Job Title: Field Investigation Officer Fraud, Waste & Abuse (FWA)

Location: Mumbai/Delhi/Bangalore/

Employment Type: Full time

About the Role

Seeking a medical professional for the position of Field Investigation Officer in the Fraud, Waste & Abuse (FWA) team. This role is responsible for overseeing end-to-end investigation workflows for suspected fraudulent health insurance claims, managing investigation vendors, and ensuring rigorous ground-level verification to support informed claim decisions (payable, rejection, or query)

Key Responsibilities

- Case Quality Check & Allocation: Review claims referred to the FWA unit, identify and refine fraud triggers, design case-specific questionnaires, and allocate cases to field vendors within established Turnaround Time (TAT) targets.
- Vendor & Field Management:



Supervise external investigation vendors and field executives. Ensure ground investigations cover essential touchpoints (Insured, Hospital, Treating Doctor, Diagnostic Labs, and Pharmacy) with verifiable evidence.
- Evidence Quality & Rework: Scrutinize collected field evidence and documentation. Instruct vendors on rework where gaps exist, and ensure reports meet Grade-A evidence standards.
- Fraud Detection & Nexus Identification: Monitor local branch ecosystemsincluding sales staff, local network hospitals, vendors, and policyholdersto identify any organized fraudulent nexus or biased reporting. Escalate findings promptly to Zonal and Vertical Managers.

📌 Field Investigation Officer Claims (Bengaluru)
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📍 Bengaluru