The role involves conducting structured, risk-based fraud, waste, and abuse investigations to support effective detection and mitigation
Job Summary
The role involves conducting structured, risk-based fraud, waste, and abuse investigations to support effective detection and mitigation.
Candidates will analyze claims, transactional, and behavioral data to identify suspicious patterns and emerging fraud typologies.
The position requires collaboration with the Special Investigation Unit and claims operations to enhance risk indicators and investigation effectiveness.
Matching Summary
The role involves conducting structured, risk-based fraud, waste, and abuse investigations to support effective detection and mitigation.
Skills & Requirements
Must-have
Conduct fraud waste and abuse investigations
Analyze claims transactional and behavioral data
Perform end-to-end FWA investigations
Identify suspicious patterns and emerging typologies
Verify claim documentation for forged information
Utilize AI-enabled insights for case assessment
Nice-to-have
Collaborate with stakeholders to strengthen detection
Participate in knowledge-sharing activities
Support claims processing during peak periods
Contribute to fraud trend monitoring
Adhere to non-tipping-off principles
Key Requirements
Experience in fraud investigation frameworks
Knowledge of governance and regulatory requirements
Ability to conduct claimant or provider interviews