FWA Officer - Omani National Required

Job Description: FWA, Network & Managed Care Oversight Officer

Key Responsibilities

FWA Oversight & Risk Management

Lead the oversight of FWA detection and prevention processes, including governance of tools, rules, and investigation frameworks
Drive timely escalation, investigation, and closure of suspected FWA cases, in coordination with relevant stakeholders including TPA.
Continuously enhance FWA controls, analytics, and reporting frameworks in conjunction with TPA governance.

TPA Governance & Performance Management

Act as a central governance point for TPA operations, ensuring adherence to SLAs, KPIs, and contractual requirements
Monitor and assess TPA claims adjudication quality, accuracy, and consistency
Conduct periodic governance reviews and performance assessments of TPAs

Provider Network Performance Oversight

Oversee provider performance and billing behavior through TPA data and insights
Perform network provider onsite & offsite audits
Support implementation of corrective actions, cost containment strategies, and provider engagement initiatives

Stakeholder Management & Collaboration

Collaborate with TPAs, provider networks, internal teams (Claims, Medical, Compliance, Finance), and external stakeholders
Present insights, findings, and recommendations to management and cross-functional teams
Support training, feedback, and capability building initiatives across TPAs

Reports to: Head of Managed Care Services

Direct Reports: NA

Candidate Qualifications

Business Knowledge/Technical Skills:

3 - 5 years of experience with provider and / or payer to have a strong knowledge of billing patterns and coding
Strong record of success in data analytics and identification of fraud patterns within claims.
Possess skills to develop creative solutions for medical quality management
Possess skills for feedback mechanism for different stakeholders
A graduate degree, MBA degree or other advance degree is preferred
A nursing degree or Pharmaceutical or Medical degree will be of value however not mandatory.

MetLife is proud to be an equal opportunity employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce. It is the policy of MetLife to ensure equal employment opportunity without discrimination on any basis protected by law.

FWA Officer - Omani National Required

Related Jobs

Ingénieur IA - AXA Luxembourg - CDI

Assistant Manager - Digital Customer Platform

Senior Associate Pricing

Related Jobs

Ingénieur IA - AXA Luxembourg - CDI

Assistant Manager - Digital Customer Platform

Senior Associate Pricing

Cookie Settings