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Fraud Risk Management Jobs in Miami, FL (NOW HIRING)

Oscar Health

Auditor, Risk Adjustment

Miami, FL · Remote

$82K - $108K/yr

You will report into the Manager, Risk Adjustment. Work Location: This is a remote position, open ... Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an ...

Humana

Senior Insider Threat Engineer

Miami, FL · On-site +1

$109K - $150K/yr

Hands-on experience configuring and tuning Microsoft Purview Insider Risk Management, Communication ... fraud, IP theft, and sabotage. Proficiency with KQL and PowerShell for querying, automation, and ...

Humana

Senior Insider Threat Engineer

Miami, FL · On-site +1

$109K - $150K/yr

Hands-on experience configuring and tuning Microsoft Purview Insider Risk Management, Communication ... fraud, IP theft, and sabotage. Proficiency with KQL and PowerShell for querying, automation, and ...

Humana

Senior Insider Threat Engineer

Miami, FL · On-site +1

$109K - $150K/yr

Hands-on experience configuring and tuning Microsoft Purview Insider Risk Management, Communication ... fraud, IP theft, and sabotage. Proficiency with KQL and PowerShell for querying, automation, and ...

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Showing results 41-60

All JobsFraud Risk Management JobsFraud Risk Management Jobs in Miami, FL

Fraud Risk Management information

See Miami, FL salary details

$49.3K

$106.7K

$162.6K

How much do fraud risk management jobs pay per year?

As of Aug 16, 2026, the average yearly pay for fraud risk management in Miami, FL is $106,697.00, according to ZipRecruiter salary data. Most workers in this role earn between $86,100.00 and $123,400.00 per year, depending on experience, location, and employer.

What are some common challenges faced in fraud risk management roles and how are they addressed?

Professionals in Fraud Risk Management often face challenges such as staying ahead of constantly evolving fraud tactics, analyzing large volumes of transactional data, and ensuring compliance with regulatory standards. To address these challenges, teams typically employ advanced analytic tools, collaborate cross-functionally with IT and compliance departments, and engage in continuous training to stay updated on emerging threats. The work environment is dynamic and may involve both independent analysis and team-based investigations, fostering a culture of vigilance and proactive risk mitigation. This dynamic landscape offers professionals the opportunity to develop specialized expertise and grow into senior risk or leadership roles over time.

What does a fraud risk management do?

A fraud risk management professional identifies, assesses, and implements strategies to detect and prevent fraudulent activities within an organization. They analyze data, develop controls, and monitor transactions to reduce financial losses and ensure compliance with regulations. Strong analytical skills and knowledge of fraud detection tools are essential in this role.

Is working in fraud risk management a good career?

Working in fraud risk management is a viable career option with demand across industries such as banking, finance, and e-commerce. It involves analyzing data, using tools like fraud detection software, and often requires certifications like Certified Fraud Examiner (CFE). The role offers opportunities for advancement and specialization in a growing field.

What are the key skills and qualifications needed for fraud risk management?

To thrive in Fraud Risk Management, you need strong analytical skills, attention to detail, and a solid understanding of financial systems, often supported by degrees in finance, accounting, or related fields. Familiarity with fraud detection software, data analysis tools like SQL or SAS, and industry certifications such as CFE (Certified Fraud Examiner) are highly valued. Excellent communication, problem-solving abilities, and ethical integrity are critical soft skills for collaborating with teams and handling sensitive investigations. These skills and qualities are essential to effectively identify, investigate, and mitigate fraud risks, protecting organizational assets and maintaining compliance.

What is fraud risk management?

A Fraud Risk Management job involves identifying, assessing, and mitigating risks related to fraudulent activities within an organization. Professionals in this role develop and implement policies, controls, and monitoring systems to prevent fraud and financial crimes. They work closely with compliance, legal, and operational teams to investigate suspicious activities and ensure regulatory compliance. The goal is to minimize financial losses and protect the organization's reputation.

What are popular job titles related to Fraud Risk Management jobs in Miami, FL?

For Fraud Risk Management jobs in Miami, FL, the most frequently searched job titles are:

What job categories do people searching Fraud Risk Management jobs in Miami, FL look for?

The top searched job categories for Fraud Risk Management jobs in Miami, FL are:

What cities near Miami, FL are hiring for Fraud Risk Management jobs?

Cities near Miami, FL with the most Fraud Risk Management job openings:

Fraud Risk Management jobs near you
Infographic showing various Fraud Risk Management job openings in Miami, FL as of August 2026, with employment types broken down into 1% As Needed, 91% Full Time, 7% Part Time, and 1% Temporary. Highlights an 90% In-person, 1% Hybrid, and 9% Remote job distribution, with an average salary of $106,697 per year, or $51.3 per hour.

Auditor, Risk Adjustment

Oscar Health

Miami, FL • Remote

$82K - $108K/yr

Full-time

Re-posted 18 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

257th of 308 rated insurance

Job description

Hi, we're Oscar. We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Associate, Risk Adjustment Auditor conducts internal and external quality audits. Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and identified clinical documentation improvement opportunities. You will work with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs.

You will report into the Manager, Risk Adjustment.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

  • Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts.
  • Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data is supported within provider encounter documentation
  • Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented.
  • Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
  • Conduct CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
  • Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
  • Identify and execute on the creation of clinical document improvement resources for provider education in both MA and ACA line of business.
  • Manage the implementation process improvements that will maximize risk adjustment factor increases.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Bachelor's degree in a relevant field of study or commensurate work experience.
  • Certified professional coder (CPC)
  • 3+ year(s) retrospective risk adjustment coding experience.
  • 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience

Bonus points:

  • Certified Risk Adjustment Coder (CRC) or similar certification
  • Experience coding in a variety of different Electronic Medical Record (EMR) systems.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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