Fraud Analyst

Role Overview

This position sits inside the Payment Integrity function and acts as the first line of defence against fraudulent, wasteful and abusive health claims submitted from around the world. Day to day, you triage incoming referrals, chase supporting documentation from providers, and decide which cases are strong enough to justify a deeper investigation — work that directly protects affordability for the business and its clients. You also feed what you learn back into a global network of Payment Integrity and cost containment colleagues, turning individual case findings into sharper detection rules and better reporting.

Key Responsibilities

• Own the team's shared inbox: review incoming enquiries, respond directly where you can, and route the rest to the right owner without delay.
• Act as the initial review point for claims suspected of being fraudulent, and screen claims for indicators of waste and abuse.
• Carry out first-pass research and analysis on flagged claims, gathering enough evidence to determine whether a case should be escalated for full investigation.
• Contact providers to request supporting documents and confirm the accuracy of claim information.
• Compile and store evidence appropriately so it can be used in investigation reports for internal and external stakeholders.
• Track team savings and make sure they are recorded and reported accurately.
• Partner with payment integrity and cost containment teams in other locations to exchange best practices and share emerging FWA claiming schemes.
• Work alongside the Data Analytics team on automating future FWA triggers, and contribute to broader projects that improve business processes.

Requirements & Qualifications

• At least 2 years of experience in health insurance or with a health care provider; a background in fraud investigation is strongly preferred.
• Working knowledge of claims coding, regulatory rules and medical policy.
• A medical or paramedical qualification is a clear advantage.
• Strong organisational skills and close attention to detail, with the discipline to keep documentation and process standards consistent.
• The ability to pick up new and complex tasks and concepts quickly.
• A critical mindset with a knack for spotting cost containment opportunities.
• Excellent verbal and written communication skills, including the confidence to deal directly with internal stakeholders and work within a cross-functional team.
• Proven ability to balance several priorities at once and deliver against tight timelines.
• Comfort working with global teams across varying time zones.
• Fluency in a language other than English is a strong plus.

Why Join This Team

You will be part of a group of high performers who hold one another accountable for doing their best work, in a role where the results of your judgement are visible in the savings reported and the schemes stopped. The position offers genuine global exposure, regular collaboration with analytics and cost containment colleagues in other geographies, and the chance to shape how the function detects and prevents FWA in future.