Requirements Description and Requirements The Team You Will Join You will join the Claims FWA & Audit team within the Claims Department, part of Global Technology and Operations at MetLife. The team is responsible for identifying, investigating, and preventing fraud, waste, and abuse (FWA) across medical claims and healthcare provider activities, ensuring compliance, cost control, and operational integrity.The Opportunity The FWA Officer is responsible for investigating fraud, waste, and abuse risks and implementing preventive controls to protect the organization from financial and operational losses across Egypt. This role plays a critical part in safeguarding the integrity of claims operations and supporting cost optimization initiatives.This is an exciting opportunity to work on advanced fraud detection tools, analyze large healthcare datasets, and collaborate with cross-functional teams to identify suspicious patterns and enforce corrective actions. The role offers exposure to medical analytics, provider performance evaluation, and strategic fraud prevention initiatives.Success in this role requires strong analytical thinking and attention to detail. The FWA Officer is responsible for fraud detection analysis and case investigations while collaborating closely with Medical Claims, Medical Network, Portfolio Management, Underwriting, and other stakeholders in an environment where every contribution is valuedHow You’ll Help Us Build a Confident Future (Key Responsibilities)Lead fraud detection initiatives by analyzing system data and identifying suspicious trends using automated tools and dashboards.Create detailed investigation reports, including findings, evidence, and financial exposure calculations.Oversee fraud case validation processes and ensure proper documentation and escalation to stakeholders.Perform utilization reviews and claims trend analyses for key accounts to assess performance, optimize costs, and detect emerging risks.Prepare and present regular FWA reports, highlighting trends, risks, savings achieved, and opportunities for improvement.Contributes to achieving defined savings and loss mitigation targets through effective FWA detection and prevention strategies.Manage FWA cases end-to-end, including investigation, coordination, and closure with appropriate actions.Develop and enhance fraud detection scenarios, tools, and KPI dashboards to improve detection accuracy.Coordinate with internal departments (Medical Claims, Medical Network, Underwriting, DOS, Call Center) to resolve investigations and enforce corrective actions.Ensure full compliance with regulatory requirements, internal policies, and the company’s Code of Conduct.Undertake additional responsibilities as required to support business objectives and operational priorities.What You Need To Succeed (Required Qualifications)Bachelor’s degree in Pharmaceutical Sciences with application in reviewing medical claims and medications. 2–4 years of experience in Insurance industry.Strong analytical and investigative skills with high attention to detail.Excellent communication and coordination skills to work with cross-functional teams.Very good command of English (written and spoken)Proficiency in Microsoft Office (especially Excel) and reporting toolsWhat Can Give You An Edge (Additional Skills)Experience in medical claims insurance with strong knowledge of medications, dosage forms, and contraindications. Experience using fraud detection tools, dashboards (Power BI), data analysis platforms and AI tools.Knowledge of healthcare insurance laws and regulations and their application in fraud investigations.Strong problem-solving mindset, decision-making ability and negotiation skills.Ability to work under pressure and meet savings and performance target.About MetLifeRecognized on Fortune magazine's list of the "World's Most Admired Companies" and Fortune World’s 25 Best Workplaces™, MetLife, through its subsidiaries and affiliates, is one of the world’s leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East.Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we’re inspired to transform the next century in financial services. At MetLife, it’s #AllTogetherPossible . Join us!