Senior Officer – Fraud, Waste & Abuse (FWA)

About the role

The Senior Officer – FWA will lead medium to complex investigations into healthcare fraud, waste and abuse. This role supports cost containment, quality assurance and payment integrity through structured audits of claims.

Key responsibilities

• Lead investigations through claims analysis, provider audits and medical record reviews.
• Develop audit samples and analytical methodologies to spot suspicious trends and billing irregularities.
• Conduct onsite and offsite provider audits, including pre‑authorization reviews and provider interviews.
• Prepare comprehensive audit, recovery and regulatory reports ensuring accuracy and timely submission.
• Monitor provider irregularities, utilization trends and payment discrepancies, providing actionable recommendations.
• Collaborate with Claims, Network, Medical and Analytics teams to strengthen fraud prevention.

Required profile

• Bachelor’s or master’s degree in insurance, medical or paramedical fields.
• 3–5 years’ experience in the UAE insurance market (TPA, insurer or healthcare provider).
• Proven experience conducting on‑site and off‑site audits and handling FWA investigations in the UAE.
• Excellent English communication skills.

Required skills

• Strong proficiency in MS Office, especially Excel.
• Experience with data analytics tools.