WHAT DOES AN INVESTIGATIONS ANALYST DO?
Updated: Dec 11, 2025 - The Investigations Analyst analyzes claim and member data, conducts financial and fraud-related analyses, and prepares detailed reports to identify corporate losses, restitution activities, and ineligible claims. This role involves supporting fraud investigators by researching, collecting, and evaluating data, interpreting policies, and maintaining specialized departmental files and documentation. The Analyst also collaborates with other departments, provides training on analytical tools and claims systems, and contributes to special projects and task forces to improve investigative efficiency.
A Review of Professional Skills and Functions for Investigations Analyst
1. Investigations Analyst Responsibilities
- Fraud Detection: Proactively investigate and identify potentially fraudulent risk factors and trends.
- Fraud Monitoring: Maintain an appropriate level of oversight to detect fraudulent activity.
- Fraud Investigation: Investigate referrals of unusual activity relating to fraud.
- Data Analysis: Use SQL to size the potential impact of specific fraud trends and to understand the user impact of mitigation strategies.
- Stakeholder Communication: Liaise and report to external stakeholders, including external banks.
- Root Cause Analysis: Support investigations and root cause analysis into events to identify main fraud typologies (scam claims) and suggest risk mitigation actions.
- Claims Resolution: Effectively resolve all claims in an accurate and timely manner.
- Documentation Management: Document all investigations, approvals, and rejections.
2. Investigations Analyst Job Summary
- Data Analysis: Provide real-time event data and analysis to assist key partners with operational decisions.
- Operational Communication: Communicate issues, trends, and upcoming events, and provide analysis to assist with operational and staff planning.
- Team Support: Assist in handling the day-to-day functions of a team of regional analysts.
- Open-Source Research: Prepare and assist with any requests or products requiring open-source analytic support.
- Investigative Support: Provide investigative support, after-action reviews, and information sharing.
- Reporting and Presentation: Prepare and assist with reporting, presentations, and overall awareness efforts.
- Issue Escalation: Identify and escalate potential issues discovered during open-source research.
- Threat Monitoring: Communicate issues and trends with potential impact across both physical and cyber verticals.
- Collaboration: Collaborate and share information on upcoming issues and events with potential security impact.
3. Investigations Analyst Accountabilities
- Incident Management: Assist in managing privacy incidents and conducting related investigations to ensure timely and effective resolution.
- Policy Development: Support the review and development of privacy policies to maintain compliance with evolving regulatory standards.
- Training Design: Contribute to the design and delivery of privacy awareness training, creating targeted course content based on real incident experiences.
- Research and Analysis: Conduct research and analysis on privacy and data security issues to provide informed insights and recommendations.
- Regulatory Compliance: Help the team interpret and apply regulatory requirements related to privacy and data protection.
- Cross-Department Collaboration: Collaborate with privacy offices, as well as IT and risk management departments, to align on enterprise-wide privacy and data security initiatives.
- Documentation Support: Assist in drafting guidance materials and documentation to support ongoing privacy compliance efforts.
- Meeting Participation: Participate in cross-functional meetings to ensure consistent application of privacy practices across the organization.
- Regulatory Monitoring: Monitor trends and emerging regulations in data protection to keep the team updated on potential compliance impacts.
- Record Maintenance: Maintain detailed records of incidents, reviews, and training activities to support audit readiness and transparency.
4. Investigations Analyst Functions
- Financial Crime Detection: Identify and investigate suspicious activity in relation to financial crime within the client base.
- Transaction Monitoring: Conduct effective transaction monitoring on large volumes of payments.
- Rule Development: Contribute to the building of new transaction monitoring rules targeting unusual and suspicious activity across a diverse client portfolio of payment service providers.
- Investigation and Reporting: Show confidence in conducting complex and in-depth financial crime investigations and submitting suspicious activity reports to the relevant authority.
- Due Diligence: Conduct ongoing due diligence on clients using credit reporting software and open-source intelligence.
- Information Requests: Issue requests for information to clients as part of wider investigations.
- Client Liaison: Confidently liaise with external clients to build a comprehensive picture of payment flows and information relating to the source of funds.
