Director, Fraud Financial Analysis

This position leads the Fraud Detection & Deterrence strategies for Policy, Billing & Payment Investigative verticals. 

Lead strategic and operational fraud investigative programs across multiple verticals on a national scale. Deliver enterprise-level direction for fraud detection, prevention, and risk mitigation while overseeing investigations that may be confidential in nature spanning across customer policy, billing and payment, vendor activity, agent misconduct, internal and/or organized fraud. Manage a team including multiple managers responsible for discrete fraud verticals; drive innovation, cross-functional collaboration, and continuous improvement in detection, controls, and investigative capabilities. Partner closely with data science, analytics, legal, talent, compliance, technology, and business units to ensure fraud strategies minimize financial loss and reputational risk while aligning with enterprise risk management objectives.  

Qualified candidates should have 5+ years' leadership experience in investigative, underwriting, or billing/finance teams, with strong analytical and communication skills. Experience collaborating across departments and with an entrepreneurial mindset is required. Candidates should be adaptable to change and ambiguity, able to research and analyze data leading to the generation of new ideas that enable the business we support to reach their goals.   This leader will have demonstrated success in creating a high performing, fully supported and engaged culture where voice is celebrated and teams are focused on quality, development, accountability, effective communication, and operational efficiency.

Primary Responsibilities:

Strategic leadership

• Develop, articulate, and implement an enterprise-wide fraud strategy that strengthens prevention, detection, investigative response, and risk mitigation across owned fraud verticals.
• Align fraud strategy with enterprise risk priorities, lines of business initiatives, regulatory obligations, and senior leadership objectives.
• Translate strategic goals into annual plans, prioritized initiatives, and measurable outcomes.
• Consult upon enterprise fraud plans, model deployment, regulator/law enforcement referrals, and material escalations. Own budget for fraud technology and headcount across verticals.

People leadership, team management & talent development

• Lead and develop multiple managers and supervisors and their investigative teams nationwide; hold regular 1:1s, conduct formal evaluations, and build individual development plans.
• Build and sustain a high performing, ethical culture focused on operational excellence, collaboration, retention, and continuous learning.
• Drive targeted hiring, effective onboarding, career pathing, recognition, and workload balancing to maintain capacity and engagement.

Fraud detection, intake oversight & confidential investigations

• Oversee intake prioritization, triage, and investigative assignment processes to ensure timely, thorough analysis of referrals and alerts.
• Manage and provide executive oversight for highly confidential and sensitive investigations; ensure investigative rigor, defensible findings, and compliance with legal, privacy, and organizational standards.
• Establish and implement investigative methodologies, evidence handling, chain-of-custody, and documentation standards.

Investigation quality & integrity

• Establish QA program to measure holistic quality and address the opportunities in the organization and conduct senior-level calibrations with managers; ensure adherence via audits of audits.
• Enforce ethical standards and a culture of integrity; ensure investigations are objective, well documented, and legally defensible.

Cross-functional collaboration & stakeholder engagement

• Partner with data science, analytics and others to co-develop detection queries, models, dashboards, and investigative tooling that enhance proactive identification of fraud.
• Coordinate with legal, compliance, Technology, Talent, Procurement, Underwriting Effectiveness, Director of State Operations and Billing Operations units to design controls, remediation plans, and escalation protocols.
• Work closely with Claims SIU to coordinate joint investigations, share investigative tools, systems and knowledge.
• Represent fraud investigations in senior leadership forums and enterprise risk committees; communicate trends, risk posture, and recommended actions.

Vendor management

• Collaborate with Procurement and CFH Process to identify vendors that enable investigative accuracy and efficiency.
• Manage the relationship and contract with the vendor ensuring adherence and quality work product
• Ensure the teams are engaging the right vendor for the right task without redundancy or unnecessary engagement.

Rapid response leadership & external agency coordination

• Lead the investigative aspects of rapid response capabilities for urgent fraud incidents (including cyber fraud) and coordinate cross functional incident response.
• Partner with state Departments of Insurance (DOI), law enforcement, and regulatory agencies to report criminal activity, support investigations, and facilitate prosecution where appropriate.

Operational oversight & resource management

• Oversee resource allocation, capacity planning, and budgeting to optimize investigative coverage and operational efficiency.
• Set unit-level productivity, quality, and SLA targets; monitor throughput, backlog, and workforce planning to meet business needs.
• Resolve prioritization conflicts and reallocate resources to protect critical investigative throughput and team wellbeing.

Governance, compliance & risk oversight

• Establish, maintain, and enforce consistent investigation standards, policies, and compliance frameworks across owned fraud verticals.
• Ensure activities meet regulatory requirements, privacy/security standards, contractual obligations, and enterprise policies.
• Manage escalations for material fraud events and support legal or enforcement actions as needed.

Reporting, analytics & performance metrics

• Define and own KPIs, dashboards, and reporting for fraud activity, financial impact, remediations, and operational health.
• Leverage analytics to identify trends, root causes, and opportunities for automation and enhanced controls.
• Prepare and present fraud risk reports and strategic recommendations to senior leadership and risk committees.

Change management & continuous improvement

• Lead process improvement, automation, and technology adoption initiatives to increase investigative effectiveness and operational efficiency.
• Communicate changes early, solicit stakeholder input, and manage rollouts to minimize disruption and secure adoption.
• Promote continuous learning, quality assurance, and manager calibrations to sustain high investigative standards.