FWA Officer – Omani National Required

About the role

MetLife is seeking an Omani national to lead Fraud, Waste & Abuse (FWA) oversight and managed‑care network performance. The role combines risk management, TPA governance, and provider network auditing to protect the organization from fraudulent claims and ensure high‑quality care delivery.

Key responsibilities

• Lead FWA detection and prevention, governing tools, rules, and investigation frameworks.
• Escalate, investigate, and close suspected FWA cases in coordination with TPAs.
• Continuously improve FWA controls, analytics, and reporting in partnership with TPA governance.
• Act as central governance point for TPA operations, monitoring SLAs, KPIs, and contractual compliance.
• Assess TPA claims adjudication quality, accuracy, and consistency.
• Oversee provider performance and billing behavior using TPA data, conduct onsite and offsite audits, and support corrective actions.
• Collaborate with internal teams (Claims, Medical, Compliance, Finance) and external stakeholders, presenting insights and recommendations to management.

Required profile

• 3‑5 years of experience with provider or payer organizations, strong knowledge of billing patterns and coding.
• Proven track record in data analytics and identifying fraud patterns within claims.
• Ability to develop creative solutions for medical quality management and stakeholder feedback mechanisms.
• Graduate degree preferred; MBA, nursing, pharmaceutical or medical degree considered an asset.

Required skills

• Data analytics

What we offer

• Opportunity to influence fraud prevention strategy within a global insurer.
• Collaboration with cross‑functional teams and external partners.
• Professional development in managed‑care and compliance domains.