Manager, Medical Advisory, Health Technical Excellence, and Fraud, Waste & Abuse Management
Core
Lead a team in medical advisory, fraud detection, and waste/abuse management to reduce claim leakages and improve loss ratios.
Role type
Manager, Medical Advisory and Fraud Waste Abuse Management
Builds
AI/ML tools for fraud detection, FWA policies, and audit processes
Domain
Insurance / Healthcare / Fraud Prevention
Deliverable
production ML models
Required skills
Medical advisory, audit leadership, FWA policy development, AI/ML for fraud detection, data analysis, stakeholder communication, healthcare regulations compliance
Preferred skills
Experience with health claims leakages, doctor fee schedules, process improvement
Technologies
AI, machine learning, FWA analysis tools
Responsibilities
Provide medical advisory and conduct audits, develop and oversee FWA policies, implement AI/ML algorithms for fraud detection, conduct training on FWA procedures, ensure compliance and implement corrective actions, analyze FWA data and report insights
Seniority
Manager, team leadership