Job Description
Fraud, Waste & Abuse Investigator
Job Description
Key Responsibilities & Accountabilities:
Design, implement, and maintain a comprehensive FWA program aligned with industry best practices and regulatory requirements. Implement FWA policies and procedures in collaboration with legal, compliance, and business units. Establish and oversee a robust FWA tracking and reporting system to monitor program effectiveness. Conduct regular FWA risk assessments to identify potential vulnerabilities and implement mitigation strategies. Support claims and approval team in any reported suspected fraud / abuse case. Conduct in-depth investigations of suspected fraud, waste, and abuse cases, utilizing advanced data analytics and investigative techniques. Develop and implement proactive fraud prevention strategies, including education and training programs for employees. Collaborate with internal and external stakeholders to share intelligence and best practices on fraud prevention. Develop and execute recovery plans for identified fraudulent claims. Conduct root cause analysis of fraud incidents to prevent recurrence. Implement cost-saving measures to reduce waste and optimize resource utilization. Prepare regular reports on FWA activities, including investigation outcomes, recoveries, and prevention initiatives. Provide expert advice and support on FWA matters to various departments within the organization. Ensure adherence to all applicable laws, regulations, and company policies related to FWA. Conduct regular audits and reviews of FWA processes and controls. Stay informed about emerging fraud trends and industry best practices. Contribute to the development and implementation of compliance initiatives.
Skills
Education / Certification:
Bachelor of medicine or Bachelor in Pharmaceutical sciences. Previous experience in relevant fields (3 years minimum in insurance field)
Soft Skills & Behavioral Competencies:
Excellent organizational and planning skills Reliable and trustworthy English / Computer Skills Ability to accurately create reports Detail Oriented Strong Analytical Skills
Job Location Cairo, Egypt Job Role Other
