• Oversee support of customers encountering problems • Manage operations of product support teams • Develop and monitor operating structures and procedures • Monitor call queues, call volume, and productivity • Report new or recurring issues to management • Ensure team members are trained on new products • Contribute to development of product support function • Serve as escalation point for client issues • Manage budgets, staffing plans, and service level commitments

Company : Highmark Inc.Job Description : JOB SUMMARY The incumbent is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. Must be able to testify in a court of law, prepare cases for referral to various federal, state and local law enforcement entities and work with those agencies through closure of the case. Conduct audits for proactive and investigative purposes to comply with internal audit and regulatory requirements. For this role, we are looking for Clinical Nursing and/or Medical Coding experience. ESSENTIAL RESPONSIBILITIES - Performs investigations into potential and existing provider and member fraud, waste and abuse activities. Identifies parties involved by reviewing inquiries and complaints against providers, members, facilities, pharmacies, groups, and/or employees of Highmark and Subsidiaries. Conduct Interviews with providers, members or any other individual(s) necessary to complete an assigned investigation or special project. Determines the scope of the allegation or special project by assembling the necessary information, statistics, policies and procedures, licensure information, doctors’ agreements, contract, etc. - Coordinates data extracts by assessing multiple databases both internally and externally. Takes action to prevent further improper payments. Forwards case to the Credentialing and/or Medical Review Committee, law enforcement and regulatory agencies. - Develop and maintain annual anti-fraud program which includes facilitating fraud training and fraud awareness day, as well as filing annual fraud plans and reports according to state regulations. Responsible for updating annually the changes in insurance laws with regard to lines of business. - Will be called upon as a subject matter expert for Investigators. Will provide guidance and help train/mentor other team members. Could serve as a project lead for special projects within the department. - Responsible for completing all necessary field (externally) investigative work for resolution or alleged fraud/waste and abuse cases or special projects. - Provides advisory support as needed to internal and external law enforcement and regulatory agencies, Credentialing or Medical Review Committee. - Engages in delivery of audit results and overpayment negotiations. Responsible for recovery/ savings of misappropriated funds paid by Highmark and affiliated companies and work with Finance to ensure proper recording the financial statements. - Conduct audits for proactive and investigative purposes to comply with internal audit and regulatory requirements. Audits consist of contract, commissions, surveillance, workers’ compensation and IME. In addition, this position will complete Office of Foreign Asset Control (OFAC) to ensure payments are not issued to unauthorized parties. - Other duties as assigned or requested. EDUCATION Required - Bachelor's Degree in Accounting, Finance, Business Administration, Nursing, IT or related field Substitutions - 6 years of related and progressive experience in lieu of Bachelor's degree Preferred - Master's Degree Fraud, Forensics Accounting, Business or related field EXPERIENCE Required - 5 years in the Health insurance industry and/or Healthcare fraud investigations - 1 year of leading projects of varying size and complexity Preferred - 3 years of financial analysis in an acute care hospital or health insurance setting - 3 years in professional billing, facility Patient Financial Services, HIM, Internal Audit, Professional/Facility Reimbursement or Provider Contracting LICENSES or CERTIFICATIONS Required - None Preferred - Certified Fraud Examiner (CFE) - Certified Professional Coder (CPC) - Certified Outpatient Coder (COC) - Accredited Healthcare Fraud Investigator (AHFI) SKILLS - Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency - Must have understanding of technical and financial aspects of the health insurance industry - Strong personal computer skills, along with the ability to use fraud/abuse data mining tools are required - Must possess excellent communication skills and be detailed oriented - Strong written and oral communication skills - Strong relationship building skills - Client focused with strong business acumen - Self-starter with the ability to work under pressure independently and as part of a team - Ability to think strategically and act proactively to create strong trust and confidence with business units - Strong innovative problem-solving capabilities 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: $67,500.00 Pay Range Maximum: $126,000.00 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 any category protected by applicable federal, state, or local law. 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 the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

• Conduct comprehensive analysis of loan applications, including the collection of essential borrower documents and the procurement of necessary third-party reports. • Maintain consistent outreach via phone, email, and text to provide status updates, resolve inquiries, and ensure all required information is gathered within established timeframes. • Serve as the primary point of contact for borrowers throughout the processing and underwriting stages, providing personalized assistance and support. • Review and evaluate all file components against internal credit policies to ensure applications are fully prepared for a final underwriting decision. • Meet or exceed daily and monthly quotas while maintaining a rigorous standard of quality and accuracy. • Identify potential roadblocks or policy misalignment, collaborating with sales and operations teams to determine the most effective path forward. • Work closely with cross-functional partners to contribute to the achievement of weekly and monthly processing and funding targets. • Support departmental growth by participating in special projects, such as testing new systems, mentoring new hires, or serving as a "power user" for internal solutions. • Regularly attend team meetings and provide actionable feedback to help refine internal processes and operational efficiency.