- Data Analysis: Compile effective management information to identify patterns in financial crime-related behaviour and any key fraud or AML findings.
- Stakeholder Communication: Liaise with relevant stakeholders and counterparts in relation to financial crime matters.
- Risk Assessment: Provide opinions and recommendations regarding higher-risk customer relationships and transactions.
- Compliance Projects: Undertake ad hoc compliance-related projects.
5. Fraud Investigations Analyst Job Description
- Policy Compliance: Understand and follow company policies and procedures on invoice entry, transaction processing, and account creation in digital systems.
- Fraud Investigation: Carry out the vision and mission of the investigations team to prevent, detect, and investigate potential fraud scenarios using transactional data.
- Risk Mitigation: Identify and clearly define issues and root causes of potential fraud and provide recommendations on controls to mitigate associated risks.
- Audit Execution: Execute audits, deep dives, and special projects on time while communicating recommendations and findings to management and relevant stakeholders.
- Data Analytics: Collaborate with technical teams to create and test new analytics and examine data sets to identify trends and suspicious behaviors.
- Process Improvement: Propose process improvement ideas and work with other teams to implement solutions that enhance control and efficiency.
- Performance Management: Maintain productivity targets and adhere to established timelines.
- Team Coordination: Coordinate tasks with team members, including other finance operations teams, on activities assigned to the group.
6. Investigations Analyst Overview
- Merchant Monitoring: Review the first-order channel daily for unusual merchant activity and potentially suspicious merchants.
- Onboarding Quality Assurance: Quality-assure the onboarding process of new merchants via the internal system.
- Account Investigation: Conduct both triggered and data-driven analysis and investigations into customer and merchant accounts.
- Reporting Development: Develop and review reporting on offboarded merchants and customers.
- Referral Management: Develop and manage the internal and external suspicious activity referral process.
- Activity Review: Review inbound referred suspicious activity.
- Team Coordination: Coordinate with fraud and risk teams.
- Regulatory Communication: Collaborate with and communicate complex regulatory requirements to internal partners and stakeholders, including merchant operations, account management, and customer experience teams.
- Information Sharing: Develop and manage a global information-sharing process to share potentially suspicious activity with global internal partners.
- Data Analysis: Leverage business intelligence and visualization tools to conduct data analytics and network analysis.
- Policy Support: Support AML teams in developing and maintaining AML-related policies and procedures.
- Identity Verification: Collaborate with product, engineering, and external vendors to enhance merchant identity validation.
7. Investigations Analyst Details and Accountabilities
- Data Investigation: Proactively identify investigations by extracting data evidence from internal reports, analyzing data, reviewing theft incidents, dashboards, queries, and identifying theft trends both internally and externally.
- Open-Source Intelligence: Conduct thorough public records research and open-source intelligence gathering to support investigative efforts.
- Root Cause Analysis: Perform root cause analysis to determine how to prevent future theft or fraud incidents and influence operational best practices with key stakeholders.
- Report Preparation: Prepare detailed reports of investigative findings and communicate results to relevant stakeholders.
- Query Development: Create and maintain queries that identify anomalies for future investigative research.
- Fraud Mitigation: Leverage fraud detection models and strategies to mitigate fraud and loss while minimizing impact on customers and operations.
- Performance Tracking: Develop, enhance, and track performance metrics and key indicators to measure effectiveness and ensure timely achievement of goals.
- Workload Management: Manage expectations by prioritizing workload, providing project visibility, and updating managers on timelines and deliverables.
- Cross-Functional Collaboration: Collaborate with cross-functional teams to address fraud risks and conduct investigations.
- Regulatory Compliance: Ensure internal controls and compliance with applicable regulatory requirements related to the area of responsibility.
- Interviewing Skills: Conduct interviews as part of investigative procedures to gather evidence and insights.
8. Investigations Analyst Tasks
- Data Analysis: Analyze and prepare reports such as claim and member data analysis using database and analytical tools.
- Financial Analysis: Conduct financial analysis to compile corporate losses and court restitution activity.
- Case Resolution: Resolve non-prosecutable inquiries and cases such as ineligible dependents and billing or processing errors.
- Law Enforcement Communication: Communicate directly with law enforcement personnel at the request of the fraud investigator.
