Remote Fraud Jobs in Mauldin, SC (NOW HIRING)

The Business Analyst (RAS) is responsible for protecting the integrity of RedSail's products, services, and customer ecosystem by monitoring account activity, conducting account reviews, and analyzing operational data to identify potential risks, unusual activity, and opportunities to strengthen business controls. The role reviews information from the RAS/PowerLine environment and, when appropriate, validates activity within the Pharmacy Management System (PMS) to identify patterns, support business decisions, and recommend corrective actions. This position operates under general supervision with latitude for independent judgment and is expected to manage sensitive information with a high degree of discretion, professionalism, and accuracy. This role helps ensure the secure, compliant, and appropriate use of RedSail's products and services while supporting a fair, consistent, and positive customer experience.

• Review account activity when unusual or potentially non-compliant activity is identified, including researching anomalies, evaluating transactional patterns, and documenting findings.
• Conduct proactive reviews of randomly selected accounts to help ensure appropriate use of RedSail products and services and to identify emerging operational and business risks.
• Analyze and compare data from RAS/PowerLine and other internal systems to identify inconsistencies, unusual activity, and account integrity indicators.
• Review data directly within the PMS for specific cases to validate activity, confirm details, and support account reviews and investigations.
• Document account reviews, investigation outcomes, trends, and recommendations clearly and accurately for leadership and cross-functional partners.
• Collaborate with internal teams to escalate findings, recommend corrective actions, strengthen internal controls, and support account integrity initiatives 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
  
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