Fraud Senior Analyst –Payment Integrity Provider Investigation APAC Team

Job Purpose The Fraud Senior Analyst plays a critical role in protecting the organization’s International Health portfolio by leading Fraud, Waste and Abuse (FWA) investigations, driving measurable affordability outcomes, and strengthening prevention strategies across the claims lifecycle. The position combines investigative expertise, data-driven insight, and stakeholder influence to reduce financial leakage, improve claim governance and support sustainable savings delivery across the region. This role is responsible for detecting and recovering FWA payments, creating solutions to prevent claims overpayment and future spend monitoring within a dedicated region. He / She will work closely with other PI team members, Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners, and Product. Job Profile Operating with a high degree of independence, the Fraud Senior Analyst owns end-to-end investigative activities within a dedicated region. The role extends beyond case handling to include proactive identification of systemic risks, development of preventive controls, and partnership with regional and global stakeholders to enhance Payment Integrity strategy. The incumbent acts as a subject matter expert, contributing to operational improvements, automation initiatives, and cross-market collaboration to strengthen FWA detection and mitigation capabilities. Reports to:   Fraud Manager       Critical Tasks and Expected Contributions / Results: Lead FWA investigations across International Markets, applying investigative judgement to identify billing anomalies, emerging fraud typologies, and systemic risk patterns. Deliver quantifiable financial impact through cost containment, recoveries, and forward-looking prevention initiatives aligned to regional savings objectives. Translate data insights into actionable investigation strategies by partnering closely with Data and Analytics teams to refine triggers, reporting frameworks and automation opportunities. Influence provider behavior through structured Provider audit engagement, negotiation, and collaboration with regional and global stakeholders to reduce future risk exposure. Drive continuous improvement of Payment Integrity processes by identifying operational gaps and proposing scalable solutions that enhance efficiency and accuracy. Produce clear, defensible investigative findings and recommendations for senior stakeholders, ensuring transparency and audit readiness. Ensure investigations and cost containment actions are balanced with fair member outcomes, regulatory expectations, and client commitments. Collaborate with Customer Service and Client Management teams to support clear, consistent communication approaches that protect member experience while maintaining investigative integrity Operate within established governance frameworks, ensuring investigative activities are compliant with internal policies, regulatory requirements, and audit standards. Collaborate with the Member Investigation Unit on Fraud cases when required. Perform periodic TPA oversight and partner with TPAs on FWA investigations when required. Partner with Data Analytics team in building future FWA triggers automation. Mentor and provide support  through knowledge sharing, quality review input and guidance on investigative best practices and share FWA claiming schemes. Ad hoc duties as assigned Key Challenges / Anticipated Changes in Environment: Rapid evolution of provider billing models and fraud schemes requiring adaptive investigative approaches. Increasing claim volumes and evolving FWA typologies requiring advanced analytical and investigative skills Balancing operational turnaround times with deep investigative rigor, stakeholder expectations and member experience considerations Expanding use of automation, data analytics, and cross-market collaboration within Payment Integrity operations Managing complex provider relationships while maintaining firm compliance and