Description
The Fraud Senior Analyst plays a critical role in protecting the organisation's International Health portfolio by leading Fraud, Waste and Abuse (FWA) investigations, driving measurable affordability outcomes, and strengthening prevention strategies across the claims lifecycle.
Operating with a high degree of independence, the Fraud Senior Analyst owns end-to-end investigative activities within a dedicated region. The role extends beyond case handling to include proactive identification of systemic risks, development of preventive controls, and partnership with regional and global stakeholders to enhance Payment Integrity strategy.
Key responsibilities:
- Lead FWA investigations across International Markets, applying investigative judgement to identify billing anomalies, emerging fraud typologies, and systemic risk patterns.
- Deliver quantifiable financial impact through cost containment, recoveries, and forward-looking prevention initiatives aligned to regional savings objectives.
- Translate data insights into actionable investigation strategies by partnering closely with Data and Analytics teams.
- Influence provider behavior through structured Provider audit engagement, negotiation, and collaboration with regional and global stakeholders.
- Drive continuous improvement of Payment Integrity processes by identifying operational gaps and proposing scalable solutions.
Requirements:
- Experience of investigation within payment integrity or similar discipline.
- Minimum of 4 years of health insurance or health care provider experience.
- Knowledge of Mainframe, GlobalCare, Actisure and / or Diamond essential.
- Knowledge of claims coding, regulatory rules and medical policy.
- Critical mind-set with ability to identify cost containment opportunities.
- Experience with data analytics.
- Demonstrated strong organisation skills.
- Strong attention to detail.
- Ability to quickly learn new and complex tasks and concepts.
- Excellent verbal and written communication skills.