MedNet Egypt is one of the leading managed care service organizations that caters to healthcare needs. We are looking for a skilled Team Leader, Medical (FWA) who will develop, translate, and execute strategies or functional/operational objectives for the company with regard to fraud, waste, and abuse. Develop and maintain an FWA log and tracking system.
Independently researches FWA issues and effectively employs investigative resources/techniques. team.
Your Role
- Lead and mentor a team of FWA investigators, providing coaching, training, and performance feedback.
- Develop, implement, and manage the team's FWA detection and investigation strategies.
- Analyze healthcare data to identify potential FWA red flags, such as billing irregularities, overutilization of services, and potential provider misconduct.
- Conduct thorough investigations into suspected FWA cases, following established protocols and legal guidelines.
- Prepare comprehensive case reports, documenting findings and recommendations.
- Collaborate with internal departments (e.g., Network, Claims) as needed.
- Stay up-to-date on the latest healthcare FWA trends and regulations.
- Handle all system-related issues for the Live or Beta MN+ environment.
- Follow up on PH utilization & Early detection of fraud and abuse cases, whether from the provider or client.
- Responsible for pre-payment checks for FWA.
- Communicate with the PICs and clients the FWA findings, reports, and savings.
- Monthly reporting of FWA cases and savings.
- Monthly reporting to each PIC on the members detected and the cases recovered.
Your Profile
- Bachelor’s degree in medicine, pharmacy, or dentistry.
- Minimum 3 years' experience in his\her educational field, with at least one year of which in a supervisory level.
- Minimum 4 years’ experience in Medical Management TPA / medical insurance sector.
- Computer literacy (MS Office, Excel, PowerPoint).
- Industry knowledge related to the local healthcare services system would be a plus.
- Good command of English.
- Attention to detail.
- Strong leadership, planning, and organizational skills.
- Ability to operate effectively with people at all levels of the business.