- Staff Training: Provide on-the-job training to fraud investigators and management staff, sharing technical knowledge of company products, policies, and procedures.
- System Training: Train fraud investigators on the analysis and interpretation of all claims systems, transactions, utilization files, and field descriptions.
- Investigative Support: Provide investigative staff support through the research, collection, and evaluation of data, along with the interpretation of policies concerning benefits, membership, reimbursement, and provider enrollment.
- File Management: Maintain specialized department files, including recovery referrals, provider exclusion lists, utilization review files, participation records, and corporate documentation.
- Project Development: Assist in project development and data gathering for new initiatives.
- Department Liaison: Act as a liaison with other departments and represent the team on various task forces and work groups.
- Research Studies: Research and prepare special studies.
9. AML Investigations Analyst Roles
- AML Review: Exercise independent and professional judgment when reviewing AML investigations to ensure adherence to all policies, procedures, and regulatory standards.
- Case Monitoring: Monitor the aging of cases and escalate issues to maintain compliance with timeliness requirements.
- Model Testing: Participate in Below-the-Line (BTL) and Above-the-Line (ATL) testing to enhance model accuracy and overall effectiveness.
- Regulatory Awareness: Stay informed about new rules, regulations, and reputational risks to continuously improve investigation processes and methodologies.
- Compliance Management: Understand business and regulatory requirements, ensuring all functions are performed in compliance with applicable laws and internal standards.
- Typology Expertise: Maintain a comprehensive understanding of internal AML typologies related to correspondent banking, private banking, and investment banking clients.
- Complex Investigation: Manage complex investigations involving multiple relationship accounts, layered or structured transactions, international wires linked to high-risk jurisdictions, and other intricate financial activities to identify potential money laundering or related financial crimes.
- Research Collaboration: Utilize both internal and external data sources and collaborate with stakeholders across departments to conduct thorough research and investigations.
- Technical Coordination: Liaise with technology teams to address production issues, coordinate software updates, and participate in user acceptance testing (UAT) to ensure system effectiveness.
- SAR Reporting: Draft and file suspicious activity reports (SARs) accurately and in accordance with regulatory deadlines and requirements.
10. Fraud Investigations Analyst Additional Details
- Operational Leadership: Design and influence operational best practices within the fraud response team to enhance efficiency and effectiveness.
- Program Management: Manage the daily execution of new and specialized programs aimed at improving fraud detection and prevention.
- Trend Analysis: Analyze diverse data sources to identify fraud trends and proactively develop strategies to detect and mitigate new fraud techniques, tactics, and procedures.
- Fraud Pattern Analysis: Examine fraud data to uncover sophisticated patterns and behaviors associated with fraudulent activity.
- Countermeasure Deployment: Deploy countermeasures against emerging fraud schemes and evaluate their impact.
- SQL Analytics: Monitor evolving fraud clusters and propose new rule criteria using SQL to strengthen detection capabilities.
- Performance Optimization: Analyze rule performance trends to ensure effectiveness and optimize fraud prevention measures.
- Reporting and Insights: Report on daily fraud trends, cluster characteristics, and emerging methods of operation, sharing insights with the broader fraud community.
- Research Collaboration: Collaborate with data scientists and research scientists to design and implement long-term protective strategies.
- Escalation Analysis: Conduct deep-dive analyses and prepare detailed summaries of complex and sensitive escalations for legal and fraud leadership.
- Risk Mitigation: Work with internal teams to develop corrective and preventive action plans that effectively mitigate risk.
- Process Improvement: Partner with stakeholders to drive process improvements benefiting both internal operations and customer experience.
- Project Leadership: Contribute to and lead special projects aimed at reducing fraud-related losses while maintaining a positive customer experience.
- Innovation Support: Support innovation in fraud prevention by participating in internal proof-of-concept initiatives.
- Investigation Leadership: Lead deep-dive investigations and prepare executive escalation summaries for senior management.
- Cross-Functional Collaboration: Collaborate with cross-functional teams to address fraud risks and investigations comprehensively.
- Tool Development: Work with team members to define and prioritize feature needs for investigative tools and technologies.