As a member of Munich Rethe 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 is responsible for the proactive management of claims analysis / 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 & 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.
Your profile:
Minimum Qualifications and Experience:
*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunity employer.
MedNet is a managed care service provider of quality solutions that meet an individual's long-term healthcare needs and offers financial protection against unforeseen health crisis and expenses.
We work with stakeholders to provide access to high-quality healthcare for our members while ensuring that better healthcare outcomes are achieved within the parameters of optimized healthcare costs. With an experience of more than two decades, MedNet is well positioned as the leading managed care service organization, specializing in health risk management, in the region.
Our services reach beyond mere provision of administrative support for healthcare products and are enhanced by product design, pricing support, medical risk evaluation, medical management, healthcare provider (network) management, claims management, training and consulting services.
Together with our mother company, Munich Health (One of the three business segments of Munich RE Group), we are also able to offer risk finance solutions starting from traditional reinsurance products to sophisticated financial reinsurance arrangements.
