The role involves conducting structured, risk-based fraud, waste, and abuse investigations to support effective detection and prevention
Job Summary
The role involves conducting structured, risk-based fraud, waste, and abuse investigations to support effective detection and prevention.
Candidates will analyze claims, transactional, and behavioral data to identify suspicious patterns and abnormal behaviors using analytics-supported approaches.
The position requires collaborating with the Special Investigation Unit and claims operations to strengthen fraud detection capabilities and improve investigation effectiveness.
Matching Summary
The role involves conducting structured, risk-based fraud, waste, and abuse investigations to support effective detection and prevention.
Skills & Requirements
Must-have
Conduct fraud waste and abuse investigations
Analyze claims transactional and behavioral data
Perform end-to-end fraud investigation activities
Utilize claims analytics and AI-enabled insights
Verify claim documentation for forged information
Nice-to-have
Collaborate with Special Investigation Unit stakeholders
Support adoption of digital tools and analytics
Participate in knowledge-sharing and training sessions
Identify emerging fraud typologies and patterns
Maintain professionalism during claimant interviews
Key Requirements
Experience in fraud investigation frameworks
Knowledge of regulatory and confidentiality requirements
Ability to conduct claimant and provider interviews