Officer - FWA
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As a member of Munich Re the MedNet Global Health Care Solutions LLC is one of the leading managed care service organizations that caters to healthcare needs We are currently looking for a Officer FWA supports the execution of claims audits and investigations to detect review and report potential Fraud Waste and Abuse FWA The role focuses on assisting in off-site and on-site audits of claims files ensuring accurate documentation timely reporting and compliance with company policies and regulatory requirements The position contributes to cost containment and payment integrity initiatives under supervision
Your Job
- Conduct claims audits to identify potential Fraud Waste amp Abuse FWA indicators and ensure compliance with internal policies and controls
- Prepare audit samples perform off-site and on-site audits and maintain accurate audit documentation and case files
- Investigate discrepancies escal suspicious findings to the Team Lead and monitor pending cases through to resolution and recovery
- Prepare clear audit summaries case reports and final audit reports for management review and case closure
- Analyze provider irregularities utilization trends and payment discrepancies to identify potential risks and improvement opportunities
- Produce weekly monthly quarterly and annual FWA reports including audit findings sampling methodology recoveries and outcomes
- Prepare and submit regulatory FWA reports in accordance with applicable compliance and reporting requirements
- Maintain audit logs recovery trackers and other reporting tools to ensure accurate monitoring of audit activities and performance
- Collaborate with cross-functional teams promote knowledge sharing and provide regular productivity updates to the Team Lead on planned versus completed activities
Your profile
Minimum Qualifications and Experience
- A bachelor s degree in insurance, Medicine, Paramedicine, or related discipline is required. Audit and Coding certifications preferred.
- 1-3 years experience within the insurance market (TPA, Insurance Company, or Healthcare Provider).
- Proven experience conducting on-site and off-site audits and handling FWA investigations in the market.
- Experience with data analytics tools.
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