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Fraud Claims Operations Representative Jobs in Texas

Citizens Bank

Fraud Operations Professional

Irving, TX · On-site

As the Fraud Operations Professional , you will support the Fraud and Claims Operations teams through the Command Center. The Command Center is the centralized workforce orchestration and management ...

Citizens

Fraud Operations Professional

Irving, TX · Hybrid

As the Fraud Operations Professional , you will support the Fraud and Claims Operations teams through the Command Center. The Command Center is the centralized workforce orchestration and management ...

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Fraud Claims Operations Representative information

What does a fraud claims operations representative do?

A Fraud Claims Operations Representative is responsible for investigating and resolving claims related to fraudulent activities on customer accounts. They review transaction details, communicate with customers to gather information, and determine the validity of reported fraud. Their work helps protect both the financial institution and its customers from financial losses due to unauthorized or suspicious activity. They also ensure compliance with company policies and legal regulations during the claims process.

How does a fraud claims operations representative typically collaborate with other departments during an investigation?

Fraud Claims Operations Representatives regularly work with teams such as Customer Service, Risk Management, and IT Security to thoroughly investigate and resolve fraud cases. Collaboration often involves sharing detailed case information, coordinating on account holds or restrictions, and ensuring that customers are kept informed throughout the process. Effective communication and teamwork are essential, as representatives must often escalate complex cases or seek specialized expertise from other departments to reach a resolution promptly.

What are the key skills and qualifications needed to thrive as a fraud claims operations representative, and why are they important?

To thrive as a Fraud Claims Operations Representative, you need strong analytical skills, attention to detail, and experience in financial services or fraud investigation, often supported by a relevant associate's or bachelor's degree. Familiarity with fraud detection software, case management systems, and banking platforms is typically required. Excellent communication, problem-solving, and customer service skills help you resolve claims efficiently and reassure affected clients. These skills are essential for accurately identifying fraudulent activity, mitigating losses, and maintaining customer trust in financial institutions.

What are popular job titles related to Fraud Claims Operations Representative jobs in Texas?

For Fraud Claims Operations Representative jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Fraud Claims Operations Representative jobs in Texas look for?

The top searched job categories for Fraud Claims Operations Representative jobs in Texas are:

What cities in Texas are hiring for Fraud Claims Operations Representative jobs?

Cities in Texas with the most Fraud Claims Operations Representative job openings:

Fraud Claims Operations Representative jobs near you
Infographic showing various Fraud Claims Operations Representative job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 10% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution.

Provider Network Operations Representative

Houston, TX • On-site

Astrana Health, Inc.
See more jobs at Astrana Health, Inc.external

$47K - $60K/yr

Full-time

Posted 12 days ago

Job description

Provider Network Operations Representative
Department: Provider Relations
Employment Type: Full Time
Location: 19500 HWY 249, Suite 570 Houston, TX 77070
Reporting To: Julie Wohrlin
Compensation: $47,000 - $60,000 / year
Description
About the Role
We are currently seeking a highly motivated Provider Network Operations Representative to support our Texas Market Provider Network Operations team. This role reports to the Sr. Manager, Provider Network Operations and is responsible for supporting the day-to-day operational activities of the provider network, including provider onboarding, maintenance, issue resolution, and compliance-related processes.
The ideal candidate is detail-oriented, customer-focused, and highly organized, with a passion for supporting providers and improving operational efficiency. This individual will serve as a key liaison between providers and internal departments, helping ensure accurate provider data, timely issue resolution, and compliance with regulatory and health plan requirements.
Our Values:
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team

What You'll Do
  • Support provider network operations, including provider onboarding, terminations, demographic updates, and maintenance of provider records.
  • Coordinate provider-related activities across Contracting, Credentialing, Claims, Provider Relations, and other internal teams.
  • Serve as a primary point of contact for provider operational inquiries, network status questions, and administrative support needs.
  • Investigate, track, and resolve provider issues related to claims, reimbursement, EDI rejections, network participation, and operational processes.
  • Maintain accurate provider records, documentation, tracking logs, and operational workflows.
  • Assist with provider directory validation, audits, regulatory reporting, and data accuracy initiatives.
  • Compile and distribute operational reports related to provider network activities and performance.
  • Collaborate with internal departments and field-based network teams to support provider onboarding, education, and operational readiness.
  • Participate in process improvement initiatives designed to enhance provider experience, operational efficiency, and data quality.
  • Support health plan, regulatory, and organizational compliance requirements, including audit preparation and readiness activities.

Qualifications
  • Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
  • At least 2 years of experience in provider network operations, provider relations, healthcare operations, managed care, health plan administration, or a related healthcare environment.
  • Experience supporting provider onboarding, provider maintenance, claims resolution, credentialing, or network operations.
  • Strong organizational skills with exceptional attention to detail and accuracy.
  • Excellent customer service, communication, and relationship-building skills.
  • Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment.
  • Proficiency with Microsoft Office Suite, including Word, Excel, Outlook, and Teams.
  • Ability to work independently while collaborating effectively across multiple departments.

Preferred Qualifications
  • Experience working with health plans, IPAs, ACOs, MSOs, or value-based care organizations.
  • Knowledge of provider data management, provider directories, claims operations, credentialing, and contracting processes.
  • Experience researching and resolving provider issues related to claims, reimbursement, and network participation.
  • Familiarity with CMS, DMHC, and regulatory requirements related to provider network operations.
  • Experience working with provider management systems, healthcare platforms, or network databases.

You're Great for This Role If You
  • Enjoy building strong relationships and serving as a trusted resource for providers.
  • Have strong problem-solving skills and enjoy investigating operational issues through resolution.
  • Thrive in a fast-paced environment while managing multiple priorities.
  • Are highly organized and maintain strong attention to detail.
  • Communicate effectively with providers, health plans, and internal stakeholders.
  • Take ownership of issues and follow through to completion.
  • Enjoy collaborating across teams to improve operational processes and provider experience.
  • Bring a positive attitude, accountability, and a customer-focused mindset.

Job Benefits
  • Hybrid work environment based on business needs.
  • Frequent use of computers, healthcare systems, provider databases, and Microsoft Office applications.
  • Ability to manage multiple projects, requests, and deadlines simultaneously.
  • May require occasional travel for provider meetings, training sessions, or business-related events.

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