Fraud & Waste Avoidance (FWA) Manager – Claims Investigation

About the role

The FWA Manager oversees claim verification, coordinates field investigations, and ensures fraud detection processes meet company targets and quality standards. This role requires close collaboration with vendors, field officers, and internal teams while maintaining strict confidentiality.

Key responsibilities

• Analyze claim verification requests, create customized questionnaires, and allocate claims for field investigation.
• Monitor and guide field officers, ensuring investigations follow triggers and protocols, and capture daily updates.
• Verify evidence collected, request rework when needed, and ensure coverage of key parameters (insured, hospital, doctor, lab, pharmacy).
• Coordinate with vendors to produce closure reports, close FWA cases in the ABHI portal, and communicate outcomes to the Central OPS team.
• Maintain claim tracking from allocation to closure, meeting defined turnaround times (TAT) and quality metrics.
• Work remotely during nights, holidays, and weekends as required, adhering to digital work‑ethics guidelines.
• Identify and report fraudulent patterns, contributing to cost reduction and business growth.

Required profile

• Strong analytical mindset with attention to detail.
• Ability to manage multiple investigations simultaneously while meeting strict deadlines.
• Excellent communication skills for coordinating with vendors, field officers, and senior management.
• Commitment to confidentiality and data protection.

Required skills

• Microsoft Teams

What we offer

• Opportunity to impact fraud reduction and cost savings.
• Flexible remote work arrangements.
• Collaborative environment with clear performance targets.