Head, Fraud Waste and Abuse Control Unit

Responsible for the design and implementation of the QA/FWA strategies aligned with AXA Mansard health business strategy to ensure an effective and efficient oversight and maintain business profitability.

Role Qualification:

Academic/Professional:

• MBBS Degree from a reputable Tertiary Institution.
• Relevant postgraduate (MSc, MBA) and/or professional qualification (CFA etc) would be an added advantage.

Work Experience: 7-8 Years of professional experience in related position

Key Responsibilities:

• Responsible for the design and implementation of the QA/FWA strategies aligned with AXA and entity health business strategy.
• Defines the target operating model, organization and internal processes for his/her team according to company guidelines
• Monitors the progress of the key KPIs and defines and implements corrective actions when necessary
• Ensures the integration of FWA within operations and its efficiency regarding the customer journey
• Collects all necessary information to further investigate and analyse potential FWA cases (contacts external investigators when required, deep-dives internal files, etc.)
• Gathers all existing evidence to document positive FWA cases, communicates the final decision to the parties involved and initiates the pertinent legal actions (including cancellation of the contract, negotiation with customers/providers, etc.)
• Recommend anti-fraud processes for changing transaction patterns and trends
• Works to establish and maintain good working relationships with internal business partners
• Identifies milestones and obstacles and escalates when project timelines are at risk.

Required Skills and Competencies

• Medical network knowledge
• Interpersonal effectiveness
• Product knowledge
• Health market environment
• Analytical reasoning
• Project management
• Strategic vision