Manager, FWA & Connected Care
Core
Provides strategic medical and clinical support to strengthen claims governance, Fraud, Waste & Abuse (FWA) controls, DRG implementation, and cost containment initiatives.
Role type
Manager, Medical Claims & FWA
Builds
Medical claims integrity, cost containment strategies, and compliant claims outcomes
Domain
Insurance / Healthcare Administration
Deliverable
dashboards & analysis
Required skills
Medical degree, DRG coding, clinical evaluation, audit review, stakeholder management, training delivery, regulatory compliance, cost analysis
Preferred skills
Allied Health qualification, Business Administration, insurance analysis, customer service, healthcare front office experience
Technologies
DRG coding systems, claims management platforms
Responsibilities
Provide medical input for FWA and audit investigations; assess complex cases for medical necessity and coding accuracy; manage Doctor Panel governance and audits; design and deliver training for claims assessors; support cost containment strategies; coordinate external expert opinions for complex referrals.
Seniority
Manager, strategic oversight & team support