Overview POSITION OVERVIEW Fidelity National Financial (FNF) is seeking a Fraud Intake Analyst to join the Compliance organization and support the enterprise wire fraud prevention program. As the front line of the fraud intake process, the Fraud Intake Analyst plays a critical role in enabling downstream fraud analytics, detection improvements, incident response, and compliance reporting. The position partners closely with Fraud Operations, Compliance, Information Security, and business teams to connect signals across systems, identify discrepancies, and support post-incident reviews that uncover root causes and control gaps. The ideal candidate is highly detail-oriented, operationally disciplined, and thrives in environments where precision and structured processes are essential. Success in this role is measured through improvements in intake accuracy, documentation quality, timeliness of incident handling, and the overall strength of the organization’s wire fraud defense capabilities. LOCATION - This role sits 100% remote. DUTIES & RESPONSIBILITIES Fraud Intake & Event Documentation - Manage the fraud intake process end-to-end by capturing and logging all attempted and confirmed fraud events. - Maintain accurate and well-structured records of incident metadata, artifacts, communications, logs, and relevant documentation. - Apply consistent taxonomies, classifications, and metadata standards across all fraud events to support analytics and reporting. - Identify opportunities to improve intake processes, documentation standards, and operational workflows. Intake Triage, Routing & Queue Management - Serve as the central intake coordination point for fraud incidents, routing cases to appropriate teams including Fraud Operations, Information Security, Operations, Legal, and banking partners. - Manage intake queues and maintain service-level discipline for case triage and escalation. - Provide operational visibility into case volumes, status updates, and aging metrics. Post-Incident Review (PIR) Support - Lead or support structured Post-Incident Reviews for fraud events. - Analyze contributing factors, root causes, control gaps, and process deviations. - Document findings and track follow-up actions to completion. Continuous Improvement & Control Feedback - Ensure lessons learned from fraud events are incorporated into processes, controls, training, and detection logic. - Identify recurring patterns or operational gaps that require remediation. - Partner with Fraud Operations, Compliance, Information Security, and business teams to strengthen fraud prevention processes. Cross-Functional Collaboration & Communication - Work closely with internal stakeholders to coordinate incident handling and response activities. - Prepare incident summaries, operational updates, and documentation for leadership and partner teams. - Maintain clear communication during active fraud events and follow-up investigations. Data Quality & Reporting Support - Ensure fraud intake data is accurate, complete, and suitable for downstream analytics and reporting. - Support development of KRIs, PKIs, and trend analysis through consistent and high-quality intake documentation. - Collaborate with the Fraud Data Analyst to improve data quality and readiness for enterprise fraud analytics. MINIMUM REQUIREMENTS - Bachelor’s degree in Business, Information Systems, Criminal Justice, Finance, or a related field, or equivalent combination of education and professional experience. - 2+ years of experience in operations, compliance, fraud prevention, security operations, or similar process-driven environments. - Strong attention to detail and ability to maintain accurate documentation and structured records. - Experience working with structured workflows, case management systems, or operational ticketing platforms. - Proficiency with Excel including pivot tables, filtering, and basic data analysis. - Strong written communication skills for incident documentation and reporting. - Ability to manage competing priorities in a fast-paced operational environment. PREFERRED EXPERIENCE - Experience in fraud operations, financial crimes, wire fraud prevention, cyber fraud, or related risk management disciplines. - Background in IT Operations, Security Operations, or similar structured operational environments. - Experience participating in incident reviews, retrospectives, or operational investigations. - Familiarity with email security platforms, fraud monitoring tools, or operational case management systems. - Experience supporting KRI/PKI reporting, fraud trend analysis, or operational dashboards. - Strong analytical mindset with the ability to identify patterns and connect signals across multiple systems. COMPENSATION & BENEFITS This position has the potential to earn compensation in the range of $75,000 - $95,000 annually based on location and job-related factors such as skillset and experience. Actual rate may vary within the range provided, depending on a number of factors, including skillset, experience and location. The base compensation is one component of the total rewards package offered to our employees, including optional health and welfare insurance (medical/dental/vision/life/disability); paid holidays, vacation, and sick time off; and matching 401(k) plan and matching employee stock purchase plan.