Senior Officer – Fraud, Waste & Abuse (FWA)

About the role

We are seeking a Senior Officer to lead proactive fraud, waste and abuse (FWA) investigations within our healthcare claims environment. The role focuses on analysing claims, conducting audits and ensuring compliance with regulatory and company standards.

Key responsibilities

• Lead medium to complex FWA investigations through claims analysis, provider audits and medical record reviews.
• Develop audit samples and analytical methodologies to detect suspicious trends, billing irregularities and over‑utilisation.
• Conduct on‑site and off‑site 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 timeliness.
• Monitor provider irregularities, utilisation trends and payment discrepancies, delivering actionable insights.
• Collaborate with Claims, Network, Medical and Analytics teams to strengthen fraud prevention and risk mitigation.
• Mentor auditors, promote knowledge sharing and contribute to process improvement, automation and fraud control initiatives.

Required profile

• Bachelor’s or master’s degree in insurance, medical or paramedical fields.
• 3–5 years of 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 Excel.
• Experience with data analytics tools.