Officer – Fraud, Waste & Abuse (FWA) Auditor

About the role

The Officer – FWA supports the execution of claims audits and investigations to detect, review, and report potential Fraud, Waste, and Abuse. This role works under supervision to ensure compliance, accurate documentation, and timely reporting within our managed‑care environment.

Key responsibilities

• Conduct off‑site and on‑site claims audits to identify FWA indicators.
• Prepare audit samples, maintain audit documentation and case files.
• Investigate discrepancies, escalate suspicious findings, and monitor cases through resolution.
• Produce audit summaries, case reports, and final audit reports for management.
• Analyze provider irregularities, utilization trends, and payment discrepancies.
• Generate weekly, monthly, quarterly, and annual FWA reports, including recoveries and outcomes.
• Prepare and submit regulatory FWA reports in line with compliance requirements.
• Maintain audit logs, recovery trackers, and other performance monitoring tools.
• Collaborate with cross‑functional teams and provide productivity updates to the Team Lead.

Required profile

• Bachelor’s degree in insurance, medicine, paramedicine, or a related discipline.
• 1‑3 years of experience in the insurance market (TPA, insurance company, or healthcare provider).
• Proven experience conducting on‑site and off‑site audits and handling FWA investigations.
• Audit or coding certifications are preferred.

Required skills

• Data analytics tools

What we offer

• Opportunity to contribute to cost‑containment and payment‑integrity initiatives.
• Collaboration with a global managed‑care organization.
• Professional development within a leading insurance and healthcare solutions provider.