Senior Officer – Fraud, Waste & Abuse (FWA)

About the role

Munich Re’s MedNet Global Health Care Solutions L.L.C. is seeking a Senior Officer to lead proactive fraud, waste and abuse investigations within its healthcare claims portfolio. The role focuses on conducting off‑site and on‑site audits, ensuring compliance, and delivering actionable insights to support cost containment and payment integrity.

Key responsibilities

• Lead medium to complex healthcare FWA investigations through claims analysis, provider audits, and medical record reviews.
• Analyze claims data, develop audit samples and analytical methodologies to detect suspicious trends and billing irregularities.
• 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 with accuracy and timely submission.
• Monitor provider irregularities, utilization trends and payment discrepancies, providing actionable recommendations.
• Collaborate with cross‑functional teams (Claims, Network, Medical, Analytics) to strengthen fraud prevention and risk mitigation.
• Mentor auditors, promote knowledge sharing and contribute to process improvement and automation initiatives.

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.
• Strong proficiency in MS Office, especially Excel, and experience with data analytics tools.
• Audit and coding certificates are an advantage.

Required skills

• Excel
• Data analytics tools