Senior Fraud, waste and abuse Officer

؜ - ؜القاهرة ؜ -

تفاصيل الوظيفة

Job Description



  • In collaboration with the Corporate Compliance Officer and other business unit leaders, develop and maintain FWA policies and procedures and implement a comprehensive FWA program

  • Develop and maintain an FWA log and tracking system.

  • Independently researches FWA issues and effectively employ investigative resources/techniques.

  • Maximize the recoveries and avoidance for claims payments with a demonstrated ability to achieve results.

  • Work to develop prospective and retrospective fraud and abuse detection, investigation, recovery and avoidance.

  • Develop, translate, and execute strategies or functional/operational objectives for the company with regard to fraud, waste, and abuse.

  • Plan, organize, and execute investigations or audits utilizing document review, witness interviews and data analysis to identify, evaluate and measure potential fraud and abuse to determine valid cases for appropriate action

  • Utilize data mining and visualization programs to design queries and analyze claims data to detect outliers or suspicious patterns for further investigation

  • Follow-up with network & CRD team for any reported case.

  • Support corporate relation team and our clients with the requested analysis for I care utilization.

  • Provide regular analysis for I care utilization, monitoring any suspicious activity or medication abuse.

  • Follow up for any new initiative or project related to medications dispensing (ex-chronic posting initiative).

  • Make a regular audit on the paid claims and the issued approvals.

  • Support our claims and approval team in any reported suspected fraud / abuse case.

  • Deliver and improve business functions, and use project management disciplines to support the delivery of key initiatives.

  • Depute team leaders in tasks follow up and initiative implementation.

  • Maintain full compliance of department to AXA standards and reactivity/contribution to all compliance processes

  • Participate in all departmental meetings and support new comers.


Skills



  • Bachelor of medicine is a must.

  • Previous experience is a must (‎5 years minimum in insurance field)

  • Excellent organizational and planning skills

  • Reliable and trustworthy

  • English / Computer Skills

  • Bachelor of medicine or Bachelor in Pharmaceutical sciences

  • Ability to accurately create reports

  • Detail Oriented

  • Strong Analytical Skills


Job Details


Job Location
Cairo, Egypt
Job Role
Medical, Healthcare, and Nursing


Preferred Candidate


Career Level
Mid Career
Years of Experience
Min: ‎5

ملخص الوظيفة

  • المُعلن : AXA Egypt
  • تاريخ الإعلان : 11/09/2023
  • نوع العمل : -
  • مستوى الخبرة : -
  • المستوى التعليمي : -
  • مكان العمل : القاهرة
  • الراتب : -
  • الهاتف : -

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