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About the Role
Assess outpatient and inpatient hospitalization claims from Group policyholders as per stipulated benchmarks and requirements.Perform end‑to‑end FWA investigationsin accordance with established investigation frameworks, governance standards and confidentiality requirements
Identify, analyze and assess suspicious or potentially fraudulent claimsby reviewing claims documentation and interpreting transactional, behavioral and historical claims data
Apply risk‑based investigation techniques to prioritize cases, balancing investigation depth, timeliness and potential financial or reputational impact
Conduct claimant, provider or third‑party interviews where required, ensuring adherence to investigation protocols, professionalism and no...