Manager, Fraud, Waste & Abuse
Manager, Fraud, Waste & Abuse
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Prudentials purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured for our people customers and partners. We provide a platform for our people to do their best work and make an impact to the business and we support our peoples career ambitions. We pledge to make Prudential a place where you can Connect Grow and Succeed.
The Manager in Medical Claims Fraud Waste and Abuse (FWA) role is pivotal to safeguard the integrity of health governance framework by developing and implementing robust policies and procedure to detect prevent and manage FWA in medical claims processing. This position ensures compliance to regulatory and clinical standards and working closely with the other stakeholders to enhances the efficiency and effectiveness of fraud detection and prevention efforts within the organization (including but not limited to developing and implementing policies training programs and detection algorithms. He is a key player in the organization working closely with various departments within the company and regional office to ensure a seamless integration of solutions to identify and prevent FWA. The role is crucial in enhancing sustainability as well as reducing the claim loss ratio. The deputy manager collaborates with external partners and vendors to ensure effective integration and required enhancement of these solutions within the PruBSN process. This position is essential in aligning FWA initiatives in different departments e. g. claims quality assurance underwriting and maintaining compliance to the regulatory and industry standard.
Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex race age ethnic origin educational social and cultural background marital status pregnancy and maternity religion or belief disability or part-time / fixed-term work or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.
Required Experience:
Manager
Employment Type
Full-Time
