Officer - Fraud, Waste and Abuse (FWA)

About the role

Munich Re's MedNet Global Health Care Solutions L.L.C., a managed care service organization, is looking for an Officer - FWA. The role supports the execution of claims audits and investigations to detect, review and report potential Fraud, Waste and Abuse (FWA). It involves off-site and on-site audits of claims files, accurate documentation and timely reporting, and contributes to cost containment and payment integrity under supervision.

Key responsibilities

• Conduct claims audits to identify FWA indicators and ensure compliance with internal policies and controls.
• Prepare audit samples, carry out off-site and on-site audits, and keep accurate audit documentation and case files.
• Investigate discrepancies, escalate suspicious findings to the Team Lead, and follow pending cases through resolution and recovery.
• Write audit summaries, case reports and final audit reports for management review and case closure.
• Analyze provider irregularities, utilization trends and payment discrepancies to spot risks and improvement opportunities.
• Produce weekly, monthly, quarterly and annual FWA reports, including findings, sampling methodology, recoveries and outcomes.
• Submit regulatory FWA reports in line with compliance and reporting requirements.
• Maintain audit logs, recovery trackers and other reporting tools.
• Work with cross-functional teams, share knowledge and give the Team Lead regular productivity updates.

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 and coding certifications preferred.