Senior Fraud Analyst (Pharma)

The individual is responsible for leading compliance testing programs across online pharmaceutical and healthcare platforms. This role ensures compliance with prescription drug regulations, privacy standards, fraud prevention, and payment card brand requirements.

To oversee mystery shopping assignments that simulate pharmacy user journeys including prescription verification, checkout processes, and patient support interactions. The position requires deep expertise in pharmaceutical compliance, healthcare regulations, and online safety. You will lead a team of Senior Consultants and Analysts.

Key Responsibilities

• Design and manage pharma-focused secret shopping programs to test prescription and OTC product compliance.
• Evaluate websites for regulatory disclosures, NABP/LegitScript accreditation, and licensing validation.
• Verify compliance with HIPAA, GDPR, and other healthcare data privacy regulations.
• Conduct test transactions including both prescription and non-prescription products, verifying pharmacist consultation requirements.
• Monitor handling of controlled substances and verify prescription authenticity checks.
• Identify risks of fraud, counterfeit medications, and improper advertising practices.
• Collaborate with Legal, Compliance, and Risk teams to resolve escalated findings.
• Incorporate penetration testing or ethical hacking results into pharma-related digital platforms as needed.
• Manage and mentor Senior Consultants and Analysts, ensuring operational excellence and continuous development.
• Produce clear, evidence-based reports with regulatory impact assessments.

Qualifications

• Bachelor’s degree required (Pharmacy, Healthcare, Compliance, or related field). Advanced degree or professional certification preferred.
• 8–10 years of progressive experience in pharmaceutical compliance, healthcare risk management, fraud detection, or payments compliance.
• Practical knowledge of HIPAA, GDPR, FDA regulations, and international pharmaceutical standards.
• Ability to manage large-scale compliance testing programs with multi-disciplinary teams.
• Strong communication, risk assessment, and report writing skills.

Desired Attributes

• High ethical standards and commitment to patient safety.
• Strong analytical and regulatory interpretation skills.
• Resilient leader with ability to operate in complex and high-risk environments.
• Strategic thinker with capability to scale compliance operations across geographies.

Success Metrics

• Full compliance with pharma regulatory and payment brand requirements.
• Accurate detection of prescription, OTC, and controlled substance compliance gaps.
• Zero critical audit or card brand compliance violations.
• Timely, actionable compliance reports with clear recommendations.
• Strong retention and development of Senior Consultants and Analysts.