Requirements
Requires a Bachelor's or Master's degree in insurance, medical, or paramedical fields. Must have 3-5 years of experience in the UAE insurance market and proven experience conducting on-site and off-site audits and FWA investigations in the UAE. Excellent English communication skills and strong proficiency in MS Office, especially Excel, are required. Experience with data analytics tools is also necessary. Audit and coding certificates are advantageous.
Description
Job description / Role
Job Type
Full Time
Job Location
Dubai, UAE
Nationality
Any Nationality
Salary
Not Specified
Gender
Not Specified
Arabic Fluency
Not Specified
Job Function
Accounting & Audit
Company Industry
Insurance
About the role
As a member of Munich Re, MedNet Global Health Care Solutions L.L.C. is one of the leading managed care service organizations that caters to healthcare needs. We are currently looking for a Senior Officer - FWA who is responsible for the proactive management of claims analysis and audits to detect, investigate, address, and prevent fraud, waste, and abuse (FWA). The role supports cost containment, quality assurance, and payment integrity initiatives through structured off-site and on-site audits of both open and closed claims files. The position ensures timely audit completion, accurate documentation, appropriate recovery actions, and comprehensive reporting in alignment with regulatory requirements and company policies.
Your job
Lead medium to complex healthcare fraud, waste, and abuse (FWA) investigations through claims analysis, provider audits, and medical record reviews.
Analyze claims data and develop audit samples and analytical methodologies to identify suspicious trends, billing irregularities, and overutilization.
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, ensuring accuracy, quality, and timely submission.
Monitor provider irregularities, utilization trends, and payment discrepancies, providing actionable insights and recommendations.
Collaborate with cross-functional teams including Claims, Network, Medical, and Analytics to strengthen fraud prevention and risk mitigation efforts.
Support team development by mentoring auditors, promoting knowledge sharing, and contributing to process improvement, automation, and fraud control initiatives.
Qualifications
Your profile
Minimum qualifications and experience:
Bachelor's or master's degree in insurance, medical, or paramedical fields.
Audit and coding certificates are an advantage.
3-5 years' experience within the UAE insurance market (TPA, insurance company, or healthcare provider).
Proven experience conducting on-site and off-site audits and handling FWA investigations in the UAE market.
Excellent English communication skills.
Strong proficiency in MS Office, especially Excel.
Experience with data analytics tools.
Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunity employer.
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