FWA Audit & Investigations Officer

MedNet Global Healthcare Solutions LLC; Muscat; On-site; OMR 13,000 - 21,000; Full time

Job summary

Munich Re's MedNet Global Health Care Solutions L.L.C. seeks an Officer – FWA to support audits and investigations detecting Fraud, Waste, and Abuse in claims processing. You will conduct off-site and on-site audits, maintain case files, and prepare audit reports for management closure.

You will analyze payment discrepancies, collaborate with teams, and produce regular FWA insights while ensuring regulatory compliance and data accuracy.

Qualifications

• Bachelor’s degree in insurance, medicine, paramedicine, or related discipline is required.
• Audit and Coding certifications preferred.
• 1–3 years’ experience within the insurance market (TPA, Insurance Company, or Healthcare Provider).
• Proven experience conducting on-site and off-site audits and handling FWA investigations.
• Experience with data analytics tools.

Responsibilities

• Conduct claims audits to identify potential FWA indicators and ensure policy compliance.
• Prepare audit samples and perform off-site and on-site audits with complete documentation.
• Investigate discrepancies and escalate findings to Team Lead until resolution.
• Prepare audit summaries and final reports for management review and closure.
• Analyze provider irregularities, utilization trends, and payment discrepancies for risks and improvements.
• Produce regular FWA reports (weekly, monthly, quarterly, yearly) with findings and recoveries.
• Submit regulatory FWA reports per compliance requirements.
• Maintain audit logs and recovery trackers for monitoring activities.
• Collaborate with cross-functional teams and provide productivity updates.

Skills

Audit

Data analytics

FWA investigations

Compliance

Education

Bachelor's degree in Insurance/Medicine/Paramedicine

Tools

Audit software

Job description

Munich Re's MedNet Global Health Care Solutions L.L.C. seeks an Officer – FWA to support audits and investigations detecting Fraud, Waste, and Abuse in claims processing. You will conduct off-site and on-site audits, maintain case files, and prepare audit reports for management closure.

You will analyze payment discrepancies, collaborate with teams, and produce regular FWA insights while ensuring regulatory compliance and data accuracy.