- 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.
- Bachelor degree or equivalent through experience. Any prior experience in the field is preferred.
- Excellent knowledge of French (Written and Spoken) Any additional languages is a plus.
- Good medical knowledge or a strong interest in exploring the medical field is preferred.
- Strong knowledge of Microsoft Office, especially Excel.
- Analytical and have a critical mindset.
- 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.
If you are interested in this position, please submit your resume.