Join a global leader dedicated to building a better working world. We foster a culture of continuous learning and growth, empowering you to develop your career and achieve your full professional potential. This role focuses on strengthening fraud, waste, and abuse (FWA) management within a significant government-sponsored health insurance scheme.

ASU - Forensics - Investigations & Compliance is at the forefront of protecting organizational reputation and stakeholder trust. We help clients navigate complex disputes, regulatory challenges, and enhance their ethical and reputational risk management through an integrated, data-driven approach.

As a Senior Consultant, you will conduct desk-based medical audits, meticulously reviewing claims and clinical records to identify indicators of fraud, waste, and abuse. You'll assess clinical appropriateness against scheme guidelines and identify suspicious patterns. A key part of this role involves supporting the development and refinement of technology-enabled anti-fraud solutions and enhancing the scheme's overall anti-fraud framework.

Responsibilities include: - Conducting desk-based medical audits of claims. - Reviewing clinical records and identifying fraud indicators. - Assessing clinical appropriateness against guidelines. - Identifying suspicious claim patterns and aberrant utilization. - Supporting anti-fraud technology development and validation. - Assisting in strengthening the anti-fraud framework. - Triaging and reviewing suspected fraud cases. - Collaborating with analytics teams and stakeholders. - Contributing to fraud vulnerability assessments and trend analysis. - Preparing audit observations and reports. - Supporting capacity-building and training initiatives. - Maintaining accurate documentation and audit trails.

To excel in this role, you will need an MBBS degree from a recognized institution. A postgraduate qualification in a clinical discipline, Public Health, or a related field is desirable.

We are seeking candidates with up to 3 years of post-qualification experience. Experience in clinical practice, hospital operations, medical audits, health insurance, public health programs, or other healthcare domains is preferred.

We value individuals who are collaborative problem-solvers, delivering insightful and practical solutions. An agile, curious, and creative approach, coupled with sustained positive energy and adaptability, is essential for success in this dynamic environment.