FWA Officer

About the role

The FWA Officer will join the Claims FWA & Audit team within the Claims Department, part of Global Technology and Operations at MetLife. The role focuses on investigating fraud, waste and abuse risks across Egypt, protecting the organization from financial and operational losses while supporting cost‑optimization initiatives.

Key responsibilities

• Lead fraud detection initiatives by analysing system data and identifying suspicious trends using automated tools and dashboards.
• Create detailed investigation reports, including findings, evidence and financial exposure calculations.
• Oversee fraud case validation, ensure proper documentation and escalation to relevant stakeholders.
• Perform utilisation reviews and claims trend analyses for key accounts to optimise costs and detect emerging risks.
• Prepare and present regular FWA reports highlighting trends, risks, savings achieved and improvement opportunities.
• Contribute to defined savings and loss‑mitigation targets through effective detection and prevention strategies.
• Manage FWA cases end‑to‑end, coordinating investigations and closure actions.
• Develop and enhance fraud detection scenarios, tools and KPI dashboards to improve detection accuracy.
• Coordinate with internal departments (Medical Claims, Medical Network, Underwriting, DOS, Call Center) to resolve investigations and enforce corrective actions.
• Ensure full compliance with regulatory requirements, internal policies and the company’s Code of Conduct.

Required profile

• Bachelor’s degree in Pharmaceutical Sciences or a related field with application to medical claims review.
• 2–4 years of experience in insurance, claims handling or a related area.
• Strong analytical thinking and meticulous attention to detail.
• Ability to collaborate with cross‑functional teams and communicate findings effectively.
• Understanding of regulatory requirements and ethical standards in the insurance sector.

Required skills

• Data analysis and interpretation.
• Use of fraud detection tools and dashboard creation.
• Report writing and case documentation.
• Knowledge of medical claims processes and provider performance evaluation.
• Familiarity with regulatory compliance and code of conduct enforcement.