Senior Officer - FWA

Role overview

Key responsibilities

• Lead medium-to-complex FWA investigations through claims analysis, provider audits, and medical-record reviews.
• Analyze claims data and design audit samples and methodologies to identify suspicious trends, billing irregularities, and overutilization.
• Conduct on-site and off-site provider audits, pre-authorization reviews, claims validation, and provider interviews.
• Ensure compliance with internal controls, contractual obligations, and regulatory requirements throughout audits.
• Prepare accurate and timely audit, recovery, and regulatory reports.
• Monitor provider irregularities, utilization trends, and payment discrepancies and recommend actions.
• Work with Claims, Network, Medical, and Analytics teams on fraud prevention and risk mitigation.
• Mentor auditors and contribute to knowledge sharing, process improvement, automation, and fraud-control initiatives.

Qualifications and experience

• Bachelor’s or master’s degree in insurance, medical, or paramedical fields.
• 3–5 years’ experience in the UAE insurance market, including a TPA, insurer, or healthcare provider.
• Experience conducting on-site and off-site audits and handling FWA investigations in the UAE market.
• Excellent English communication skills.
• Strong MS Office proficiency, especially Excel.
• Experience with data analytics tools.
• Audit and coding certificates are advantageous.