Business Fraud Analyst

The Business/Fraud Analyst (RAS) is responsible for identifying, investigating, and detecting and preventing potential fraud involving customer accounts and pharmacy activity. This role conducts reviews when fraud is suspected and proactively audits selected customers to help ensure fraudulent activity is not occurring. The analyst works with data from the RAS/PowerLine environment and, when needed, reviews information directly within the PMS for specific customers to validate findings, identify patterns, and inform business decisions through investigative findings and recommendations. This position operates under general supervision with latitude for independent judgment and is expected to manage sensitive information with a high degree of discretion and accuracy.

• Investigate customer accounts and related activity when fraud is suspected, including researching anomalies, reviewing transactional patterns, and documenting findings.
• Perform proactive audits of randomly selected customers to help ensure fraudulent activity is not taking place and to identify emerging risks.
• Analyze and compare data from RAS/PowerLine and other internal systems to identify inconsistencies, suspicious behaviors, and fraud indicators.
• Review customer data directly within the PMS for specific cases to validate activity, confirm details, and support investigations.
• Document investigations, audit outcomes, trends, and recommendations clearly and accurately for leadership and cross-functional partners.
• Collaborate with internal teams to escalate findings, recommend corrective actions, and drive fraud prevention efforts through investigation outcomes and policy recommendations.
• Lead assigned reviews and projects and ensure timely completion of routine and complex investigative assignments.

• Bachelor’s degree in business, finance, healthcare administration, criminal justice, data analytics, or a related discipline is required.
• Requires 3-5 years of experience in the pharmacy industry.

• Working knowledge of pharmacy workflows, customer account activity, and pharmacy management systems.
• Ability to review and interpret data across RAS/PowerLine and PMS environments to identify suspicious activity, inconsistencies, and trends.
• Strong analytical, investigative, and problem-solving skills with exceptional attention to detail.
• Effective and professional communication skills with the ability to document findings and present information clearly to technical and non-technical audiences.
• Excellent interpersonal and organizational skills, with the ability to self-manage and work in a cooperative team environment.
• Ability to manage multiple assignments, maintain confidentiality, and exercise sound judgment when handling sensitive information.
• Proficiency in Microsoft Office Suite and comfort working with system-generated reports, data extracts, and audit documentation.

• Experience with fraud detection, audit review, compliance monitoring, or risk analysis in a pharmacy, healthcare, or related business environment.
• Experience working with RAS, PowerLine, PMS platforms, or similar pharmacy-related systems is preferred.

• Uses independent judgment and discretion based upon the employee’s experience in the position and knowledge of the products, equipment, and services, including determining the scope and direction of fraud investigations, evaluating whether account activity constitutes potential fraud, recommending corrective actions and account restrictions, and deciding how to prioritize and allocate investigative resources across competing assignments.
• Uses good judgment and possesses ethical work values.

• Moderate levels of stress may be experienced in the performance of the job.
• Position is performed in a general office environment, home office, or approved remote workspace where physical work includes, but is not limited to, sitting, standing, reaching, kneeling, bending, and lifting to 25 lbs.
• Travel may be required at times.

• Daily use of Microsoft Teams (messaging, calling, video), computer, and other routine office equipment.
• Must have internet access.

• Little responsibility for the safety of others. The job is performed in an office setting where there are no hazardous materials or equipment.

• Position is performed in an open office environment or approved remote work location.

• The anticipated base salary range for this position is $95,000-$115,000 annually. This position is also eligible for an annual target bonus of 4%. Actual compensation will be determined based on factors including relevant experience, skills, qualifications, and geographic location.
• Benefits include paid time off, medical, dental, and vision insurance, a 401(k) with a 5% company match, a fitness bonus, professional development opportunities, and programs that support overall well-being.

• Hybrid at a RedSail Office
  
  • Spartanburg, SC
  • Irving, TX
  • Shreveport, LA
  • Oak Brook, IL
  • Cranberry Township, PA
  • Long Island, NY