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Remote Anti Fraud Jobs in Michigan (NOW HIRING)

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Remote Anti Fraud information

What is a remote anti-fraud specialist?

A Remote Anti-Fraud specialist is a professional who works from a remote location to detect, prevent, and investigate fraudulent activities within an organization or in financial transactions. They use specialized software and analytical skills to monitor for suspicious behavior, analyze data patterns, and ensure compliance with anti-fraud regulations. Their role is crucial in protecting companies and customers from financial losses and maintaining trust. These specialists often collaborate with other departments, such as compliance, legal, and IT, to develop and implement effective fraud prevention strategies.

What are the key skills and qualifications needed to thrive as a remote anti-fraud specialist?

To excel as a Remote Anti-Fraud Specialist, you typically need a background in finance, cybersecurity, or risk management, often supported by a relevant degree or certification such as CFE (Certified Fraud Examiner). Familiarity with fraud detection software, data analytics tools, and case management systems is essential for monitoring and investigating suspicious activities. Strong analytical thinking, attention to detail, and effective communication skills help specialists identify threats and collaborate with team members. These skills and qualifications are crucial to proactively detect, prevent, and mitigate fraudulent activities in a remote work environment.

How does a remote anti-fraud professional typically collaborate with other departments to investigate suspicious activities?

Remote Anti-Fraud professionals often work closely with teams such as compliance, risk management, IT, and customer support. Collaboration usually involves sharing findings, coordinating investigations, and implementing preventative measures based on collected data. Effective communication is critical, as much of the collaboration takes place through digital channels like video meetings and secure messaging platforms. This teamwork ensures that fraud incidents are identified quickly and that appropriate actions are taken to protect the organization and its customers.

What is the difference between Remote Anti Fraud vs Remote Fraud Analyst?

AspectRemote Anti FraudRemote Fraud Analyst
Primary FocusPreventing and detecting fraudulent activities across platformsInvestigating and analyzing fraud cases to identify patterns
Required SkillsRisk assessment, fraud detection tools, compliance knowledgeData analysis, investigation techniques, reporting skills
Work EnvironmentCorporate security or fraud prevention teams, remote settingsFinancial institutions, e-commerce companies, remote roles
CertificationsFraud examination, risk management certifications often preferredSimilar certifications, such as Certified Fraud Examiner (CFE), valued

Remote Anti Fraud roles focus on proactively preventing fraud, while Remote Fraud Analysts investigate and analyze specific cases. Both roles require similar skills and certifications, often working in remote environments within financial or e-commerce industries.

What are popular job titles related to Remote Anti Fraud jobs in Michigan?

For Remote Anti Fraud jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Remote Anti Fraud jobs in Michigan look for?

The top searched job categories for Remote Anti Fraud jobs in Michigan are:

What cities in Michigan are hiring for Remote Anti Fraud jobs?

Cities in Michigan with the most Remote Anti Fraud job openings:

Remote Anti Fraud jobs near you
Infographic showing various Remote Anti Fraud job openings in Michigan as of July 2026, with employment types broken down into 77% Full Time, 16% Part Time, and 7% Contract. Highlights an 100% Remote job distribution.

Government Programs Appeals and Grievances Research Specialist

Delta Dental of Michigan

Okemos, MI • On-site, Remote

Full-time

Medical, Dental

Posted 9 days ago

Job description

Job Title:
Government Programs Appeals and Grievances Research Specialist
Number of Positions:
9
Location:
Okemos, MI
Location Specifics:
Fully Remote
Job Summary:
Candidates must reside in Michigan within a reasonable commuting distance of our Okemos, MI office for team meetings, collaborative sessions, and training.
At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.
At Delta Dental, we celebrate our All In culture. It's a mindset, feeling and attitude we wrap around all that we do - from taking charge of our careers, to helping colleagues and lending a hand in the community.
Position Description:
To direct and assist in the resolution of dental benefit determinations and analysis of provider and subscriber referrals, provider billing and treatment records analysis, and to support the fraud & abuse program.
Primary Job Responsibilities:
  • Researches, analyzes, and resolves cases for government programs members involving compliance issues including but are not limited to balance billing, non-delivery of care, quality of care, personality disputes, anti-fraud hotline, internal referrals, and appeals. Case research may include but is not limited to, contract review and analysis, data analysis, records audit, and interviews with external customers.
  • Works closely with the Legal and Compliance team and Customer Service to complete cases in accordance with government program and client requirements. This includes closely monitoring workflow to ensure complaints are resolved within case specific turn-around times, applicable rights are provided, and requirements for manner and content of notice to customers are met.
  • Performs case reviews for clients who have elected to handle their own appeals and grievances communicating directly with clients, Delta Dental affiliate plans and account managers. Assists clients by facilitating adjustments, record requests and exception claim payments as needed.
  • Communicates to internal and external customers to obtain necessary information and relay actions taken and the resolution of cases.
  • Prepares dental claims so appropriate determinations can be finalized with correct procedure policies and bypasses in place, adjudicates claims, analyzes documents, and maintains claims records, as well as coordinates adjustments on difficult claims and inquiries.
  • Maintains thorough case documentation in the appeal and grievance case management system.
  • Coordinates data to be used by internal or external parties including audits, hearings and for use by legal counsel when necessary. Participates in audits and hearings as necessary, including sample preparation and presentation.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
#LI-Remote
Minimum Requirements:
Position requires an associate's degree in accounting, business administration, criminal justice, dental assisting or hygiene, or a related field and four years of experience in a position requiring knowledge of dental terminology, dental procedure codes, or dental office billing and record keeping practices within a provider office, administering dental benefit contracts within the insurance industry, or identifying, analyzing, and resolving compliance issues based on policies and procedures outside of the insurance industry. Previous experience supporting an anti-fraud/abuse program preferred. Will accept any suitable combination of education, training, or experience.
Position also requires knowledge of word processing, spreadsheet, and database applications; strong verbal and written communication skills; strong analytical skills; the ability to work independently and as part of a team; the ability to manage multiple assignments with competing deadlines; and the ability to identify and resolve problems using independent judgment.
The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.

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