FWA Auditor

We are seeking a highly skilled Fraud, Waste & Abuse (FWA) Auditor to join our team. In this role, you will be at the forefront of detecting, preventing, and analyzing fraudulent activities in healthcare claims. You'll work with advanced technology and collaborate with diverse stakeholders to protect our company and clients from fraud, waste, and abuse.

Key Responsibilities:

Fraud Detection & Prevention

• Analyze healthcare claims data using medical insurance expertise
• Identify patterns and indicators of potential fraud, waste, or abuse
• Leverage advanced analytical systems and cutting-edge algorithms
• Conduct comprehensive data analysis to spot anomalies and discrepancies

Investigation & Compliance

• Perform thorough investigations of suspicious claims and billing activities
• Execute chargeback investigations and quality assurance reviews
• Ensure compliance with regulatory standards and internal policies
• Utilize technology-driven audit tools and fraud detection systems

Collaboration & Communication

• Work closely with internal teams and external stakeholders
• Prepare detailed reports and presentations for management
• Communicate findings, trends, and actionable recommendations
• Coordinate cross-departmental fraud analysis initiatives

Training & Development

• Design and deliver fraud prevention training programs
• Mentor team members on detection techniques and best practices
• Stay current with evolving fraud detection methodologies
• Contribute to continuous improvement of fraud prevention processes

Must-Have Qualifications:

• A Medical Doctor (MD) degree is required.

• Specialty: Family Medicine, Emergency Medicine, ICU/Critical Care, or Internal Medicine.

• Minimum 3–5 years of clinical practice experience.

• Experience in medical auditing, utilization review, or payer-side claims management.

• Knowledge of FWA detection methodologies and healthcare insurance systems.

• Experience working with UAE healthcare regulatory systems.

• Strong understanding of medical coding, payer rules, and clinical workflows.

• Excellent analytical and communication skills.

Nice-to-Have:

• Familiarity with healthcare technology platforms.

Why Join Us:

• Work at the intersection of healthcare and technology.

• Collaborate with a multidisciplinary team of clinicians, engineers, and product experts.

• Contribute to shaping tools that improve healthcare efficiency and integrity.

• Competitive compensation and growth opportunities.