud referral workflows, and SIU operations.
Experience working with cross-functional teams including IT, Legal, Compliance, and Operations.
Knowledge of data governance, privacy regulations, and secure data handling practices.
Excellent communication and stakeholder engagement skills, with the ability to translate complex data insights into actionable business strategies.
Experience in project management or leading initiatives that span multiple departments or systems.

Fraud Data & Analytics Lead Consultant

Key skills