مسؤول أول لمكافحة الاحتيال والهدر وإساءة الاستخدام

As a member of Munich Re the MedNet Global Health Care Solutions L.L.C. is one of the leading managed care service organizations that caters to healthcare needs. We are currently looking for a Senior Officer – FWA is responsible for the proactive management of claims analysis / audits to detect, investigate, address, and prevent Fraud, Waste, and Abuse (FWA). The role supports cost containment, quality assurance, and payment integrity initiatives through structured off-site and on-site audits of both open and closed claims files. The position ensures timely audit completion, accurate documentation, appropriate recovery actions, and comprehensive reporting in alignment with regulatory requirements and company policies.

Your Job:

- Lead medium to complex healthcare fraud, waste & abuse (FWA) investigations through claims analysis, provider audits, and medical record reviews.

- Analyze claims data and develop audit samples and analytical methodologies to identify suspicious trends, billing irregularities, and overutilization.

- Conduct onsite and offsite provider audits, including pre-authorization reviews, claims validation, and provider interviews.

- Ensure compliance with internal controls, contractual obligations, and regulatory requirements throughout the audit lifecycle.

- Prepare comprehensive audit, recovery, and regulatory reports, ensuring accuracy, quality, and timely submission.

- Monitor provider irregularities, utilization trends, and payment discrepancies, providing actionable insights and recommendations.

- Collaborate with cross-functional teams including Claims, Network, Medical, and Analytics to strengthen fraud prevention and risk mitigation efforts.

- Support team development by mentoring auditors, promoting knowledge sharing, and contributing to process improvement, automation, and fraud control initiatives.

Your profile:

Minimum Qualifications and Experience:

• - Bachelor’s or master’s degree in insurance, Medical, or Paramedical fields.
• - Audit and Coding certificates is an advantage.
• - 3–5 years’ experience within the UAE insurance market (TPA, Insurance Company, or Healthcare Provider).
• - Proven experience conducting on-site and off-site audits and handling FWA investigations in the UAE market.
• - Excellent English communication skills.
• - Strong proficiency in MS Office, especially Excel.
• - Experience with data analytics tools.

*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunity employer.