We’re committed to bringing passion and customer focus to the business.
Your Responsibilities
- You review and analyze triggered cases based on pre- and post-payment risk assessments and take appropriate action.
- You assist in analyzing files that are passed on to the FWA team for suspected fraud, waste or abuse.
- You support the team of investigators in gathering facts on suspected cases with a special focus on African health care providers.
- You give advice for claims release and track steps taken accordingly.
- You assist in reaching out to suspected providers in Africa and conduct fact-finding interviews.
- You help reveal patterns of fraud, waste or abuse in your designated region through data-mining exercises.
- Based on your initial analysis, you are able to summarize your findings in a report, to be directed to the region’s senior investigator.
- You follow-up with stakeholders to ensure deadlines are met and any delays are communicated proactively.
- You manage your workload proactively, communicating with your manager any risks or challenges to targeted completion dates.
- You are able to identify and take an active role in optimizing workflows of the department.
- You take initiative and show confidence in your correspondence with internal and external parties.
YOUR PROFILE
- You have a bachelor degree or equivalent through experience. Any prior experience in the field is preferred.
- You have an excellent knowledge of English and French. Any additional languages are a plus.
- Good medical knowledge or a strong interest in exploring the medical field is preferred.
- You have a strong knowledge of Microsoft Office, especially Excel.
- You are analytical and have a critical mindset.
- You are decisive and able to work independently as well as within a team.
- You act with the highest integrity and respect for procedures and regulations.
- You work efficiently and accurately.
- You are excellent in setting priorities.
Qualified applicants will be considered without regard to race, color, age, disability, sex (including pregnancy), childbirth or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
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