Job Title:Director of Fraud Management Department:Product Management Location:Plantation, Florida (US based candidates only) Employment Type:Full-time About NationsBenefits NationsBenefits is recognized as one of the fastest growing companies in America and a Healthcare Fintech provider of supplemental benefits, flex cards, and member engagement solutions. We partner with managed care organizations to provide innovative healthcare solutions that drive growth, improve outcomes, reduce costs, and bring value to their members. Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction. Our compliance-focused infrastructure, proprietary technology systems, and premier service delivery model allow our health plan partners to deliver high-quality, value-based care to millions of members. We offer a fulfilling work environment that attracts top talent and encourages all associates to contribute to delivering premier service to internal and external customers alike. Our goal is to transform the healthcare industry for the better! We provide career advancement opportunities from within the organization across multiple locations in the US, South America, and India. About The Job NationsBenefits is seeking a highly experiencedDirector of Fraud Managementto lead the development and execution of the company's fraud prevention and detection programs. This role will be responsible for protecting the integrity of NationsBenefits' healthcare payments ecosystem—including supplemental benefit cards, digital wallets, and e-commerce platforms—against fraud, abuse, and financial crime. The ideal candidate combines deep expertise in fraud risk management and healthcare compliance with a strong understanding of technology evaluation, includingbuild vs. buy vs. partner strategiesfor fraud tools. This leader will be instrumental in scaling our fraud defenses in alignment with our rapid growth and regulatory obligations. Qualifications • 8+ years of leadershipexperience infraud risk management, with a focus on payments, e-commerce, or healthcare. • Deep understanding ofMedicare Advantageandhealthcare benefit fraud schemes. • Proven experience infraud technology evaluation—particularly conductingbuild/buy/partner analysesand managing vendor relationships. • Familiarity withfraud detection systemsrule-based engines, machine learning platforms, and case management tools. • Bachelor's degree in Finance, Business, Information Systems, Criminal Justice, or a related field; advanced degree or certifications such asCFE, CISA, CAMSpreferred. • Strong analytical, leadership, and communication skills with the ability to influence across levels. • Experience navigatingregulatoryandcomplianceenvironments, particularly CMS,HIPAA, and related frameworks. Key Responsibilities Strategic Leadership • Define and lead the enterprise fraud management strategy across NationsBenefits' platforms, including payments, OTC/Flex benefit cards, and digital storefronts. • Serve as the internal thought leader on emerging fraud threats and prevention tactics related to Medicare Advantage supplemental benefits and consumer healthcare commerce. • Build and manage a multidisciplinary fraud team focused on analytics, investigation, controls, and enablement. Fraud Detection, Investigation, and Response • Design and operate data-driven detection systems to identify suspicious behavior, fraud attempts, and anomalous transactions. • Lead internal investigations in collaboration with compliance, legal, and external partners, ensuring timely and accurate resolution. • Manage internal escalation processes, risk scoring models, and fraud response protocols. Fraud Tool Evaluation and Selection • Own the end-to-end technology strategy for fraud detection and prevention tools. • Evaluate and recommend fraud management solutions, considering whether tobuild in-housebuy commercial platforms, orpartner with specialized vendors • Partner with Engineering, Product, and Procurement teams to execute technology decisions that support both scalability and compliance. • Stay current with innovations in fraud tech (e.g., machine learning, behavioral biometrics, device fingerprinting) and their applicability to healthcare and fintech use cases. Compliance & Risk Oversight • Ensure that all fraud-related systems and processes meet regulatory expectations, including CMS, HIPAA, and SOC 2 standards. • Develop internal policies and audit-ready documentation to support fraud risk assessments and compliance reviews. • Maintain robust controls to minimize financial losses and reputational risk. Reporting & Metrics • Define KPIs and dashboards that provide real-time visibility into fraud trends, case resolution, and operational performance. • Report regularly to executive leadership and regulatory stakeholders on fraud risk posture and incident trends. Training & Cross-Functional Collaboration • Drive fraud education and training programs across departments. • Collaborate closely with Compliance, Legal, Engineering, Data Science, and external vendors to foster a unified approach to fraud mitigation.